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Ultrasound-guided intervention techniques in the ankle and foot: a comprehensive guide Cover

Ultrasound-guided intervention techniques in the ankle and foot: a comprehensive guide

Journal of Ultrasonography
Volume 26 (2026): Issue 104 (April 2026)
By: ,   and    
Open Access
|Mar 2026
Figures & tables

Figures & Tables

Fig. 1.

US-guided injection in the ankle joint. A. US imaging of the anterior recess of the ankle joint starts in the longitudinal plane, showing a significant joint effusion (asterisk). B. The transducer is then rotated perpendicular to the plane in image (A), and the injection is performed in the axial plane, with the needle entering from the side, parallel to the transducer. C. The needle is visualized on the screen entering the anterior joint recess in the axial plane

Fig. 2.

Peritendinous injection at the peroneal longus tendon in a patient with tenosynovitis. Note the position of the needle (arrow) inside the distended tendon sheath, away from the tendon fibers

Fig. 3.

A 35-year-old man with midportion Achilles tendinopathy treated with saline stripping. A. Axial US image of the Achilles free tendon showing tendon enlargement and neovascularity consistent with Achilles tendinopathy. B. Under US guidance in the axial view, a 21-G needle (arrow) was inserted using the in-plane technique, and 20 mL of fluid (2 syringes of saline with 4 mL of local anesthetic each) was injected between Kager’s fat (asterisk) and the Achilles tendon. An extension was connected to the needle to allow easier change of the syringes during the injection. C. The injectate creates a fluid collection between Kager’s fat (asterisks) and the Achilles tendon that disrupts neovessels and neural tissue from extending from fat into the tendon. The patient was instructed to wear a boot for one week, use paracetamol as needed, and then gradually return to normal activity

Fig. 4.

A 55-year-old man with insertional Achilles tendinopathy treated with PRP injection. A. US shows a Haglund’s deformity with a prominent calcaneal spur and considerable inhomogeneity, hypoechoic appearance, and fissures/microtears at the tendon insertion (asterisk). B. Using a 23-G needle (arrow), PRP was injected inside the fissures. After one week of worsening pain, the patient experienced gradual improvement in pain and function, lasting up to eight months, when the patient was lost to follow-up

Fig. 5.

A 56-year-old woman with plantar fasciitis treated with dry needling. A. US scanning in the longitudinal axis confirmed the presence of a thick plantar fascia at the calcaneal insertion (5.7 mm, measured with calipers). B. Axial view of the plantar fascia insertion: a 21-G needle (arrow) is inserted parallel to the transducer, and local anesthetic is injected superficial to the plantar fascia (PF). C. The same needle (arrow) is redirected without retracting into the plantar fascia (PF), and multiple passes (6–10) are performed

Fig. 6.

A 34-year-old woman with a Morton’s neuroma in the third web space of the left foot treated with steroid injection. A. A 1.16 × 0.86 cm hypoechoic lesion (calipers) was identified in the web space. B. Manual compression at the dorsal side of the webspace while scanning with the transducer in the long axis at the plantar side displaced fluid in the interdigital bursa, revealing a 1.15 × 0.52 cm Morton’s neuroma (calipers). C. Injection was performed using a 23-G needle (arrow) inserted through the interdigital space parallel to the transducer

Fig. 7.

A 67-year-old woman with a small painful palpable lump at the dorsal foot causing numbness of the big toe during pressure from shoes and walking. A. Diagnostic US showed hypoechoic tissue (asterisk) around the medial branch of the deep peroneal nerve (arrow), located just lateral to the dorsalis pedis artery in close relation to the navicular-medial cuneiform joint. B. Note the enlarged hypoechoic fascicles (arrow) and surrounding intensely echogenic connective tissue, the artery visualized on color Doppler and the hypoechoic tissue between them. Impingement of the nerve by the hypoechoic tissue was suspected and reported. The surgeon asked for a diagnostic nerve block before deciding on surgical management. Using a 23-G needle, an injection of a long-lasting anesthetic (ropivacaine) was performed with a high-resolution 18 MHz hockey-stick probe. Following relief of symptoms for a few hours, surgical debridement of the nerve was performed
DOI: https://doi.org/10.15557/jou.2026.0009 | Journal eISSN: 2451-070X | Journal ISSN: 2084-8404
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Language: English
Submitted on: Nov 30, 2025
Accepted on: Feb 9, 2026
Published on: Mar 31, 2026
Published by: MEDICAL COMMUNICATIONS Sp. z o.o.
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year
Keywords:
foot,
intervention,
tendinopathy,
US,
ankle
Related subjects:
Medicine,
Basic medical science,
Basic medical science, other

© 2026 Elena Drakonaki, Georgina Allen, Lionel Pesquer, published by MEDICAL COMMUNICATIONS Sp. z o.o.
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Volume 26 (2026): Issue 104 (April 2026)
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