Siêu âm cổ chân bàn chân, Bs Tài

SIÊU ÂM CỔ CHÂN
BÀN CHÂN
BS Lê Văn Tài
Trung Tâm Y Khoa MEDIC

II. HÌNH ẢNH SIÊU ÂM BÌNH THƯỜNG
• Đầu dò độ phân giải cao: 8 – 14 MHz,
Power Doppler nhạy

CỔ CHÂN TRƯỚC (ANKLE ANTERIOR)
MẶT CẮT DỌC NGÁCH CHÀY SÊN TRƯỚC
(Longitudinal view- Anterior tibio-talar recess)
Mặt cắt dọc ngách chày sên trước (Longitudinal scan of the anterior tibio-talar
recess). T = tibia (xương chày); TA = talus (xương sên); SS = synovial space
(khoang hoạt dịch); C = capsule (bao khớp); * = articular cartilage (sụn khớp)

MẶT CẮT DỌC GÂN CHÀY TRƯỚC (Long
axis view - Tibialis anterior tendon)
Mặt cắt cắt dọc gân chày trước (Long axis view of the tibialis anterior tendon).
ATT = tibialis anterior tendon (gân chày trước); T = tibia (xương chày); TA =
talus (xương sên); * = articular cartilage (sụn khớp)

MẶT CẮT NGANG CÁC GÂN DUỖI
(Axial view Extensor tendons)
Mặt cắt ngang các gân duỗi (Axial view of the anterior aspect of the ankle). ATT
= anterior tibial tendon (gân chày trước); EHLT = extensor hallucis longus
tendon (gân duỗi ngón cái dài); EDLT = extensor digitorum longus tendon (gân
duỗi các ngón dài); TA = talus (xương sên)

CỔ CHÂN NGOÀI (ANKLE LATERAL)
MẶT CẮT DỌC DÂY CHẰNG SÊN MÁC TRƯỚC (Long
axis view Anterior talo-fibular ligament)
Mặt cắt dọc dây chằng sên mác trước (Longitudinal view of anterior talo-fibular
ligament). ATF = anterior talo-fibular ligament (dây chằng sên mác trước); LM =
lateral malleolus (mắt cá ngoài); TA = talus (xương sên).

MẶT CẮT DỌC DÂY CHẰNG MÁC GÓT
(Long axis view Calcaneo-fibular ligament)
Mặt cắt dọc dây chằng gót mác trước (Longitudinal view of the calcaneo-fibular
ligament). PB = peroneus brevis (gân mác ngắn); PL = peroneus longus (gân mác
dài); CF = calcaneo-fibular ligment (dây chằng mác gót); C = calcaneus(xương
gót); TA = talus(xương sên); R = retinaculum (mạc giữ gân mác)

MẶT CẮT NGANG CÁC GÂN MÁC
(Short axis view Peroneal tendons)
Mặt cắt ngang các gân mác (Short axis view of the peroneal tendons). PBM =
peroneus brevis muscle (cơ mác ngắn); PB = peroneus brevis (gân mác ngắn);
PL = peroneus longus (gân mác dài); R = retinaculum (mạc giữ gân mác); LM =
lateral malleulus (mắt cá ngoài).

CỔ CHÂN TRONG (ANKLE MEDIAL)
MẶT CẮT NGANG ỐNG CỔ CHÂN (Axial view
Tarsal tunnel)
Mặt cắt ngang mặt trong cổ
chân (Axial view of the
medial aspect of the ankle).
TN = posterior tibial nerve
(dây thần kinh chày sau);
PTV = posterior tibial veins
(các tĩnh mạch chày sau);
PTA = posterior tibial artery
(động mạch chày sau); R =
retinaculum (mạc giữ gân
gập); MM = medial malleolus
(mắt cá trong); PTT =
posterior tibial tendon (gân
chày sau); FDL = flexor
digitorum longus tendon
(gân gập các ngón dài).

MẶT CẮT DỌC DÂY CHẰNG DENLTA
(Long axis view Deltoid ligament)
Mặt cắt dọc dây chằng delta (Longitudinal view of deltoid ligament). PTT =
posterior tibial tendon (gân chày sau); TC = tibio-calcanear ligament (dây chằng
chày gót); TT = tibio-talar ligament (dây chằng chày sên); TA = talus (xương sên);
C = calcaneus (xương gót); MM= medial malleolus (mắt cá trong).

CỔ CHÂN SAU (ANKLE POSTERIOR)
MẶT CẮT DỌC GÂN GÓT (Long axis view
Achilles tendon)
Mặt cắt dọc gân gót (Long
axis view of the Achilles
tendon). AT = Achilles tendon
(gân gót); C = calcaneus
(xương gót); RCB =
retrocalcaneal bursa (túi hoạt
dịch sau xương gót); SM =
soleus muscle (cơ dép); FHL
= flexor hallucis longus
muscle (cơ gập ngón cái
dài); K = Kager soft pad (đệm
mỡ Kager).

MẶT CẮT NGANG GÂN GÓT
(Short axis view Achilles tendon)
Mặt cắt ngang gân gót (Short axis view of the Achilles tendon). AT =
Achilles tendon (gân gót); FHL = flexor hallucis longus muscle (gân gập
ngón cái dài); T = tibia (xương chày)

GAN CHÂN (FOOT PLANTAR)
MẶT CẮT DỌC MẠC GAN CHÂN
(Longitudinal view Plantar fascia)
Mặt cắt dọc mạc gan
chân (Longitudinal
view of the plantar
fascia). PF = plantar
fascia (mạc gan chân);
C = calcaneus (xương
gót); FDB = flexor
digitorum brevis
muscle (cơ gấp các
ngón ngắn).

MẶT CẮT DỌC KHỚP BÀN – NGÓN
(Longitudinal view Metatarso-phalangeal
joint)
Mặt cắt dọc khớp bàn –
ngón (Longitudinal view of
the foot metatarso-
phalangeal joint). FLD =
flexor longus digitorum
tendon (gân gập các ngón
dài); C = capsule and
synovial
Recess (bao khớp & khoang
hoạt dịch); M = metatarsal
bone (xương đốt bàn); P =
phalanx (xương đốt ngón);
IM = interosseus muscle (cơ
gian cốt).

MẶT CẮT NGANG CÁC ĐỐT BÀN
(Axial view Inter-metatarsal space)
Mặt cắt ngang bàn chân
(Axial view of the foot). M
= metatarsal bone
(xương đốt bàn); FDT =
flexor digitorum tendon
(gân gập các ngón); IS =
inter-metatarsal space
(khoảng gian xương đốt
bàn); PT = plantar soft
tissue (mô mềm gan
chân).

III. BỆNH LÝ
• Khớp lớn hay nhỏ, một khớp
(monoarticular), ít khớp (oligoarticular),
nhiều khớp (polyarticular).
• Nhiều khớp có đối xứng
• Tổn thương đi kèm: nốt, đốm ngoài da,
viêm niệu đạo, xơ phổi...

• Thoái hóa khớp (osteoarthritis)
• Viêm khớp do nhiễm trùng (Infectious
arthritis)
• Viêm khớp dạng thấp (Rheumatoid arthritis)
• Viêm khớp do lắng đọng tinh thể: Gout,
pseudogout
• Viêm khớp trẻ em (JRA, JIA)
• Viêm khớp do bệnh vẩy nến, bệnh lý Reiter
(kèm viêm niệu đạo, viêm kết mạc mắt), do
bệnh về máu (hemophilic arthritis)

• Bệnh lý gân cơ: tendinitis, tendinosis, viêm
bao gân (tenosynovitis), rách, đứt gân
• Chấn thương, rách, đứt gân dây chằng
• H/C ống cổ chân (Tarsal tunnel syndrome)
• Bệnh lý cân mạc gan chân: viêm (Plantar
fasciitis), rách, u xơ (fibromatosis).
• Viêm bao hoạt dịch (Bursitis)
• Nang hoạt dịch, u thần kinh (Morton‟s
Neuoma).
• Một số bệnh lý khác

THOÁI HÓA KHỚP
(OSTEOARTHRITIS)
• Bệnh do lớn tuổi, dùng quá nhiều, do công
việc, nữ thường gặp hơn nam.
• Tổn thương sụn khớp làm mòn sụn khớp
dẫn đến tiếng kêu do bề mặt xương chạm
vào nhau, tạo gai xương
• Cuối cùng gây viêm làm khớp sưng, đau,
biến dạng khớp, cứng khớp
• Chẩn đoán hình ảnh: XQ, MRI, Siêu âm

Osteoarthritis. Index finger
of the dominant hand.
Dorsal longitudinal
views.
a.Distal interphalangeal joint.
b. Proximal interphalangeal
joint.
c. Metacarpophalangeal
joint.dp = distal phalanx;
mp = middle phalanx; pp =
proximal phalanx;m=
metacarpal
bone; t = extensor tendon;
arrowhead = osteophyte
a
b
c

Heberden‟s nodes. Longitudinal dorsal US scan. a Symptomatic
joint. Dorsal subluxation of the distal phalanx with
no evidence of joint inflammation. b Symptomatic joint.
Joint effusion (*) and osteophytes (arrowheads).dp = distal
phalanx;mp = middle phalanx; t = extensor tendon; arrowhead
= osteophyte
a
b

Erosive osteoarthritis of the distal interphalangeal joint.The arrowhead indicates a
bone erosion at the head of the middle phalanx
depicted both on longitudinal (a) and transverse (b) dorsal sonograms.dp = distal
phalanx;mp = middle phalanx
a b

Osteoarthritis.Supra-patellar transverse
scan with knee in maximal
flexion demonstrates focal cartilage
thinning (arrowhead)
and marked irregularity of the
subchondral bone. f = femur
Osteoarthritis. Supra-patellar transverse
scan with knee in
maximal flexion shows complete loss of
cartilage. f = femur

Osteoarthritis. Supra-
patellar longitudinal
US scan showing
widening of the supra-
patellar pouch due to
synovial fluid (*)
and proliferation (+). f
= femur; p = upper
pole of the patella;
t = quadriceps tendon

Osteoarthritis of the
knee.Different
US features of popliteal
cysts.
a. Anechoic with floating
echogenic
spots.
b. Areas of synovial
proliferation.
c. Septa and areas of
synovial
proliferation.
d. Completely filled
by synovial proliferation
a b
c d

Osteoarthritis of the knee. Lateral longitudinal views of the suprapatellar pouch
showing different aspects of synovial proliferation (arrowheads), f = femur
a b

VIÊM KHỚP DẠNG THẤP
(RHEUMATOID ARTHRITIS)
• Thường xảy ra ở nữ, do tự miển (auto- immune).
Kháng thể tấn công bao hoạt dịch và mô mềm
quanh khớp. Vì bao hoạt dịch bị tổn thương làm
giảm tiết chất nhờn (lubrication) nên gây ra cứng
khớp
• Pannus: kháng thể tấn công hoạt mạc gây phì đại
hoạt mạc, ăn lan vào khớp và mô mềm quanh
khớp (sụn khớp, dây chằng, gân cơ) do có phản
ứng viêm, có sự thâm nhập của tế bào viêm, thực
bào hình thành cấu trúc dầy lên liên tục quanh
khớp gọi là pannus, gây tổn thượng dây chằng, ăn
mòn xương

• Siêu âm, MRI hữu ích trong giai đoạn sớm
của bệnh, XQ chỉ thấy ở giai đoạn trễ.
• Mức độ tưới máu của pannus nói lên mức
độ và giai đoạn bệnh.
• Tưới máu càng nhiều bệnh đang tiến triển,
giảm tưới máu nói lên bệnh không hoạt
động, điều trị có đáp ứng.

Early rheumatoid arthritis. Exudative synovitis of the proximal
interphalangeal joint of the dominant hand. Longitudinal volar scan
depicting anechoic joint cavity widening (*).mp= middle phalanx; pp =
proximal phalanx; t = extensor tendon

Rheumatoid arthritis.
Proliferative synovitis of the
second metacarpophalangeal
joint of the dominant hand.
Longitudinal dorsal scan
depicting hyperperfused areas of
synovial hypertrophy invading the
cartilage layer of the metacarpal
head (°). pp = proximal phalanx;
m = metacarpal bone;
t = extensor tendon

Rheumatoid arthritis.Proliferative synovitis of the second
metacarpophalangeal joint of the dominant hand. Longitudinal
dorsal scan detecting very small areas (less than 1 mm in size) of
synovial proliferation (+). pp = proximal phalanx;m = metacarpal
bone; t = extensor tendon

Rheumatoid arthritis. Proliferative synovitis of the second metacarpophalangeal
joint of the dominant hand. Dorsal longitudinal (a) and transverse (b) scans
showing clear signs of synovial proliferation and bone erosion of the metacarpal
head (arrowhead). c Intra-articular power Doppler signal. d Conventional
radiography. pp = proximal phalanx; m= metacarpal bone
a b
c d

Rheumatoid arthritis. Proliferative synovitis of the second metacarpophalangeal
joint of the dominant hand. Lateral (on the radial aspect of the joint) longitudinal (a)
and transverse (b) scans showing a large erosion (arrowhead) (maximal distance
between the edges of the erosion:4 mm).c,d Using the same scanning planes,
power Doppler revealed hyperperfused pannus within the bone erosion. e
Conventional radiography.pp = proximal phalanx;m= metacarpal bone
a b
c d c

Rheumatoid arthritis. Semi-quantitative scoring system for intraarticular
power Doppler signal. a Grade 0; no intra-articular signal. b Grade 1;single
intra-articular signal. c Grade 2;confluent intra-articular signals. d Grade 3;
huge amount of intra-articular signals
a b
c d

Rheumatoid arthritis. Proliferative tenosynovitis of the tibialis posterior tendon
(tp). Transverse (a) and longitudinal (b) scans showing a tendon sheath filled with
pannus (+). ti = tibia

Rheumatoid arthritis. Wrist pain.
Lateral transverse (a,b) and
longitudinal (c,d) scans showing
active proliferative tenosynovitis
of the extensor carpi ulnaris tendon
(t) with partial tendon rupture
(arrowheads).e Conventional
radiography
a b
c d
e

Rheumatoid
arthritis.Wrist pain.
Lateral transverse (a) and
longitudinal (b) scans
showing proliferative
tenosynovitis of the
extensor carpi ulnaris
tendon (t) with pannus (+)
invading the tendon
texture (arrowheads).u =
ulna; tr = triquetrum
a
b

Rheumatoid arthritis. Finger flexor tendons.Tenosynovitis and tendon tears.
Longitudinal (a) and cross-sectional (b-e) volar scanning of the finger flexor
tendons (t) at the level of the metacarpophalangeal joint.Tendon tears appear as
small anechoic areas (less than 1 millimeter) within tendon echotexture
(arrowheads)
a
b c
d e

Rheumatoid arthritis. Shoulder pain. Transverse (a) and longitudinal (b)
anterior scans at the bicipital groove. Proliferative subdeltoid bursitis and
tenosynovitis of the long head of biceps tendon (t). h = humerus;d = deltoid
a b

PSORIATIC ARTHRITIS
• Chiếm tỷ lệ từ 5-7% bệnh nhân mắc bệnh
vẩy nến.
• Viêm vài khớp chiếm tỷ lệ 70%. Viêm vài
khớp không đối xứng, khớp gối, khớp bàn
ngón gần, khớp liên đốt.
• Sưng nề một hoặc nhiều ngón tay, ngón
chân (hình xúc xích).
• Biến dạng co rút các ngón tay, chân

Psoriatic arthritis. Distal interphalangeal joint. Dorsal longitudinal scan
showing joint cavity widening and clear signs of synovial proliferation
(+).dp = distal phalanx;mp = middle phalanx; t = extensor tendon

Psoriatic arthritis. Sausage finger. Proximal interphalangeal joint.Volar
transverse (a) and longitudinal (b) scans showing both tendon sheath and
joint cavity widening.mp = middle phalanx; pp = proximal phalanx; t = flexor
tendons; * = synovial fluid

Psoriatic arthritis. Peritendinitis of the Achilles tendon (t). Transverse (a) and
longitudinal (b) scans showing thickened hypo-anechoic peritenon (arrowheads)
with hypoechogenicity of the peritendinous soft tissues (*)
a b

Psoriatic arthritis. Achilles tendon (t). Erosive enthesitis. Longitudinal (a) and
transverse (b) scans showing power Doppler signal within the calcaneal bone
erosions. c = calcaneal bone
a b

Gout
• Bệnh khớp do rối loạn chuyển hóa urate, lắng
đọng tinh thể urate (monosodium urate crystal)
trong khớp & mô mềm quanh khớp. Bệnh hay gặp
ở người tăng acid uric máu, béo phì, uống rượu.
• Lâm sàng: Bệnh khởi phát nhanh hơn các loại
viêm khớp khác (sưng nhiều, nóng nhiều & đỏ
nhiều & rất đau). Thường xảy ra ở khớp bàn ngón
1 bàn chân

Hình ảnh siêu âm:
• Dấu viền đôi (Double contour) đặc hiệu 92 %,
đường echo dầy không đều trên bề mặt nông sụn
khớp (hyperechoic, irregular band over the
superficial margin of the articular cartilage)
• Vùng mờ echo dầy như đám mây (hyperechoic
loudy are), cục tophy echo dầy, echo hổn hợp, có
thể có vôi hóa.
• Ăn mòn xương kế cục tophy (erosion).
• Dầy bao hoạt dịch tăng tưới máu, tụ dịch khớp,
phù nề mô mềm quanh khớp do lắng đọng
monosodium urate crystal.

• Phân biệt chondrocalcinosis (giả gout) do
lắng đọng tinh thể canxi (calcium
pyrophosphate crystal), đường echo dầy ở
trung tâm của sụn khớp. Khi bệnh nhân có
thêm bệnh gout sẽ có dầu viền ba (triple
contour)

Sonographic appearance of normal control, gout and chondrocalcinosis
in knee joints. Suprapatellar, transverse view in flexion. Schematic illustrations on left.
Top: anechoic (black) layer of hyaline cartilage (c) overlying bony contour of distal femur (b).
Middle: double contour sign. Hyperechoic (bright), slightly irregular layer of crystal deposits (open
arrowheads) overlying anechoic hyaline cartilage (c) and bony contour of distal femur (b).
Bottom: hyperechoic, crystalline material (asterisks) is layered in the centre of the anechoic hyaline
cartilage (c). This layer parallels the outline of the bony cortex (b).

Sonographic Characterization of Mixed
Crystal Arthropathy Due to Monosodium
Urate and Calcium Pyrophosphate
Dihydrate: The Triple-Contour Sign.
Mixed crystal arthropathy in an 84 year-old
man.
A, Chronic tophaceous gout of the feet.
E, Transverse sonogram of the right knee
showing a hyperechoic linear image on the
superficial margin of the hyaline cartilage
(arrowheads) and punctate hyperechoic dots
within the cartilage (open arrows).
G, Longitudinal sonograms of the lateral femoral
condyle in the left (G) knees. Hyperechoic linear
deposits (arrowheads), punctate hyperechoic
dots (open arrow), and hyperechoic
subchondral bone (solid arrow) give a “triple-
contour” appearance.
Source: Checa A, Wong H, Chun W. J
Ultrasound Med. 2011 Jun;30(6):861-2

Gout of the first
metatarsophalangeal
joint. Transverse lateral
view depicting “urate
sand”.mt = metatarsal
head

Gout of the MTP joints on both sides and the
ankle joint on the left side
MTP 1 Right MTP 1 left

Gout of the first metatarsophalangeal joint
with erosions
Longitudinal
metatarsophalangeal joint normal
Longitudinal
metatarsophalangeal joint with
erosion

Tophaceous gout. Longitudinal dorsal US scan of the first
metatarsophalangeal joint showing
“soft”tophus”(arrowhead). The echotexture has an
inhomogeneously echoic background with hyperechoic
densities that do not generate posterior acoustic
shadows.mt = metatarsal head; pp = proximal phalanx;
t = extensor tendon

Tophaceous gout. Longitudinal dorsal US scan of the first
metatarsophalangeal joint showing “hard” tophus. The bone profile of the joint
cannot be visualized due to the presence of extensive urate deposition
obstructing the path of the US beam. mt = metatarsal head; pp = proximal
phalanx; t = extensor tendon

The mixed echogenic
appearance of calcific
tophus of gout arising out
of the 1st MTPJ.
The gout extends out over
the plantar aspect of the
Flexor Hallucis Longus
tendon.

VIÊM KHỚP NHIỄM TRÙNG (Septic
arthritis)
• Do nhiễm trùng, khớp sưng nóng đỏ đau,
sốt, bạch cầu tăng

Tibio-talar septic arthritis. Joint effusion appears
inhomogeneously echogenic with turbid and sand-like
appearance (*) suggestive of septic fluid collection. ti =
tibia; ta = talus

Infectious arthritis with a pus filled anterior
recess of the ankle

Young male with severe hemophilia. Longitudinal US scan of the anterior aspect
of the knee demonstrating enormous distention of the prepatellar bursa by
echogenic effusion due to recent bleeding intra-bursal bleeding
BỆNH KHỚP DO BỆNH ƯA CHẢY MÁU
(Hemophilic arthropathy)

Recurrent hemarthrosis in a patient with
hemophilia A.Transverse US scan of
the knee depicts the suprapatellar
synovial recess which appears
distended from abundant anechoic
effusion, related to previous
hemarthrosis. Synovial villous
thickening is also depicted

JUVENILE RHUMATOID
ARTHRITIS
• Viêm khớp tự phát, gặp ở trẻ < 17 tuổi,
dạng bệnh tự miển do di truyền, tác động
môi trường. Đột biến gen làm cho dễ mắc
bệnh dưới tác động môi trường, (như do
virus) sinh ra bệnh
• Viêm sưng một hay nhiều khớp
• Kèm sốt, phát ban (rash), hạch

JUVENILE RUMATOID ARTHRITIS
US of the Achilles tendon.
(A) Longitudinal scan of the
Achilles tendon insertion in a 10-
year-old healthy boy showing
physiological bone irregularities
(arrow). (B) US scan of the same
anatomical area in a healthy adult
subject (age 32 years). C:
calcaneus; AT: Achilles tendon; *:
cartilage. GE Healthcare Voluson
i.

US of the tibio-talar joint.
(A) Longitudinal scan of the
tibio-talar joint in a 10-year-
old healthy boy showing the
unossified cartilage of the
growth plate of the tibial
epiphysis. GE Healthcare
Voluson i. (B) US scan of the
same joint in a healthy adult
subject (age 26 years).
Philips iU22. Tib: tibia; Tal:
talus; GP: growth plate.

Synovial hypertrophy in a
20-year-old woman in whom
polyarticular JIA was
diagnosed in childhood.
(a) Longitudinal gray-scale US
image through the dorsal
aspect of the wrist
demonstrates thickened,
hypoechoic, noncompressible
intraarticular tissue consistent
with synovial hypertrophy (*)
deep to the normal-appearing
extensor tendon (arrowheads).
(b) Color Doppler US image
through the same region
demonstrates marked synovial
hypervascularity, a finding that
is indicative of inflammation.

GÂN (TENDON)
A normal healthy tendon is comprised
mostly of water and a substance
called collagen. It is collagen that
allows a tendon to flex and stretch.
Individual collagen fibrils arrange
themselves into bundles which are
called collagen fibres. These fibres
are arranged with other fibres to form
a fascicle which group with other
fascicles to form a tertiary fiber bundle.
Tertiary bundles grouped together
form the tendon itself. Contained in
between the tertiary bundles, fascicles
and fibrils are nerve fibers, blood and
lymph vessels

TENDONITIS, TENDONOSIS,
TENDINOPATHY
• Tendinitis is inflammation (redness, swelling, heat,
soreness) that occurs when the body's immune
system detects an injury and responds. In the
case of tendinitis (also spelled „tendonitis‟), the
body increases the flow of blood and infection-
fighting substances to the injured tendon.
• Tendinosis is a degenerative injury to the tendon
that doesn't provoke an immune response. It
occurs when repetitive, unrelenting stress over
time causes the breakdown of collagen, growth of
abnormal blood vessels, and thickening of the
tendon's sheath (covering).

• The term tendinopathy is a generic term used
to describe a common clinical condition
affecting the tendons, which causes pain,
swelling, or impaired performance.
• Because of the fact that most pain from
tendon conditions is not actually inflammatory
in nature, tendinopathy may be a better term
than tendonitis.
• Research suggests that many injuries
diagnosed as tendinitis are actually
tendinosis.

VIÊM GÂN (TENDONITIS, TENDINITIS)
• Tendons are tough, flexible,
fibrous bands of tissue that
connect muscles to bones.
When tendons become
inflamed, irritated or suffer
microscopic tears, the
condition is called tendonitis.
• Overuse – A particular body
motion is repeated too often.
• Overload – The level of a
certain activity, such as
weightlifting, is increased
too quickly.

• Sudden, severe trauma can damage the tendons
instantly. However, most tendon injuries are caused
by repetitive injury. Even a relatively minor stress can
tear and degrade the tendon tissue if it's repeated
over and over. Examples include:
• Work tasks such as typing, clicking a mouse,
clenching a steering wheel or using power tools
• Hobbies like gardening, shoveling, raking and
painting
• Sports such as golf, tennis, baseball, basketball,
bowling, running and swimming.
• Poor posture and form during these repeated
movements can increase stress on the tendons and
make injury more likely.

• Tendon injuries occur in all parts of the body,
but are most common in these parts:
• Thumb
• Shoulder
• Elbow
• Wrist
• Hip
• Knee
• Achilles tendon (which connect the calf
muscle to the heel bone)

• Symptoms of a tendon injury usually occur near
a joint at the attachment point between the bone
and muscle.
• The first sign is often dull, aching pain that
worsens with movement. The affected area is
frequently tender to the touch. Some mild
swelling may be present.
• People with tendinitis of the shoulder may notice
an occasional "snapping" sound during
movement and may experience freezing (loss of
motion) in the shoulder joint.

• The incidence of tendon injury increases with age,
and it's especially common after age 40. Some
medical conditions can increase the risk, including
arthritis, gout, and thyroid disorders
• For uncertain reasons, tendonitis is also common
in people with diabetes.
• Rarely, tendonitis is caused by an infection, such
as gonorrhea.
• In recent years, a rare cause of tendonitis (or other
tendon disease, including rupture) has been
recognized: the use of certain antibiotics, including
ciprofloxacin or levofloxacin. Why this happens is
unknown.

• In general, tendonitis causes pain in the tissues
surrounding a joint, especially after the joint is
used too much during play or work. In some
cases, the joint may feel weak, and the area may
be red, swollen and warm to the touch.
• When tendonitis is caused by an infection such
as gonorrhea, there may be other symptoms,
including rash, fever, or a discharge from the
vagina or penis.

• The term tendinosis was first used in the 1940‟s by a group of German
researchers, however the term did not receive much attention until it was
used again in the mid 1980‟s to describe a non-inflammatory tendon
condition.
THOÁI HÓA GÂN (TENDINOSIS)

Histopathology of Tendinosis
• A typical healthy tendon is composed of primarily type I
collagen with minimal amounts of type III collagen
interspersed within the neatly arranged parallel fiber
orientation of type I collagen. The healthy tendon is said to be
white and shiny and reflect polarized light under microscope.
• Unhealthy tendons, or tendinosis, appear gray and do not
reflect polarized light under the microscope. As previously
mentioned, there are no inflammatory cells found in the
collagen of chronic tendinosis conditions, there may however
be a few chronic (not acute) inflammatory cells present if
there is healing of a partial tear of the tendon. There are
however three key findings present in tendinosis conditions.
They are: disrupted collagen fibers within the tendon,
increased cellularity, and neovascularization.

NORMAL TENDON
Uniform, Organized, & Parallel
FRAYED TENDON (TENDINOSIS)
Unorganized, Tangled, & Random
NORMAL HEALTHY TENDON
NOTICE THE COLLAGEN WAVES
NOTICE THE FRAYED & TORN APPEARANCE.
THIS IS WHAT CHARACTERIZES TENDINOSIS
Scar Tissue / Fibrosis

• Kraushaar and Nirschl found that on cross section of collagen,
an area of tendinosis showed that the collagen was of
variable diameter, uneven mixture of thick and thin fibrils and
in some areas did not even connect with each other to form a
tendinous structure. They concluded that the ultrastructure of
collagen in tendinosis is unable to sustain a tensile load.
• Maffulli et al. confirmed these findings and also discovered
that the collagen that is formed in an area of tendinosis is
actually type III collagen, instead of the predominant type I in
healthy tendon. This increase in type III collagen, and
possible decrease in type I collagen results in a decrease in
the forces that the tendon can withstand and may eventually
lead to tendon rupture.

• Tendinosis and tendinopathy are the correct
terms and they are used to describe cellular
changes that makes a tendon more prone to
injury. Some of these changes include:
• An increase in the amount of immature
collagen, the primary tissue in tendons, which is
weaker and less flexible than mature collagen.
• An increase in the amount of a binding element
called ground substance between the cells.

Healing rates. Where the difference matters.
• Tendinosis takes longer to heal than tendinitis.
Collagen requires about 100 days to produce and
mature. This is a major component of tendon
healing during tendinosis.
• Tendinosis may take 6 to 10 weeks to heal if
caught early. Chronic cases may take 3-6 months.
Treating a case of tendinitis, on the other hand,
may only require several days to 6 weeks which
would be unrealistic time frame for any tendinosis
issue.

Trait Tendinosis Tendonitis
Time to recovery, early
presentation
6-10 weeks Days to 2 weeks
Time to recovery, chronic
presentation
3-6 months 4-6 weeks
Conservative therapy
Encourage collagen
synthesis and strength
Anti-inflammatory
modalities and drugs
Prevalence Common Rare

Achilles tendonitis
• The Achilles tendon connects the calf muscles
in the back of your leg to your heel. The
tendon can become inflamed with single
activities such as skiing, or with repetitive
activities such as running. A sudden increase
in running miles, extra jumping, hiking, or
walking can also irritate the Achilles. As the
Achilles tendon can be subjected to forces of
up to 12 times body weight during certain
activities, a massive amount of force over a
short period of time or even less force over
many miles– can both lead to Achilles
tendonosis.
• Achilles tendonitis usually is caused by
overuse, especially in sports that require
running or repeated jumping, and it accounts
for 15% of all running injuries

• Women who wear high heels are also at greater risk
for Achilles tendonitis, as the daily use of high heels
causes the Achilles tendon to shorten in time, so
when flatter shoes are worn, such as running
shoes, the tendon must stretch further than it is
used to.
• Achilles tendonitis also may be related to faulty
running technique or to poorly fitting shoes, if the
back of the shoe digs into the Achilles tendon above
the heel.
• Less often, Achilles tendonitis is related to an
inflammatory illness, such as ankylosing spondylitis,
reactive arthritis, gout or rheumatoid arthritis.

• Tenderness along the calf or back of the
heel
• Thickening of the achilles tendon
• Increasing pain with increasing activity
• Increased pain following a long rest period
(overnight)
• Swelling of the achilles tendon
• Calf stretching may increase the pain

Normal left achilles tendon
longitudinal
Focal achilles tendon tendinosis
with hypervascularity
longitudinal

Fusiform thickening of the Achilles tendon with
disarray of the fibrillar echotexture typical of
tendinosis (a).The power Doppler scan (b) shows
several color spots depending on the
peritendinous hyperemia

Enthesopathy of the Achilles tendon
a. The longitudinal scan shows inhomogeneous echotexture and thickening of the
preinsertional portion of the tendon, on a degenerative basis, with a rough calcaneal
spur. Chronic inflammation of the superficial retrocalcaneal bursa with soft tissue
thickening is also shown.
b. Color Doppler scan confirms inflammation of the retrocalcaneal bursa and shows
many vascular spots in the tendon
a b

Achilles tendinopathy and retrocalcaneal
bursitis.

Subcutaneous complete rupture of a
degenerative Achilles tendon.
a The US scan shows a complete tear. Note
the effusion between the stumps.
b The MR scan confirms the diagnosis (SE
T1W)

Full thickness achilles tendon rupture and
intact plantaris tendon
Full thickness achilles tendon
rupture
Full thickness achilles tendon
rupture

Achilles tendon tendinosis and
intratendinous rupture
Longitudinal Longitudinal

BỆNH CHUYỂN HÓA (Metabolic
diseases)
• Vôi hóa trong gân thường gặp ở bệnh
nhân viêm gân mạn (thoái hóa gân) gặp ở
bệnh nhân tiểu đường, tăng cholesterol
máu gia đình (diabetes mellitus and
familial hypercholesterolemia).

Calcific tendinopathy of the Achilles tendon (t). Longitudinal (a) and
transverse (b) scans showing an intratendinous hyperechoic line
(arrowheads) generating an acoustic shadow. c = calcaneal bone

Anterior ankle
• Tenosynovitis of the extensor digitorum
tendons
Longitudinal Transverse

Hypervascularized thickened
tendon longitudinal
Hypervascularized thickened
tendon and synovium transverse

Normal distal tendon insertion
longitudinal
Thick distal tendon insertion
longitudinal
Anterior tibialis tendon insertion
tendinopathy with a thick distal tendon
insertion

Tenosynovitis of the anterior tibial tendon
with a thickened tendon and synovial fluid
Thickened tendon
and synovial fluid
longitudinal
Thickened tendon
and synovial fluid
transverse
Tenosynovitis with
vascularized synovium
transverse

Tenosynovitis of the
anterior tibial tendon with
effusion

Tenosynovitis with tendon swelling and effusion and a
tendon split of the anterior tibial tendon
Tendon split of the anterior tibial
tendon transverse
Tendon split longitudinal
Tenosynovitis with
hypervascularity longitudinal
Thickened distal
insertion longitudinal

Tendinosis of the anterior tibial tendon
with intratendinous rupture caused by an
osteophyte
Longitudinal Transverse

Partial rupture of the anterior tibial tendon

Full thickness rupture of the anterior tibial tendon

Anterior tibial tendon rupture with
retracted proximal stump
Retracted proximal stump
longitudinal
Retracted proximal stump
transverse
Anterior tibial tendon rupture longitudinal

Thickenining of the extensor hallucis longus tendon
caused by osteosynthesis material

Medial ankle
Tendinitis and split posterior tibial tendon
and ostephyte of the medial malleolus
Split posterior tibial tendon
and ostephyte transverseI
Split posterior tibial tendon
longttudinal

Tenosynovitis of the posterior tibial tendon
with intratendinous rupture on both sides.
Left post. tib. tendon
transverse
Right post. tib. tendon
transverse
Increased vascularity
longitudinal
Increased vascularity
longitudinal

Bilateral tendinosis and insertion tendinopathy of the
posterior tibial tendon right > left with a thickened
inhomogeneous tendon

Tenosynovitis of the posterior tibial (*1) and
flexor digitorum longus tendon (*2)

Effusion in the tendon sheath of the flexor hallucis
longus tendon. The tendon is normal
Normal flexor hallucis longus
tendon longitudinal
Effusion in the
tendon sheath of
the flexor hallucis
longus tendon
transverse
There is no effusion in the tendon
sheath of the flexor hallucis longus
tendon on the other side.
Flexor hallucis longus tendon transverse

• Tarsal tunnel syndrome (TTS) refers to an
entrapment neuropathy of the posterior
tibial nerve or of its branches within the
tarsal tunnel.
• This condition is analogous to carpal
tunnel syndrome. While carpal tunnel
syndrome is usually bilateral, tarsal tunnel
syndrome is unilateral.

Aetiology
• Idiopathic (50% cases)
• Ganglion cysts
• Bone deformity after calcaneal fractures
• Varicosities
• Tenosynovitis of the flexor tendons
• Tumours (e.g. neurilemmoma 6, lipoma)
• Synovial hypertrophy
• Post-traumatic fibrosis

• The most common symptoms are pain and
paresthesia in the toes, sole, or heel and the
main finding at physical examination is the Tinel
sign (distal paresthesias produced by
percussion over the affected portion of nerve).
• Electromyography are useful in confirming the
diagnosis.
• Ultrasound: may be able to demonstrate the
presence of some of the aetiological factors
listed above.
• MRI imaging clearly depicts the bones, soft-
tissue contents, and boundaries of the tarsal
tunnel as well as the different pathologic
conditions responsible for tarsal tunnel
syndrome.

• Treatment of Tarsal Tunnel Syndrome includes rest,
physiotherapy and analgesics. Rest entails
immobilization of the ankle in a brace, boot or a cast. In
certain conditions aggravated by an excessive flat foot
an orthotic arch support is helpful.
• If these treatments do not relieve symptoms, surgery
(Tarsal Tunnel Release) may be performed. An incision
is made behind the ankle and a ligament that
compresses the nerve is released. This decreases the
pressure on the nerve by the overlying ligament.
Following surgery a removable boot is worn for
approximately four weeks. Physical therapy will
decrease the swelling and scarring over the nerve.

Thrombus in the tibial vein in the tarsal tunnel

Tumor of the posterior tibial nerve

Ganglion cyst on the medial side of the ankle
with compression of the tibial nerve and artery

Transverse images of the posterior tibial
nerve at the tarsal tunnel showing uneven
enlargement of the nerve fascicles on the
symptomatic side compared to the normal
side. Short arrows mark the epineural
margins of the nerve
Longitudinal images of posterior tibial
nerve across the tarsal tunnel showing
enlargement on the symptomatic side
compared to the normal side
Transverse image showing the
synovial cyst from flexor hallucis
longus tendon communicating
with posterior tibial nerve. FHL -
Flexor hallucis longus

Lateral ankle
Peroneal Tendonitis
• The peroneal muscles are located
on the external side of the lower leg.
The function of these muscles is
moving the ankle and the foot away
from the midline of the body i.e.
eversion. When there is excessive
contraction in the peroneal muscles,
it causes excessive tension in the
peroneal tendons resulting in
damage or injury to the neal
tendons. Repetition or excessive
force causes damage to the
peroneal tendons leading to
degeneration and inflammation of
the peroneal tendon. This condition
is known as peroneal tendonitis. The
peroneal tendons are located behind
the lateral malleolus on the external
side of the ankle. Inflammation of
these tendons causes pain and
swelling on the outer ankle.

• Excessive running on uneven surfaces such as
slopes causing excessive eversion of the foot can
cause Peroneal Tendonitis or Peroneal Tendinitis.
• Tense or stiff calf muscles or peroneal muscles.
• Overuse of the muscles or tendons especially seen
in basketball players or dancers.
• Overpronation of the foot or excessive eversion of
the foot.
• Weakness of the peroneal muscles can cause
Peroneal Tendonitis or Peroneal Tendinitis.
• Joint stiffness especially the foot and ankle joints.
• Excessive exercise or training can lead to Peroneal
Tendonitis or Peroneal Tendinitis.
• Poor biomechanics of the foot.
• Inappropriate or ill fitting footwear
• Lack of proper warm up before exercise.
• Muscle imbalances may also lead to this condition.
• Incorrect running techniques is also a cause of
Peroneal Tendonitis or Peroneal Tendinitis.

Lateral ankle
Tenosynovitis of the peroneal tendons with a thickened
peroneal retinaculum and slight displacement of the
peroneal tendons, hypervascularity

Tenosynovitis of the peroneal tendons and an
intratendinous rupture of the short peroneal tendon

Rupture of the proximal peroneal retinaculum with instability
of the tendons. The peroneal tendons are inhomogeneous
and thickened
Rupture of the proximal
peroneal retinaculum
Proximal peroneal
retinaculum transverse
Rupture of the proximal peroneal retinaculum with a small
calcification and instability of the tendons

Luxating peroneal tendons and thickened retinaculum

Ganglion cyst on the lateral side of the ankle

Tumor next to the peroneal tendons that proved to be a
benign fibrous mass

Dorsal ankle
Tendinosis of the plantaris tendon with a thickened
hypoechoic plantaris tendon in a patient with tendinosis
of the achilles tendon
Thickened plantaris tendon transverse
Thickened plantaris
tendon longitudinal
Tendinosis of the achilles
tendon longitudinal

Ganglion cyst or synovial cyst in Kagers
triangle with fluid in the peroneal tendon sheath
Achilles tendon longitudinal
Peroneal tendon longitudinal
Achilles tendon transverse

Plantar Fasciitis, Plantar fascial tears
A thickened plantar
fascia origin (red
arrows) compared to a
normal plantar fascia on
the right

Fasciitis
Plantar fasciitis with a thickened
plantar fascia
Insertion fasciitis with inhomogeneous
fascia thickening
hypoechoic plantar fascia insertion
with calcifications
Plantar fasciitis with a
thickened inhomogeneous
insertion of the plantar
fascia with microruptures

Plantar fasciitis with an
inhomogeneous thickened
hypervascularized insertion
inhomogeneous plantar fascia and
a small heel spur

A large partial tear of the
plantar fascia. There is a
surrounding haematoma and
inflammation (red).The
irregular outine and disrupted
fibres are visible (green).
Increased vascularity of the
plantar fascia tear and
surrounding tissues.

Ruptures:
Plantar fasciitis with a small intratendinous rupture
(There is also a heelspur)
Full thickness plantar fascia rupture
with retraction and a hematoma

PLANTAR FIBROMATOSIS
Scan plane for plantar
fibromatosis
A small nodule in the
superficial surface of the
plantar fascia

The fusiform hypoechoic
nodule (purple) with typical
disruption to the uniform
fibrillar achitecture of the
Plantar fascia (yellow).
Always scan right along the
plantar fascia. There are
usually more nodules than are
palbable. (Note the mirror
image artefact deep to the
nodule)

Plantar fibroma in the
proximal part
longitudinal
Plantar fibroma in the
distal part longitudinal
Normal plantar fascia insertion
longitudinal

Longitudinal
The fibroma is vascularized longitudinal
The fibroma is
vascularized transverse

MORTON NEUROMA
The same scan plane and
technique is employed to
examine for Mortons neuromas
or metatarsal bursae because
they are differential diagnoses
for each other.
The bulging bursa seen from the
plantar aspect with dorsal counter-
pressure applied. Be careful not to
apply too much transducer pressure
which will prevent visualisation of the
burs

• Morton's neuroma is a painful condition that affects
the ball of the foot, most commonly the area
between your third and fourth toes. Morton's
neuroma may make you feel as if you are standing
on a small stone or a marble in your shoe.
Typically patients get shoe pain and feels better
“out of shoes than in shoes”.
• Morton's neuroma involves a thickening of the
tissue around one of the nerves leading to your
toes. In some cases, Morton's neuroma causes a
sharp, burning pain in the foot. Patients also get
toe pain and their toes also may sting, burn or feel
numb. They may get burning in the feet . Mortons
neuroma can also lead to Metatarsalgia.

• The treatment of a neuroma is by wearing wide fitting shoe,
avoiding a high heel, wearing a pad or orthotic support in
the shoe, and occasionally, the use of cortisone injections
into the affected area. These treatments are often effective.
• If these conservative treatments fail to alleviate or
eradicate the symptoms, then surgery with removal of the
nerve is an option. Operation can be done under G.A or
Local Anaesthetic block very successfully as a day case
procedure.
• By removing the nerve, the pain in the front of the foot and
in between the toes invariably decreases, although there is
numbness in between the toes which is present and which
is permanent.

Mortons neuroma with tiny
bursal effusion
Mortons neuroma with some fluid in
the bursa
Mortons neuroma and a small
bursal effusion with effect of
compression. The effusion is
compressible. The neuroma
remains unchanged
Mortons neuroma
and bursal effusion

Chấn thương cổ chân – Bong gân
khớp cổ chân
• Bong gân” là tình trạng khớp bị vặn xoắn
mạnh và đột ngột khiến dây chằng khớp bị
căng quá mức bình thường, hay thậm chí
bị rách một phần hay toàn phần. Các
mạch máu vùng khớp có thể bị tổn thương
ít nhiều làm chảy máu ra vùng khớp. Các
dấu hiệu của bong gân là: đau, viêm, khớp
sưng phù, đốm xuất huyết dưới da.

• Chấn thương vùng cổ chân rất hay gặp
trong thể thao cũng như trong sinh hoạt bình
thường hằng ngày, thường gặp nhất là tình
trạng cổ chân bị lật sang bên hay còn gọi là
”lật sơ mi”, khi đi khám thường được chẩn
đoán là bong gân cổ chân.
• Khi mới bị chấn thương nếu được điều trị
đúng cách sẽ khỏi hoàn toàn một cách
nhanh chóng, ngược lại sẽ rất ảnh hưởng
đến chất lượng cuộc sống cũng như rất khó
khăn để chữa dứt điểm về sau này.

• BONG GÂN NHẸ
(ĐỘ I): đau vừa, sưng
tại chỗ, vẫn đi lại
được. Thời gian lành
hoàn toàn khoảng 4-6
tuần

• BONG GÂN TRUNG BÌNH
(ĐỘ II): có thể nghe tiếng
rách nhỏ khi bị chấn
thương. Cổ chân sưng to
và đau nhiều làm đi lại khó
khăn. Vài ngày sau có thể
có dấu bầm tím ngoài da.
Bệnh vẫn phục hồi nhưng
lâu hơn, khỏang 4-8 tuần

• BONG GÂN NẶNG (ĐỘ III):
dây chằng bị đứt hoàn toàn,
toàn bộ cổ chân sưng và rất
đau. Cổ chân bị “lỏng lẻo ”
rất rõ và đi lại hết sức khó
khăn và rất đau. Mức độ
này cần được điều trị tích
cực mới mong phục hồi
hoàn toàn, có thể kéo dài tới
12 tuần

Thickened anterior talofibular ligament with
calcifications and a partial rupture
Partial rupture Normal ligament

Partial medial ligament rupture

Anterior talofibular ligament rupture

Thickened anterior tibiofibular ligament
with small cortical avulsion

Ultrasonography in
transverse (A) and
longitudinal (B)
sections showing
effusion
(arrowheads) in
the left ankle in the
neutral position.

Ultrasonography of the ankle (arrowheads) in the neutral position
(transverse and longitudinal sections, A and B), of the ankle with
(arrowheads) and without effusion (C), and the possible difference
between plantar and dorsal (arrows) flexion (D).

• A bursa is a fluid-filled sac that cushion the
bones, tendons and muscles near your joints.
Bursae reduce friction between moving parts of
the body, such as around the joints of the
shoulder, elbow, hip, knee, and adjacent to the
Achilles tendon in the heel.
• The number varies, but most people have about
160 bursae throughout the body. Bursae are
lined with special cells, called synovial cells,
which secrete a fluid rich in collagen and
proteins. This synovial fluid acts as a lubricant
when parts of the body move. Inflammation of a
bursa is referred to as bursitis.

• The most common causes of bursitis are repetitive motions (for
example, repeated throwing of a ball), trauma (extensive
kneeling.
• Trauma causes inflammatory bursitis from repetitive injury or
direct impact.
• Bursae close to the surface of the skin are the most likely to
get infected with bacteria, a condition that is called septic
bursitis. The most common bacteria to cause septic bursitis are
Staphylococcus aureus or Staphylococcus epidermis. People
with diabetes, alcoholism, certain kidney conditions, those with
suppressed immune systems such as from cortisone
medications (steroid treatments), and those with wounds to the
skin over a bursa are at higher risk for septic bursitis
• Rheumatoid condition, gout and pseudogout can develop
bursitis from crystal deposits. When these crystals form in a
bursa, they cause inflammation leading to bursitis.

• Adventitious bursae are not permanent bursae
and can develop in adulthood at sites where
subcutaneous tissue becomes exposed to high
pressure and friction, which could then lead to
their formation.
• Adventitial bursitis refers of inflammation
associated with adventitious bursae.
• These begin when pre-existing small fluid
spaces coalesce in loose connective tissue. The
walls then progressively become differentiated
from the adjacent connective tissue and a well-
defined fluid-filled cavity is formed, which is lined
by synovium-like columnar cells.

• Foot and ankle region: typical
site and usually adjacent to
bony prominences:
– medial aspect of the first
metatarsal head
– towards the plantar aspect of
the metatarsal heads
• Overlying amputation stumps
Hallux valgus (Bunion)
Hammertoe
Hallux varus

Interdigital bursitis with fluid filled bursa
Rheumatoid arthritis with an interdigital
bursitis on both sides with compressable
interdigital masses right foot

Submetatarsal bursitis (= plantar bursitis):
Submetatarsal bursitis with a thick walled fluid filled submetatarsal bursa
Submetatarsal bursitis with a fluid filled bursa underneath the
flexor tendon at the level of the metatarsal head
Submetatarsal bursitis with a thickened
bursa underneath the flexor tendon at the
metatarsophalangeal joint of digit 3
Submetatarsal bursitis dig.
1 both sides in rheumatoid
arthritis

Ganglion cyst (Synovial cyst)
• A ganglion cyst, or a synovial cyst is a
non-neoplastic soft tissue lump that may
occur in any joint, but most often occurs
on, around, or near joints and tendons in
the hands or feet.
• These cysts are caused by leakage of
fluid from the joint into the surrounding
tissue.
• The average size of these cysts is 2.0
cm, but excised cysts of more than 5 cm
have been reported. The size of the cyst
may vary over time, and may increase
after activity.

Tenosynovitis of the extensor
hallucis longus tendon with a
slightly thickened tendon and
effusion
extensor hallucis longus
tendon with synovial
effusion in a patient with
arthrosis of the
metatarsophalangeal joint
Tenosynovitis of the distal
flexor hallucis longus
tendon and arthritis of the
MTP and IP joint
Tenosynovitis of the distal
flexor hallucis longus tendon
insertion

Tenosynovitis of the flexor hallucis
longus tendon with synovial thickening

Tenosynovitis of the extensor tendons of the foot
with hypervascularized thickened synovium

Insertion tendinopathy of the extensor tendon of digit 1
with effusion around the tendon
Transverse
Longitudinal

Tendon calcifications in the
flexor hallucis longus tendon

Contusion of the extensor hallucis longus tendon with
tendon thickening and a hematoma

Cysts and ganglia:
Ganglion cyst on the dorsal aspect of the
foot
(Ganglion) Cyst in
relation to the tendon
sheath of the extensor
hallucis longus
Multilocular ganglion
cyst in the sole of the
foot with connection to
the flexor hallucis
longus tendon
Ganglioncyst on the
medial side of the
metatarsophalangeal
joint of digit 1

flexor tendon of digit
2 and arthritis of the
metatarsophalangeal
joint
Foot ulcer in a patient
with diabetes with
tenosynovitis of the flexor
digitorum tendons

Lesions mimicking plantar
fascia pathology:
Heel fat pad syndrome with a thin
heel fat pad with abnormal mobile
fat and effusion between plantar
fascia and heel fat pad

Wooden splinter in the
lateral aspect of the foot with
a small abscess at the tip.
The visibility depends on the
angulation of the probe.
Glass fragments in the
sole of the foot
Foreign bodies:
Glass fragments in the sole of the foot

Giant cell tumor with extension
around the flexor tendon of digit 3 of
the foot
Glomus tumor with a
subungual mass and bony
erosion in digit 1 of the foot
Interdigital lymfangioma
with a multilocular cystic
mass

Glomus tumor with hypoechoic
vascularized mass and bony erosion

Lipoma next to the plantar
fascia longitudinal
Lipoma longitudinal
Lipoma transverse
Normal plantar fascia
insertion

Thrombophlebitis:
Thrombophlebitis with a non
compressible thrombus filled vein
in the sole of the foot extending to
the medial ankle
Thrombophlebitis:
Thrombophlebitis with
thrombus filled veins in the
sole of the foot

Stress Fracture:
Arrow is pointing to an
alteration in the dorsal
cortex of this
metatarsal. Adjacent is
a hypoechoic area that
represents bleeding in
this area.

Longitudinal (A and B) and axial (C and D) images over the dorsal side of the
second metatarsal shaft of a 24-year-old woman with metatarsalgia. Gray scale
images (A and C) over the painful area show the presence of a cortical break with
periosteal elevation (arrow), early callus formation (c), and a hypoechoic periosteal
and soft tissue hematoma (h). Color Doppler images (B and D) show prominent
neovascularity at the site of the periosteal elevation and surrounding soft tissue.

Siêu âm cổ chân bàn chân, Bs Tài

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Siêu âm cổ chân bàn chân, Bs Tài