Indeed. I used to think it was very difficult to visualise the PITFS. But now I have a good technique. The anatomy is nice and symmetrical. The tibial end of the PITFS is more proximal and the fibular end more distal, just like the AITFS. I scan just lateral to the Achilles tendon. Anchor one end of the transducer on the distal fibula. If you orientate the other end of the transducer to the point of the calcaneum you will see the CFL perfectly. Then rotate the calcanea end of the transducer until you are perfectly axial and you will see the PTFL. Continue the rotation until the transducer points to about the level of the opposite tibial tuberosity and you see the PITFS between the tibia and fibula. You may need firm heel toe pressure to flatten the ligament parallel to the transducer face. Sometimes IO need to bow the Achilles with my opposite hand to make room for the transducer. I feel like I covered this technique on the birdultrasound.com.au website webinars under withe "Fundamentals of ankle ultrasound" or " Challenging aspects of foot and ankle ultrasound" Give it a go and let me know how it works for you. Steve Bird
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Thank you, Steven. Another good and helpful video. Could you please show how to find the PTFS?It must be difficult. Maybe in the next video?
Indeed. I used to think it was very difficult to visualise the PITFS. But now I have a good technique. The anatomy is nice and symmetrical. The tibial end of the PITFS is more proximal and the fibular end more distal, just like the AITFS. I scan just lateral to the Achilles tendon. Anchor one end of the transducer on the distal fibula. If you orientate the other end of the transducer to the point of the calcaneum you will see the CFL perfectly. Then rotate the calcanea end of the transducer until you are perfectly axial and you will see the PTFL. Continue the rotation until the transducer points to about the level of the opposite tibial tuberosity and you see the PITFS between the tibia and fibula.
You may need firm heel toe pressure to flatten the ligament parallel to the transducer face. Sometimes IO need to bow the Achilles with my opposite hand to make room for the transducer.
I feel like I covered this technique on the birdultrasound.com.au website webinars under withe "Fundamentals of ankle ultrasound" or " Challenging aspects of foot and ankle ultrasound"
Give it a go and let me know how it works for you.
Steve Bird