The patient is a 30 year old male referred to physical therapy after trauma to bilateral ankles with pinning with ORIF of bilateral calcaneus. The patient's left foot and ankle have been progressing well with physical therapy and the right foot and ankle have had limitations throughout the physical therapy plan of care. Two weeks prior to the ultrasound scan the patient's right ankle was forcibly dorsiflexed and the patient had an acute onset of pain.
Diagnostic musculoskeletal ultrasound reveals an ankle joint effusion in the talofibular joint. Additionally, there is tendinosis of the tibialis posterior insertion with tenderness to sono-palpation. Also, there is tibialis anterior tenosynovitis with tenderness to sono-palpation. On the lateral ankle, hardware can be seen approximating into fibularis brevis and longus tendons with tenderness to sono-palatpion. Dynamic maneuvers with the foot and ankle were done indicating hardware placement into the tendon sheath. The patient's orthopedic surgeon was notified and patient was referred back to orthopedics.
In this case, diagnostic musculoskeletal ultrasound was able to diagnose tibialis posterior tendinosis, tibialis anterior tenysynovitis, and failed hardware from a calcaneus ORIF which was tearing into the fibularis tendons.
Doctor of Physical Therapy, Registered in Musculoskeletal Sonography, Certified Orthopedic Manual Therapist, Certified Lymphedema Therapist, Certified in Vestibular Assessment and Management, and Founder of Mobile Therapy Services
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