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Objective <p>To validate high-frequency ultrasound as a valuable imaging modality in the assessment of the annular pulley system of the toes, describing their normal sonographic appearance and presenting some illustrative pathological cases.</p> Materials and methods <p>The first phase of this observational study involved examining the annular pulley system of the flexor tendons of the toes in a series of cadaveric specimens, testing the ability of ultrasound to recognize these structures. In the second phase, two expert sonographers examined a sample of 15 healthy adult participants using two different 18–5&#xa0;MHz and 24–8&#xa0;MHz linear array ultrasound probes. Sonographic visibility, position, and maximal thickness of each annular pulley were assessed.</p> Results <p>In the cadaveric study, ultrasound provided identification of 4 annular pulleys in the lesser toes and 3 in the great toe across 8 feet from 4 cadavers. In 30 feet of 15 healthy participants, ultrasound was able to consistently recognize and measure the annular pulleys of toes I–IV, with minimal variability between operators. The V toe annular pulleys were less reliably visualized. The intraclass correlation coefficient (ICC) analysis of pulley maximal thickness measurements between the two sonographers showed moderate agreement for the 24–8&#xa0;MHz probe with a mean ICC of 0.393 (CI: 0.315–0.471) and better agreement for the 18–5&#xa0;MHz probe with a mean ICC of 0.529 (CI: 0.442–0.616).</p> Conclusion <p>This study provides a comprehensive description of the sonoanatomy of the annular pulleys of the flexor tendons in the toes and demonstrates the potential of ultrasound as a valuable tool for diagnosing pathologies of these structures.</p>

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High-resolution ultrasound of the annular pulley system in the toes: sonographic anatomy and pathological cases

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年3月22日

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  • Federico Pistoia,
  • Marta Macciò,
  • Maria Elena Susi,
  • Riccardo Picasso,
  • Federico Zaottini,
  • Giovanni Marcenaro,
  • Simone Rinaldi,
  • Maribel Miguel Perez,
  • Antonio Quaglio,
  • Matteo Formica,
  • Carlo Martinoli

摘要

Objective

To validate high-frequency ultrasound as a valuable imaging modality in the assessment of the annular pulley system of the toes, describing their normal sonographic appearance and presenting some illustrative pathological cases.

Materials and methods

The first phase of this observational study involved examining the annular pulley system of the flexor tendons of the toes in a series of cadaveric specimens, testing the ability of ultrasound to recognize these structures. In the second phase, two expert sonographers examined a sample of 15 healthy adult participants using two different 18–5 MHz and 24–8 MHz linear array ultrasound probes. Sonographic visibility, position, and maximal thickness of each annular pulley were assessed.

Results

In the cadaveric study, ultrasound provided identification of 4 annular pulleys in the lesser toes and 3 in the great toe across 8 feet from 4 cadavers. In 30 feet of 15 healthy participants, ultrasound was able to consistently recognize and measure the annular pulleys of toes I–IV, with minimal variability between operators. The V toe annular pulleys were less reliably visualized. The intraclass correlation coefficient (ICC) analysis of pulley maximal thickness measurements between the two sonographers showed moderate agreement for the 24–8 MHz probe with a mean ICC of 0.393 (CI: 0.315–0.471) and better agreement for the 18–5 MHz probe with a mean ICC of 0.529 (CI: 0.442–0.616).

Conclusion

This study provides a comprehensive description of the sonoanatomy of the annular pulleys of the flexor tendons in the toes and demonstrates the potential of ultrasound as a valuable tool for diagnosing pathologies of these structures.