hi I'm Dr Frank Johnson from Sports Medicine ultrasound I'm here with one of my patients who when she's in Mexico she loves to walk for enjoyment and for fitness but after she leaves Canada after an injection about a month or so later her feet start aching so badly that she can't enjoy her holidays so she's back now we're going to do an injection she's going to head back and enjoy the rest of the winter in Mexico so right now we're over the third metatarsal intermediate cuneiform joint I prefer to do these joints from lateral to medial when we get to the second you'll see the dorsalispedus artery and you'll see why I'm going to slide the target to the edge of the screen and we're going to be able to come in from the left side of the screen to the right side at about a 30 degree angle downwards I've got sterile gloves on I've disinfected the skin with sandhexidine and I don't actually need to use any sterile gel in this case so here's an example of where needle guidance sometimes we can't see the needle perfectly but we can see the flow of the fluid into the joint now when we get to the second metatarsal it'll be a bit more obvious now we're on the second metatarsal we can see the dorsalis pedis artery I'll put that right in the center you can see a small dark structure pulsating at the top of the joint so going straight down like this I'm almost guaranteed to go through the artery so I prefer to say well I could come from the right side of the screen to the left but if I slide approximally a little bit I lose the artery I'm going to slide back down to this position and I'm simply going to drop in underneath the artery there you can see as I inject it actually lifts up the artery and so this is an example of how ultrasound can keep my patients safe you're going to walk out of here without a huge bruise and the cortisone is in the right spot foreign
