Ankle - Medial View
How to perform the examination
Patient Positioning
Primary position (recommended): the patient is placed supine with the lower limb extended and the foot externally rotated to fully expose the medial compartment of the ankle. The foot should be maintained in a neutral or slight inversion position to optimize visualization of the deltoid ligament and medial tendinous structures.
Alternative position: the patient may be positioned in ipsilateral lateral decubitus (on the same side being examined) with the ankle facing upward. This position facilitates access to the posteromedial structures and allows dynamic examination with eversion stress to assess deltoid ligament stability.
Anatomy to Identify
- Medial malleolus (fractures, osteophytes, bony alterations)
- Superficial and deep deltoid ligament (tears, laxity, thickening)
- Posterior tibial tendon (tendinopathy, tears, tenosynovitis)
- Posterior tibial tendon sheath (thickening, effusions)
- Vascularization of the medial plantar arch (perfusion alterations)
- Navicular and cuneiform bones (tendinous insertional changes)
Probe
High-frequency linear transducer (10–15 MHz) optimal for imaging the superficial structures of the medial compartment. Beam steering techniques are essential to minimize anisotropy of the posterior tibial tendon. Doppler is crucial for assessing vascularization in tenosynovitis and inflammatory processes of the deltoid ligament. Frequency modulation allows analysis from superficial tendinous structures to deeper subtalar joints.
Anatomical Zones
Medial malleolus
The medial malleolus represents the medial prominence of the ankle and serves as the insertion site of the strong deltoid ligament. In hemophilic arthropathy, this bony structure may exhibit significant alterations due to chronic mechanical stress and periarticular inflammatory processes that characterize the disease.
Characteristic: Medial prominence of the distal tibia, insertion of the deltoid ligament
Findings:
- Traction osteophytes: Osteophytic formations at the deltoid ligament insertions caused by chronic mechanical stress
- Cortical erosions: Irregularities of the bony contour due to chronic periarticular inflammatory processes
- Reactive sclerosis: Subcortical bone thickening in response to altered mechanical loading
- Deltoid ligament enthesopathy: Structural changes at the ligament insertion with possible calcifications
Probe Positioning
Place the probe longitudinally along the medial surface of the tibial malleolus, from the posterior to the anterior margin. The marker should be oriented anteriorly. It is important to maintain uniform pressure to optimize visualization of ligament insertions.
Clinical Cases by Severity grade
The clinical cases are organized according to the HEAD-US protocol (Head-to-Head Assessment of Ultrasound Score), which classifies the severity of hemophilic arthropathy into four levels. Click on each level to explore the available cases for that specific joint–projection combination.