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The University of Southampton
Health Sciences

Novel techniques for ultrasound imaging in podiatry and physiotherapy

Researchers in the School of Health Sciences have pioneered the use of ultrasound imaging in two novel applications in musculoskeletal assessment: podiatry (foot and ankle medicine) and physiotherapy. The research has directly influenced worldwide adoption of ultrasound imaging into allied health clinical practice, education and research.


Musculoskeletal conditions are the highest contributor to global disability, with low back pain being the leading cause. Ultrasound imaging (USI) offers a safe, accessible, less expensive alternative to magnetic resonance imaging (MRI) for diagnosis of such conditions.

Ultrasound imaging in Podiatry

Research led by Professor Cathy Bowen was the first to identify diagnostic USI as an additional skill that could be used reliably by podiatrists, particularly those working in musculoskeletal health.

In collaboration with radiologists, rheumatologists and podiatrists from University Hospital Southampton, University of Southampton and University of Oxford, Cathy led a major study, FeeTURA, which increased understanding of foot problems in rheumatic diseases. Findings indicated that diagnostic USI was more beneficial than clinical examination alone to determine effective care pathways for patients with foot symptoms.

As a result of the research, USI has been adopted globally by those working within the fields of foot and ankle musculoskeletal medicine, with particularly widespread use reported across the UK, Spain, Netherlands, Canada and Australia. Reported benefits include improved access, reduced waiting times for appointments, and improved patient journeys through tighter, focussed management plans.

Further, USI is included as a key component in national guidelines such as the UK Podiatry Rheumatic Care Association, which guide practice of the UK College of Podiatry’s 13,000 members UK wide.

The research team continue to drive national and international initiatives to ensure the research directly informs podiatric training and clinical practice. Cathy is adjunct professor at Auckland University of Technology in New Zealand and Queensland University of Technology in Australia to support research capacity building in diagnostic USI.

Ultrasound imaging in Physiotherapy

Professor Maria Stokes was involved in research that established USI as a powerful tool for visualising and estimating a muscle’s strength from its size. She led the development at the University of Southampton of robust protocols for accurate assessment of specific muscles using USI, studying technical aspects, reliability of repeated measurements and validity against the gold standard of MRI.

Novel applications resulting from Maria’s research include monitoring muscle size of astronauts in space and aiding their reconditioning after returning to Earth, with implications for inactive patients.

In groundbreaking research by Maria, Dr Martin Warner and Paul Muckelt, the Southampton team train astronauts at the European Space Agency (ESA) and the US National Aeronautics and Space Administration (NASA) to image each other’s muscles while in space. Astronauts are measured pre-flight and then guided to take images in-flight via direct video link and a remote motorised ultrasound probe.

Monitoring of astronauts’ muscles during 6 months on the International Space Station increases knowledge of the effects of inactivity on specific muscles, which vary between individuals. This will help development of targeted exercise programmes for the individual astronauts and patients with muscle wasting conditions on Earth.

Remote monitoring of astronauts provided valuable lessons for rapid implementation of virtual Physiotherapy clinics during the Covid-19 pandemic.

The wider impact of Maria and her team’s pioneering research in the field of rehabilitative USI is well evidenced through her leading position in an international consortium who first established the field. The consortium acknowledged the crucial contributions made by Maria and the Southampton team in the widespread adoption of rehabilitative USI, with a survey indicating a wide range of applications. These include diagnosis of musculoskeletal pathology, monitoring healing after muscle trauma, biofeedback to re-educate muscle contraction and guiding needles for acupuncture. Use of rehabilitative USI has spread to 50 countries worldwide.

Ultrasound Imaging
Ultrasound Imaging

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