Ultrasound Imaging Is Reliable for Tibialis Posterior Size Measurements

Abstract

Objectives-The tibialis posterior (TP) is a vital muscle for controlling the medial longitudinal arch of the foot during weight-bearing activities. Dysfunction of this muscle is associated with a variety of pathologic conditions; thus, it is important to reliably assess its morphologic characteristics. Ultrasound (US) has been used to assess characteristics of TP tendons but not the muscle crosssectional area (CSA). The purpose of this study was to establish a reliable US technique to measure the TP CSA and thickness. Methods-Twenty-three healthy volunteers participated. We evaluated the CSA and thickness at 4 measurement locations (anterior and posterior views at both 30% and 50% of the shank length). Results-The participants included 12 female and 11 male volunteers (mean age AE SD, 31.23 AE 14.93 years). Excellent reliability was seen for the CSA and thickness at all locations (intraclass correlation coefficients, 0.988-0.998). Limits of agreement (LoA) and standard errors of the measurement (SEMs) were slightly lower at the 30% locations

Ultrasonographic Validation for Needle Placement in the Tibialis Posterior Muscle

“…The cross-sectional area of the TP muscle at this location is approximately 3.5 to 4.0 cm 2 . 20 This is important for clinicians to consider when determining appropriate needle length for needling the TP muscle, and in this study supports the selection of 50-60mm filament/needle length allowing for 1-2 cm filament length outside of the body at full insertion.…”

“…This is consistent with previous research assessing reliability of ultrasound imaging of the tibialis posterior muscle. 20 In addition, this range was selected to target more of the muscle belly of the tibialis posterior given the muscle transitions to tendon more distally in the deep posterior compartment. Due to the location of the TP muscle within the deep posterior compartment and the inability to directly palpate the muscle, the needle approach and insertion was based on anatomical aspects.…”

“…Diagnostic ultrasound imaging has been shown to reliably measure the thickness of tibialis posterior muscle and identify muscle contraction. 20 Ultrasound has been utilized in previous studies to confirm needle placement, but not of the TP muscle. [21][22][23] Therefore, given the clinical relevance of the TP muscle for normal foot and ankle function, the purpose of this study was to assess the accuracy of needle placement in the TP muscle and determine the needle placement in relation to the neurovascular structures located within the deep compartment.…”

Ultrasonographic Evaluation of Three Approaches for Botulinum Toxin Injection into Tibialis Posterior Muscle in Chronic Stroke Patients with Equinovarus Foot: An Observational Study

“…TP could potentially be obscured by either the tibia or fibula and the overlying structure such as the interosseous membrane or fibrous muscles could alter the view. Therefore, in contrast to Johnson et al [33] who recommend measuring the CSA of TP using the anterior view at 30% of the shank length, we noted that it was difficult to image and measure the whole CSA at this level in our patients. We then measured the CSA by a posterior approach at the junction of middle and lower limb: at this level, the image was clearer as it was possible to visualize all the TP border and the measurement depth is reduced compared to the proximal leg because it is necessary to scan through only the soleus and not the gastrocnemius.…”

Leg muscle cross‐sectional area measured by ultrasound is highly correlated with MRI

“…The use of US imaging has several advantages for the evaluation of soft tissue. It allows for reliable, highresolution assessment of soft-tissue under static and dynamic conditions [9][10][11]. Dynamic movement patterns, such as muscle contraction, can be recorded in retrospective video clips (Cine-loops), that have been shown to decrease operator imaging and measurement error [11].…”