Ankle and foot pain can be a challenging clinical diagnosis, notably in patients with vague and chronic pain. Thus, imaging modalities are used. Currently, magnetic resonance is the most reliable method for physicians. However, ultrasound is now widely thought to help evaluate tendon, muscle, bursa, and other soft tissue abnormalities. Particularly early and small inflammatory and structural changes. Therefore, this paper seeks to assess the agreement between ultrasound and MRI in evaluating different soft tissue disorders that cause ankle and foot pain and the efficacy of ultrasound compared to MRI. The current study illustrated that as regards the different diagnoses overall, there is almost perfect agreement between US and MRI in the detection of soft tissue disorders (K coefficient of 0.850) and that US showed high sensitivity and specificity, being of 95% and 90%, respectively. The US has proven to be an effective, excellent cost-benefit imaging technique in diagnosing ankle and foot soft tissue disorders with a spatial resolution showing almost perfect agreement with MRI and diagnostic accuracy almost equal to it. Hence US should be used more frequently before MRI when soft tissue injury is suspected, or at the very least as a complementary study when MRI cannot explain the cause of ankle and foot pain.