الفهرس 
Musculoskeletal UltrasonographyOnly 14 pages are availabe for public view
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Abstract
The ankle joint is one of the major weight-bearing joints in the body, forming the kinetic linkage that allows the lower limb to interact with the ground and is essential for locomotion and other daily tasks. It is a common afflicted joint in both young and old people, leading in discomfort, poor movement, and a lower quality of life.
Clinical implications of ankle involvement appear to be underestimated. This may be explained by the difficult anatomical accessibility of the ankle that may require much effort for someone with arthritis for proper examination. Thus, it needs more substantial studies finding out more accurate evaluation of the ankle and its role in functional disability.
Musculoskeletal ultrasound is used for diagnosis and monitoring treatment efficiency in patients with inflammatory arthritis. In particular, gray-scale ultrasonography to detect synovitis and power Doppler signals at multiple joint levels are valid disease activity markers, especially in rheumatoid arthritis, that are modified after effective therapy. US can also identify residual subclinical inflammation in patients with clinically silent patients.
The main aim of this study is to detect the underlying causes of symptomatic ankle joint by clinical and ultrasound evaluation, and compare the findings among the different patient groups.
The study included 100 patients suffering from ankle or foot pain without a history of foot or ankle trauma or surgery who are attending the Rheumatology outpatient clinic to the respective area. Subjects were allocated to two groups:
•group (I): 34 patients recruited from Vienna University.
group (II): 66 patients recruited from Benha University.
All patients were subjected to:
•History taking
•Clinicalexamination:Generalexamination,systemic examination,Local examination of the foot and ankle.
• Functional assessment: by Foot Function Index for all patients.
•Ultrasonography evaluation of ankle and foot joints using power Doppler and grey scale evaluation.
The results of current study revealed that:
1.Demographic data of the studied cases; 65% of cases were females and 35% of cases were males, their ages ranged from 19-86 years.
2.The majority of cases were diagnosed as RA (34%), followed by SpA (23%) while (16%) of cases were undiagnosed and presented only with ankle swelling and\or pain without prior diagnosis.
3.Swelling was most common (25%) of the right ankle joint while tenderness was most common (80%) in the fore-foot area.
4.Tibiotalar joint is the most affected among all hindfoot joints by US imaging regarding the three grades of synovitis, while the posterior subtalar joint is the most affected regarding erosions and osteophytes.
5.Talonavicular joint is the most affected joint regarding the three grades of synovitis especially with grey scale scoring when compared to other mid-foot joints by US imaging while the naviculocuniform joint is the most affected regarding Doppler signals and erosions.
6.2nd MTP joint is the frequently affected joint with gray scale and doppler grading in addition to erosions and osteophytes presence (70.5%, 38.5%, 18%, and 20% respectively) noted that the 3rd MTP is equally affected by erosions as 2nd MTP joint.
7.Tibialis posterior tendon is the most frequent and the most severely affected tendon among all medial compartment tendons by grey scale and power Doppler.
8.Tibialis anterior tendon is the most frequent affected tendon referring to the grey scale grading followed by the extensor halluces longus and the extensor digitorum longus tendons among anterior compartment tendons.
9.Achillis tendon is the most frequently and most severely affected one among lateral and posterior compartment tendons.
10.Anterior tibiofibular ligament bligament was the most commonly affected ligament among all ligaments of ankle and foot.
11.The most common involved joint by US examination in RA patients were fore- foot joints, while in AS patients; Achilles tendon was the most commonly involved tendon.
12.There was a significant association between tenderness in ankle, forefoot joints and Achilles tendon and US finding abnormalities.
13.There was a significant correlation between synovitis on US of most of mid- foot joints, tabio-talar and anterior sub-talar joint and FFI pain and disability.
14.There was a significant correlation between synovitis on US of most of MTP joints and FFI pain and disability.
15.There was a significant correlation between tenosynovitis in the US of Tibialis Anterior and Peronus Bervis tendons and FFI pain and disability.
16.There was a significant correlation between positive US findings of all foot ligaments and FFI pain while there is significant correlation between ATIFL positive US finding and FFI pain and disability.