Ankle/Foot

Fluoroquinolone induced achilles tendinopathy – David Baker, ESP and MSK Sonographer (@davebakerphysio)

The information set out below is designed to give a synopsis of aetiology and mechanism of action of Floroquinolone induced tendinopathy. I have included below a number of useful articles in the reference list. A number of medications are known to potentially induce tendinopathic changes. These include fluorouinoline antibiotics, long term use of glucocorticosteroids, statins and aromatase inhibitors (Kirchgesner et al,2014). The fluoroquinolones are a family of broad spectrum, systemic antibacterial agents that have been used widely as therapy of respiratory and urinary tract infections. Fluoroquinolones are the most potent oral antibiotics in clinical use today. Increasingly, these drugs are …

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Achilles tendinopathy – Peter Gettings, MSK Physiotherapist (@Peter_Gettings)

This male patient in their early 60's was referred to our ultrasound clinic for evaluation of his bilateral Achilles pain. He had been assessed by a colleague and diagnosed clinically as Achilles tendinopathy. The main reason for referral was to rule out other pathology and check the quality of his tissue prior to commencing treatment. It is well documented that musculoskeletal ultrasound is an important imaging modality when considering Achilles' tendon pathology. This very useful article by Klauser et al (2012) used a Delphi-based consensus to come up with clinical indications for musculoskeletal ultrasound. Using the criteria below they concluded …

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Exertional tibialis anterior muscle hernia – Suresh Sudula, MSK Consultant

This interesting case demonstrates the benefit of linking  musculoskeletal ultrasound with a clinical examination...with great images!. This 18 year old football club academy player had been referred to the ultrasound department with a three year history of a lump which appeared intermittently over the medial aspect of her leg. She had been seen by an Orthopaedic physician and had an ultrasound scan without conclusive findings or diagnosis.  She was also referred to an Orthopaedic surgeon who requested an MRI scan which came back with no lump. The MRI Images can be seen here... When I saw her in the clinic …

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Achilles rupture – Rob Mast , Extended Scope Physiotherapist

I reviewed this lady in her 40's in my ultrasound clinic 6 months post injury. She informed me that when landing from a jump, during an exercise session she heard a loud snapping sound and felt an immediate severe pain in her right Achilles area. She was unable to walk and was brought to an A&E department. She had an x-ray done which was negative. She was told that she had suffered an “Achilles Sprain” for which nothing could be done except wait for it to heal. She subsequently carried on with her normal ADLs as best she could. She had …

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Peroneus longus tendon tear – Rob Mast, Extended Scope Physiotherapist

This case involved a patient in their 70s who sustained an acute lateral ankle injury when turning and pivoting on his right foot whilst at work. The pain was very severe and he therefore visited his local Accident and Emergency department. He subsequently had an x-ray taken of the ankle as it was feared that he had fractured his ankle or his lateral foot. This was reported as normal. A useful reference point for a Peroneus Longus tendon rupture is this free access article by Smania et al (2007).    We hope you have found some useful learning points from …

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Tear of the musculotendinous junction of an achilles tendon

Well delineated hypo-echogenic area in the musculotendinous junction of the Achilles tendon and early emergence of soleus muscle on musculoskeletal ultrasound

Thanks to Rob Mast, Extended Scope Physiotherapist for this interesting case... This patient was a 30 year old male. He ran up the steps at a tube station and felt a sudden pulling sensation in the lower calf.  He then struggled to walk for several days, with a sharp pain and tightness. Two days following the injury there was a well delineated hypo-echogenic area in the musculotendinous junction of the  Achilles tendon and early emergence of soleus muscle on musculoskeletal ultrasound (Figure 1). This finding was discussed with two experienced musculoskeletal ultrasound specialists.  As this was such a well defined …

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