Stepping into clarity: high-resolution ultrasound unveils the hidden spectrum of ankle and foot pain

J Ultrasound. 2026 Mar 13. doi: 10.1007/s40477-026-01141-z. Online ahead of print.

ABSTRACT

PURPOSE: High-resolution ultrasonography (HRUS) has emerged as an accessible imaging modality for evaluating ankle and foot pain. This study aimed to describe the spectrum of HRUS findings in patients presenting with ankle or foot pain and document the range of pathologies identifiable with this technique.

METHODS: A prospective descriptive study was conducted over 12 months involving systematic HRUS examination of 40 adult patients presenting with ankle or foot pain. All relevant compartments of the ankle (anterior, posterior, medial, and lateral) and the foot (plantar and dorsal) were evaluated using a standardized protocol. Vascularity was assessed using color and power Doppler imaging. Plain radiographs were obtained in all cases, and MRI or surgical correlation was available in selected cases.

RESULTS: HRUS found 50 pathologies in 40 patients. There were 31 patients with a single pathology, 8 with dual pathologies, and 1 with three pathologies. Ligamentous injuries were most common (21 cases, 36%), followed by tendon abnormalities (14 cases, 28%). Other findings were plantar fasciitis (4 cases, 8%), soft tissue collections with bony irregularities suggestive of tuberculosis (4 cases, 8%), joint effusion with internal echoes (2 cases, 4%), ganglion cysts (2 cases, 4%), and vascular malformations (2 cases, 4%). There was one case each of synovial osteochondromatosis, retrocalcaneal bursitis, synovial sarcoma, and plexiform neurofibroma.

CONCLUSION: HRUS identified multiple ankle and foot pathologies, proving especially effective for superficial soft tissues. Its high spatial resolution, dynamic assessment, accessibility, and lack of ionizing radiation support its use as a first-line imaging tool. A planned sensitivity-specificity comparison with MRI, aiming for at least 90% agreement, may validate HRUS and foster research funding. However, limitations such as small sample size, operator bias, and limited MRI correlation warrant cautious interpretation and highlight the need for further research.

PMID:41824205 | DOI:10.1007/s40477-026-01141-z