AB0145 ULTRASOUND VALUE IN ASSESSMENT OF ANKLE AND FOOT IN RHEUMATOLOGY PRACTICE: A CROSS-SECTIONAL MULTICENTRIC STUDY
Authors: A. Abdalla, P. Mandl, Y. Abdelaziz, M. Mahgoub
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> The ankle is a frequently affected joint in rheumatic &amp; musculoskeletal diseases in both young and older populations, resulting in pain, limited mobility, and decreased quality of life[1]. UltraSound (US) is particularly suited for evaluating soft tissue structures, including the joint capsule, tendons and ligaments and is used for diagnosis and monitoring of patients with both inflammatory rheumatic diseases and degenerative joint disease[2]. <h3>Objectives:</h3> To investigate and identify different pathologies of soft tissue lesions and synovitis of the ankle and foot in patients presenting with foot and ankle complaints using US and their functional impact. <h3>Methods:</h3> A cross-sectional, multicenter observational study on consecutive patients who are attending the rheumatology outpatient clinics of Medical Unviersity of Vienna and Benha University Hospitals due to ankle or foot pain or swelling. All patients were subjected to clinical and ultrasound examination of the ankle and foot. Sonographic evaluation was performed for the joints of both ankles, forefoot, mid foot and hind foot for the presence of synovitis on gray scale (GS), power Doppler (PD), erosions (GS) and osteophytes (GS). The tendons and ligaments of Anterior, medial, lateral and posterior compartments were evaluated for the presence of tenosynovitis and/or tendon damage on GS and PD. Ankle or foot pain and disability were assessed by Foot Function Index (FFI)[3]. <h3>Results:</h3> A total of 200 ankles and feet were examined in 100 patients with mean age of 41 years. 65% of cases were females and 35% of cases were males. The majority of cases had a diagnosis of Rheumatoid Arthritis (RA) (34%), followed by SpondyloArthritis (SpA) (23%) and (16%) of cases were undiagnosed. Most of patients (25%) presented with swelling at right ankle joint while (80%) of patients presented with tenderness at the fore-foot area. US examination revealed that joints were more affected than tendons and ligaments of different compartments of ankle and foot. Metatarsophalangeal (MTPs) joints were the most common affected joints (83%) followed by talonavicular (TNJ) joint (63%), subtalar joint (46%) and tabiotalar joint (TTJ) (35%). Achilles tendon was the most commonly affected tendon followed by tibialis posterior tendon. Anterior-inferior tabio-fibular ligament (ATIFL) ligament was the most commonly affected ligament (28%). Among different cases, the most common involved joint by US in RA patients were MTPs, while in SpA patients; Achilles tendon was the most commonly involved tendon. There were significant association between clinical and US findings in tabiotalar (p&lt;0.001), MTPs (p&lt;0.001) joints and achillis tendon (p&lt;0.001) whereas no significant association between clinical and US findings in the remaining joints, tendons and ligaments. Regarding functional assessment, We found a significant correlation between synovitis in US of most of MTPs joints and pain and disability in FFI (p&lt;0.001).There were significant correlation between the presence of synovitis and erosions in naviculo-cuniform joint and pain and disability in FFI (p=0.004), also between the presence of synovitis in talonavicular joint and pain and disability in FFI (P=0.005). <h3>Conclusion:</h3> Ultrasound is an essential tool in identifying different pathologies of the ankle and foot as well as clinical examination due to their complicated anatomy. It clearly distinguish between synovitis, tenosynovitis, enthesitis and ligament injury. Ankle and foot pathologies have a significant impact on patients' function and disability, and they should be evaluated accurately using US. <h3>REFERENCES:</h3> [1] Brockett CL, Chapman GJ. Biomechanics of the ankle. Orthopaedics and Trauma. 2016; 30:232–238. [2] De Maeseneer M, Marcelis S, Jager T, Shahabpour M, Van Roy P, Weaver J, et al. Sonography of the normal ankle: a target approach using skeletal reference points. AJR Am J Roentgenol 2009;192:487–495. [3] Carter K, Lahiri M, Cheung PP, Santosa A, Rome K. Prevalence of foot problems in people with inflammatory arthritis in Singapore. Journal of Foot and Ankle Research, 2016:9, 37. <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>