1
|
Gupta A, Singh PK, Xu AL, Bronheim RS, McDaniel CM, Aiyer AA. Turf Toe Injuries in the Athlete: an Updated Review of Treatment Options, Rehabilitation Protocols, and Return-to-Play Outcomes. Curr Rev Musculoskelet Med 2023; 16:563-574. [PMID: 37789169 PMCID: PMC10587038 DOI: 10.1007/s12178-023-09870-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/05/2023]
Abstract
PURPOSE OF REVIEW First metatarsophalangeal joint sprains or turf toe (TT) injuries occur secondary to forceful hyperextension of the great toe. TT injuries are common among athletes, especially those participating in football, soccer, basketball, dancing, and wrestling. This review summarizes the current treatment modalities, rehabilitation protocols, and return-to-play criteria, as well as performance outcomes of patients who have sustained TT injuries. RECENT FINDINGS Less than 2% of TT injuries require surgery, but those that do are typically grade III injuries with damage to the MTP joint, evidence of bony injury, or severe instability. Rehabilitation protocols following non-operative management consist of 3 phases lasting up to 10 weeks, whereas protocols following operative management consist of 4 phases lasting up 20 weeks. Athletes with low-grade injuries typically achieve their prior level of performance. However, among athletes with higher grade injuries, treated both non-operatively and operatively, about 70% are expected to maintain their level of performance. The treatment protocol, return-to-play criteria, and overall performance outcomes for TT injuries depend on the severity and classification of the initial sprain. For grade I injuries, players may return to play once they experience minimal to no pain with normal weightbearing, traditionally after 3-5 days. For grade II injuries, or partial tears, players typically lose 2-4 weeks of play and may need additional support with taping when returning to play. For grade III injuries, or complete disruption of the plantar plate, athletes lose 4-6 weeks or more depending upon treatment strategy.
Collapse
Affiliation(s)
- Arjun Gupta
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287 USA
- Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, 185 South Orange Ave, Newark, NJ 07103 USA
| | - Priya K. Singh
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287 USA
- Department of Orthopaedic Surgery, Montefiore Medical Center at Albert Einstein College of Medicine, 1250 Waters Place, Bronx, NY 10461 USA
| | - Amy L. Xu
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287 USA
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Rachel S. Bronheim
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287 USA
| | - Claire M. McDaniel
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287 USA
| | - Amiethab A. Aiyer
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287 USA
| |
Collapse
|
2
|
Singh P, Agrawal K, Tripathy SK, Patro SS, Velagada S. Emerging role of bone scintigraphy single-photon emission computed tomography/computed tomography in foot pain management. Nucl Med Commun 2023; 44:571-584. [PMID: 37114428 DOI: 10.1097/mnm.0000000000001698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Foot and ankle joints being weight-bearing joints are commonly subjected to wear and tear and are prone to traumatic and other pathologies. Most of these foot and ankle pathologies present with pain. The diagnosis of pathology and localization of pain generators is difficult owing to the complex anatomy of the foot and similar clinical presentation. This makes the management of foot pain clinically challenging. Conventional anatomical imaging modalities are commonly employed for evaluation of any anatomical defect; however, these modalities often fail to describe the functional significance of the anatomical lesions, especially in presence of multiple lesions which is common in ankle and foot; however, hybrid single-photon emission computed tomography/computed tomography (SPECT/CT) by virtue of its dual modalities, that is, highly sensitive functional imaging and highly specific anatomical imaging can serve as a problem-solving tool in patient management. This review attempts to describe the role of hybrid SPECT/CT in overcoming the limitation of conventional imaging and describes its potential application in the management of foot and ankle pain.
Collapse
Affiliation(s)
- Parneet Singh
- Nuclear Medicine, All India Institute of Medical Sciences, AIIMS, Bhubaneswar
| | - Kanhaiyalal Agrawal
- Nuclear Medicine, All India Institute of Medical Sciences, AIIMS, Bhubaneswar
| | - Sujit Kumar Tripathy
- Department of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar, Odisha
| | - Sai Sradha Patro
- Nuclear Medicine, All India Institute of Medical Sciences, AIIMS, Bhubaneswar
| | - Sandeep Velagada
- Department of Orthopedics, S.L.N Medical College and Hospital, Koraput, India
| |
Collapse
|
3
|
Reeve A, Linklater JM, Dimmick DS. Lesser Metatarsophalangeal Joint Plantar Plate Degeneration and Tear and Acute First Metatarsophalangeal Joint Capsuloligamentous Injury: What the Surgeon Wants to Know. Semin Ultrasound CT MR 2023. [DOI: 10.1053/j.sult.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
|
4
|
Dimmick S, Reeve A, Linklater J. Presurgical Perspective and Postsurgical Evaluation of Plantar Plate and Turf Toe. Semin Musculoskelet Radiol 2022; 26:695-709. [PMID: 36791738 DOI: 10.1055/s-0042-1760221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Capsuloligamentous injury of the first metatarsophalangeal (MTP) joint (eponymously called "turf toe") mostly occurs in athletes and involves acute trauma, whereas tears of the lesser MTP joint plantar plate typically are an attritional-degenerative condition. This article reviews the anatomy, pathophysiology, mechanism and patterns of injury, grading and classification of injury, imaging appearances (pre- and postoperative), and management of first MTP joint capsuloligamentous injuries and lesser MTP joint plantar plate tears. These two distinct pathologies are discussed in separate sections.
Collapse
|
5
|
Carneiro BC, Araújo FF, Guimarães JB, Chemin RN, Jorge RB, Filho AGO, Nico MAC. Stener-like lesions in the hand, knee and foot: a review of anatomy, mechanism of injury and imaging evaluation. Clin Imaging 2021; 76:235-246. [PMID: 33975225 DOI: 10.1016/j.clinimag.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 04/14/2021] [Accepted: 05/03/2021] [Indexed: 11/26/2022]
Abstract
A Stener lesion is a displaced tear of the ulnar collateral ligament in the metacarpophalangeal joint of the thumb in which the adductor pollicis aponeurosis is positioned between the retracted ligament and the injury site, preventing natural healing. This lesion was first described in 1962, and since then, both radiologists and orthopedists have considered it important to treat surgically. Although this lesion was originally described in the thumb, this injury mechanism can occur in other joints of the hand, knee, and foot. The purpose of this study was to review the relevant aspects of classic Stener lesions of the thumb, as well as other Stener-like lesions, including their anatomy, mechanisms of lesion formation and imaging features. The Stener-like injury pattern often necessitates surgical repair or reconstruction; thus, it is essential that radiologists recognize and report the different patterns of injury.
Collapse
Affiliation(s)
- Bruno Cerretti Carneiro
- Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1° Andar, Higienópolis, São Paulo, SP 01239-040, Brazil.
| | - Flávia Ferreira Araújo
- Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1° Andar, Higienópolis, São Paulo, SP 01239-040, Brazil.
| | - Júlio Brandão Guimarães
- Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1° Andar, Higienópolis, São Paulo, SP 01239-040, Brazil.
| | - Renan Nogueira Chemin
- Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1° Andar, Higienópolis, São Paulo, SP 01239-040, Brazil.
| | - Rafael Baches Jorge
- Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1° Andar, Higienópolis, São Paulo, SP 01239-040, Brazil.
| | - Alípio Gomes Ormond Filho
- Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1° Andar, Higienópolis, São Paulo, SP 01239-040, Brazil.
| | - Marcelo Astolfi Caetano Nico
- Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1° Andar, Higienópolis, São Paulo, SP 01239-040, Brazil.
| |
Collapse
|
6
|
Padua L, Coraci D, Gatto DM, Glorioso D, Lodispoto F. Relationship Between Sensory Symptoms, Mulder's Sign, and Dynamic Ultrasonographic Findings in Morton's Neuroma. Foot Ankle Int 2020; 41:1474-1479. [PMID: 32856473 DOI: 10.1177/1071100720946748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Morton's neuroma (MN) is often a diagnostic dilemma lacking a gold standard set of diagnostic criteria. Advanced imaging of MN is evolving including ultrasonography. The current study aimed to analyze the relationship between ultrasonographic findings and symptoms, clinical data, and operative findings in a subgroup of patients. METHODS We evaluated physical examination, ultrasonographic findings, symptoms, and in a subgroup, the operative findings for Morton's neuroma. We analyzed the symptoms, the findings on physical examination, and ultrasonography data and performed a statistical correlation between them. A total of 175 patients were seen for suspected Morton's neuroma during the last 7 years. RESULTS Neuropathic pain of the toes was reported in 63% of patients. Presence of ultrasonographic findings suggesting Morton's neuroma was observed in 77% of cases. A mild significant relationship between neuropathic pain and positive ultrasonographic findings was observed. We found a strong correlation between ultrasonographic and clinical evaluation, but more than half with clinical negative Morton's neuroma had positive findings at ultrasonography. In the subgroup of operatively treated patients (n = 44) surgery confirmed Morton's neuroma in all patients who had positive ultrasonography findings. CONCLUSIONS The current study suggests that the association of ultrasonographic evaluation and clinical evaluation can be very useful for the management of Morton's neuroma. Our study could help with the development of a multiperspective approach in the diagnosis of Morton's neuroma. LEVEL OF EVIDENCE Level II, prospective cohort survey study.
Collapse
Affiliation(s)
- Luca Padua
- Department of Geriatrics, Neurosciences and Orthopaedics, Catholic University of the Sacred Heart, Rome, Italy.,Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Daniele Coraci
- Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Dario Mattia Gatto
- Department of Geriatrics, Neurosciences and Orthopaedics, Catholic University of the Sacred Heart, Rome, Italy
| | - Davide Glorioso
- Department of Geriatrics, Neurosciences and Orthopaedics, Catholic University of the Sacred Heart, Rome, Italy
| | | |
Collapse
|
7
|
Steadman J, Sripanich Y, Rungprai C, Mills MK, Saltzman CL, Barg A. Comparative assessment of midfoot osteoarthritis diagnostic sensitivity using weightbearing computed tomography vs weightbearing plain radiography. Eur J Radiol 2020; 134:109419. [PMID: 33259992 DOI: 10.1016/j.ejrad.2020.109419] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/02/2020] [Accepted: 11/16/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE Accuracy in diagnosing osteoarthritis in the midfoot using weightbearing plain radiography (WBPR) remains questionable due to the overlapping osseous architecture present, occluding visualization. Weightbearing computed tomography (WBCT), providing clearer bony landmark identification and joint space visualization, can also be used for evaluation. The aim of this project is to perform a standardized retrospective intra-patient analysis identifying the discrepancy of midfoot osteoarthritis diagnosis and osteoarthritis severity grading between WBPR and WBCT. METHODS AND MATERIALS A cohort of 302 patient feet was acquired from an internal, consecutive patient database using detailed inclusion criteria. The musculoskeletal radiologist interpretation of the WBCT and WBPR of each specimen was then assessed for any direct diagnosis or mention of osteoarthritic signs in specific articulations of 3 midfoot joint groups (Chopart, "central", and tarsometatarsal). WBPR sensitivity and specificity metrics were calculated with WBCT considered the gold standard for comparison. RESULTS From the WBPR radiologist interpretation, we found diagnostic sensitivity of 72.5 % and specificity of 87.9 % for Chopart joints; 61.5 % sensitivity, and 96.1 % specificity for central joints; and 68.4 % sensitivity, and 92.9 % specificity for tarsometatarsal joints. The severity of degenerative changes was also consistently underestimated when interpreted from WBPR relative to WBCT. CONCLUSIONS In this series, midfoot osteoarthritis was often undetected on WBPR. WBCT imaging facilitates an earlier, more reliable diagnosis and grading of midfoot osteoarthritis relative to WBPR.
Collapse
Affiliation(s)
- Jesse Steadman
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA.
| | - Yantarat Sripanich
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA; Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, 315 Rajavithi Road, Tung Phayathai, Ratchathewi, Bangkok 10400, Thailand.
| | - Chamnanni Rungprai
- Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, 315 Rajavithi Road, Tung Phayathai, Ratchathewi, Bangkok 10400, Thailand.
| | - Megan K Mills
- Department of Radiology and Imaging Sciences, University of Utah, 30 N. 1900 E. #1A071, Salt Lake City, UT 84132, USA.
| | - Charles L Saltzman
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA.
| | - Alexej Barg
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA; Department of Orthopaedics, Trauma and Reconstructive Surgery, University of Hamburg, Martinistrasse 52, 20246 Hamburg, Germany.
| |
Collapse
|
8
|
Hallinan JTPD, Statum SM, Huang BK, Bezerra HG, Garcia DAL, Bydder GM, Chung CB. High-Resolution MRI of the First Metatarsophalangeal Joint: Gross Anatomy and Injury Characterization. Radiographics 2020; 40:1107-1124. [PMID: 32412828 DOI: 10.1148/rg.2020190145] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The first metatarsophalangeal joint (MTPJ) is vital to the biomechanics of the foot and supports a weight up to eight times heavier than the body during athletic activities. The first MTPJ comprises osseous and cartilaginous surfaces along with a complex of supporting structures, including the dorsal extensor tendons, collateral ligaments, and a plantar plate complex. In contradistinction to the lesser MTPJ plantar plates, a single dominant fibrocartilaginous capsular thickening does not exist at the first MTPJ. Instead, the plantar plate complex comprises a fibrocartilaginous pad that invests the hallux sesamoids and is inseparable from the plantar capsule, the intersesamoid ligament, paired metatarsosesamoid and sesamoid phalangeal ligaments (SPLs), and the musculotendinous structures. Acute injury at the first MTPJ is typically secondary to forced hyperextension-turf toe-and can involve multiple structures. During hyperextension, the resulting forces primarily load the distal SPLs, making these structures more susceptible to injury. SPL injuries are best seen in the sagittal plane at MRI. Radiography can also aid in diagnosis of full-thickness SPL tears, demonstrating reduced sesamoid excursion at lateral dorsiflexed (stress) views. Hallux valgus is another common condition, resulting in progressive disabling deformity at the first MTPJ. Without appropriate treatment, first MTPJ injuries may progress to degenerative hallux rigidus. The authors detail the anatomy of the first MTPJ in cadaveric forefeet by using high-resolution 3-T and 11.7-T MRI and anatomic-pathologic correlation. Injuries to the plantar plate complex, collateral ligaments, and extensor mechanism are discussed using clinical case examples. Online supplemental material is available for this article. ©RSNA, 2020.
Collapse
Affiliation(s)
- James T P D Hallinan
- From the Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, 119074 Singapore (J.T.P.D.H.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (J.T.P.D.H.); Department of Radiology, VA San Diego Healthcare System, San Diego, Calif (S.M.S., G.M.B., C.B.C.); Department of Radiology, San Diego Medical Center, University of California, San Diego, Calif (B.K.H., C.B.C.); Department of Radiology, Hospital do Coração (HCor) and Teleimagem, São Paulo, Brazil (H.G.B.); and Universidade Federal de São Paulo, São Paulo, Brazil (UNIFESP) and Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil (D.A.L.G.)
| | - Sheronda M Statum
- From the Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, 119074 Singapore (J.T.P.D.H.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (J.T.P.D.H.); Department of Radiology, VA San Diego Healthcare System, San Diego, Calif (S.M.S., G.M.B., C.B.C.); Department of Radiology, San Diego Medical Center, University of California, San Diego, Calif (B.K.H., C.B.C.); Department of Radiology, Hospital do Coração (HCor) and Teleimagem, São Paulo, Brazil (H.G.B.); and Universidade Federal de São Paulo, São Paulo, Brazil (UNIFESP) and Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil (D.A.L.G.)
| | - Brady K Huang
- From the Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, 119074 Singapore (J.T.P.D.H.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (J.T.P.D.H.); Department of Radiology, VA San Diego Healthcare System, San Diego, Calif (S.M.S., G.M.B., C.B.C.); Department of Radiology, San Diego Medical Center, University of California, San Diego, Calif (B.K.H., C.B.C.); Department of Radiology, Hospital do Coração (HCor) and Teleimagem, São Paulo, Brazil (H.G.B.); and Universidade Federal de São Paulo, São Paulo, Brazil (UNIFESP) and Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil (D.A.L.G.)
| | - Higor Grando Bezerra
- From the Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, 119074 Singapore (J.T.P.D.H.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (J.T.P.D.H.); Department of Radiology, VA San Diego Healthcare System, San Diego, Calif (S.M.S., G.M.B., C.B.C.); Department of Radiology, San Diego Medical Center, University of California, San Diego, Calif (B.K.H., C.B.C.); Department of Radiology, Hospital do Coração (HCor) and Teleimagem, São Paulo, Brazil (H.G.B.); and Universidade Federal de São Paulo, São Paulo, Brazil (UNIFESP) and Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil (D.A.L.G.)
| | - Diego A L Garcia
- From the Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, 119074 Singapore (J.T.P.D.H.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (J.T.P.D.H.); Department of Radiology, VA San Diego Healthcare System, San Diego, Calif (S.M.S., G.M.B., C.B.C.); Department of Radiology, San Diego Medical Center, University of California, San Diego, Calif (B.K.H., C.B.C.); Department of Radiology, Hospital do Coração (HCor) and Teleimagem, São Paulo, Brazil (H.G.B.); and Universidade Federal de São Paulo, São Paulo, Brazil (UNIFESP) and Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil (D.A.L.G.)
| | - Graeme M Bydder
- From the Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, 119074 Singapore (J.T.P.D.H.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (J.T.P.D.H.); Department of Radiology, VA San Diego Healthcare System, San Diego, Calif (S.M.S., G.M.B., C.B.C.); Department of Radiology, San Diego Medical Center, University of California, San Diego, Calif (B.K.H., C.B.C.); Department of Radiology, Hospital do Coração (HCor) and Teleimagem, São Paulo, Brazil (H.G.B.); and Universidade Federal de São Paulo, São Paulo, Brazil (UNIFESP) and Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil (D.A.L.G.)
| | - Christine B Chung
- From the Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, 119074 Singapore (J.T.P.D.H.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (J.T.P.D.H.); Department of Radiology, VA San Diego Healthcare System, San Diego, Calif (S.M.S., G.M.B., C.B.C.); Department of Radiology, San Diego Medical Center, University of California, San Diego, Calif (B.K.H., C.B.C.); Department of Radiology, Hospital do Coração (HCor) and Teleimagem, São Paulo, Brazil (H.G.B.); and Universidade Federal de São Paulo, São Paulo, Brazil (UNIFESP) and Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil (D.A.L.G.)
| |
Collapse
|
9
|
Gorbachova T, Chang EY, Ha AS, Amini B, Dorfman SR, Fox MG, Khurana B, Klitzke A, Lee KS, Mooar PA, Shah KH, Shah NA, Singer AD, Smith SE, Taljanovic MS, Thomas JM, Kransdorf MJ. ACR Appropriateness Criteria® Acute Trauma to the Foot. J Am Coll Radiol 2020; 17:S2-S11. [PMID: 32370964 DOI: 10.1016/j.jacr.2020.01.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 01/22/2020] [Indexed: 12/26/2022]
Abstract
Acute injuries to the foot are frequently encountered in the emergency room and in general practice settings. This publication defines best practices for imaging evaluations for several variants of patients presenting with acute foot trauma. The variants include scenarios when the Ottawa rules can be evaluated, when there are exclusionary criteria, and when suspected pathology is in anatomic areas not addressed by the Ottawa rules. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Collapse
Affiliation(s)
| | - Eric Y Chang
- Panel Chair, VA San Diego Healthcare System, San Diego, California
| | - Alice S Ha
- Panel Vice-Chair, University of Washington, Seattle, Washington
| | - Behrang Amini
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | | | - Alan Klitzke
- Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Kenneth S Lee
- University of Wisconsin Hospital & Clinics, Madison, Wisconsin
| | - Pekka A Mooar
- Temple University Hospital, Philadelphia, Pennsylvania; American Academy of Orthopaedic Surgeons
| | - Kaushal H Shah
- Icahn School of Medicine at Mt Sinai, New York, New York; American College of Emergency Physicians
| | - Nehal A Shah
- Brigham & Women's Hospital, Boston, Massachusetts
| | - Adam D Singer
- Emory University School of Medicine, Atlanta, Georgia
| | - Stacy E Smith
- Brigham & Women's Hospital & Harvard Medical School, Boston, Massachusetts
| | | | - Jonelle M Thomas
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | | |
Collapse
|
10
|
Meyer NB, Jacobson JA, Kalia V, Kim SM. Musculoskeletal ultrasound: athletic injuries of the lower extremity. Ultrasonography 2018; 37:175-189. [PMID: 29794963 PMCID: PMC6044222 DOI: 10.14366/usg.18013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 04/14/2018] [Indexed: 12/23/2022] Open
Abstract
Athletic injuries of the lower extremities are commonly encountered in clinical practice. While some pathology can be diagnosed on physical exam, others are a clinical dilemma with nonspecific symptomatology. In these situations, ultrasound imaging can be utilized as an exceptional diagnostic tool, offering unique advantages over other imaging modalities. This article will review the imaging characteristics of commonly encountered athletic injuries of the lower extremity.
Collapse
Affiliation(s)
- Nathaniel B Meyer
- Department of Radiology, University of Michigan Hospital, Ann Arbor, MI, USA
| | - Jon A Jacobson
- Department of Radiology, University of Michigan Hospital, Ann Arbor, MI, USA
| | - Vivek Kalia
- Department of Radiology, University of Michigan Hospital, Ann Arbor, MI, USA
| | - Sung Moon Kim
- Department of Radiology, University of Michigan Hospital, Ann Arbor, MI, USA
| |
Collapse
|
11
|
LiMarzi GM, Scherer KF, Richardson ML, Warden DR, Wasyliw CW, Porrino JA, Pettis CR, Lewis G, Mason CC, Bancroft LW. CT and MR Imaging of the Postoperative Ankle and Foot. Radiographics 2017; 36:1828-1848. [PMID: 27726748 DOI: 10.1148/rg.2016160016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
A variety of surgical procedures exist for repair of both traumatic and degenerative osseous and soft-tissue pathologic conditions involving the foot and ankle. It is necessary for the radiologist to be familiar with these surgical procedures, so as to assess structural integrity, evaluate for complicating features, and avoid diagnostic pitfalls. Adequate interpretation of postoperative changes often requires access to surgical documentation to evaluate not only the surgery itself but the expected timeline for resolution of normal postoperative changes versus progressive disease. Appropriate use of surgical language in radiology reports is another important skill set to hone and is instrumental in providing a high-quality report to the referring surgeons. The pathophysiology of a myriad of surgical complaints, beginning from the Achilles tendon and concluding at the plantar plate, are presented, as are their common appearances at computed tomography and magnetic resonance imaging. Commonly encountered entities include Achilles tendon tear, spastic equinus, nonspastic equinus, talar dome osteochondral defect, tarsal tunnel syndrome, plantar fasciitis, pes planovalgus, pes cavovarus, peroneal tendinosis, lateral ligament complex pathology, Morton neuroma, plantar plate tear, and metatarsophalangeal joint instability. Computer-generated three-dimensional models are included with many of the procedures to provide a more global view of the surgical anatomy. Correlation with intraoperative photographs is made when available. When appropriate, discussion of postoperative complications, including entities such as infection and failure of graft integration, is presented, although a comprehensive review of postoperative complications is beyond the scope of this article. Notably absent from the current review are some common foot and ankle procedures including hallux valgus and hammertoe corrections, as these are more often evaluated radiographically than with cross-sectional imaging. ©RSNA, 2016.
Collapse
Affiliation(s)
- Gary M LiMarzi
- From the Department of Radiology, Florida Hospital, 601 E Rollins St, Orlando, FL 32803 (G.M.L., K.F.S., D.R.W., C.W.W., C.R.P., L.W.B.); Department of Radiology, University of Washington, Seattle, Wash (M.L.R., J.A.P.); Department of Podiatry, University of Central Florida, Orlando, Fla (G.L.); and Department of Podiatry, Florida Foot and Ankle Specialist, Lake Mary, Fla (C.C.M.)
| | - Kurt F Scherer
- From the Department of Radiology, Florida Hospital, 601 E Rollins St, Orlando, FL 32803 (G.M.L., K.F.S., D.R.W., C.W.W., C.R.P., L.W.B.); Department of Radiology, University of Washington, Seattle, Wash (M.L.R., J.A.P.); Department of Podiatry, University of Central Florida, Orlando, Fla (G.L.); and Department of Podiatry, Florida Foot and Ankle Specialist, Lake Mary, Fla (C.C.M.)
| | - Michael L Richardson
- From the Department of Radiology, Florida Hospital, 601 E Rollins St, Orlando, FL 32803 (G.M.L., K.F.S., D.R.W., C.W.W., C.R.P., L.W.B.); Department of Radiology, University of Washington, Seattle, Wash (M.L.R., J.A.P.); Department of Podiatry, University of Central Florida, Orlando, Fla (G.L.); and Department of Podiatry, Florida Foot and Ankle Specialist, Lake Mary, Fla (C.C.M.)
| | - David R Warden
- From the Department of Radiology, Florida Hospital, 601 E Rollins St, Orlando, FL 32803 (G.M.L., K.F.S., D.R.W., C.W.W., C.R.P., L.W.B.); Department of Radiology, University of Washington, Seattle, Wash (M.L.R., J.A.P.); Department of Podiatry, University of Central Florida, Orlando, Fla (G.L.); and Department of Podiatry, Florida Foot and Ankle Specialist, Lake Mary, Fla (C.C.M.)
| | - Christopher W Wasyliw
- From the Department of Radiology, Florida Hospital, 601 E Rollins St, Orlando, FL 32803 (G.M.L., K.F.S., D.R.W., C.W.W., C.R.P., L.W.B.); Department of Radiology, University of Washington, Seattle, Wash (M.L.R., J.A.P.); Department of Podiatry, University of Central Florida, Orlando, Fla (G.L.); and Department of Podiatry, Florida Foot and Ankle Specialist, Lake Mary, Fla (C.C.M.)
| | - Jack A Porrino
- From the Department of Radiology, Florida Hospital, 601 E Rollins St, Orlando, FL 32803 (G.M.L., K.F.S., D.R.W., C.W.W., C.R.P., L.W.B.); Department of Radiology, University of Washington, Seattle, Wash (M.L.R., J.A.P.); Department of Podiatry, University of Central Florida, Orlando, Fla (G.L.); and Department of Podiatry, Florida Foot and Ankle Specialist, Lake Mary, Fla (C.C.M.)
| | - Christopher R Pettis
- From the Department of Radiology, Florida Hospital, 601 E Rollins St, Orlando, FL 32803 (G.M.L., K.F.S., D.R.W., C.W.W., C.R.P., L.W.B.); Department of Radiology, University of Washington, Seattle, Wash (M.L.R., J.A.P.); Department of Podiatry, University of Central Florida, Orlando, Fla (G.L.); and Department of Podiatry, Florida Foot and Ankle Specialist, Lake Mary, Fla (C.C.M.)
| | - Gideon Lewis
- From the Department of Radiology, Florida Hospital, 601 E Rollins St, Orlando, FL 32803 (G.M.L., K.F.S., D.R.W., C.W.W., C.R.P., L.W.B.); Department of Radiology, University of Washington, Seattle, Wash (M.L.R., J.A.P.); Department of Podiatry, University of Central Florida, Orlando, Fla (G.L.); and Department of Podiatry, Florida Foot and Ankle Specialist, Lake Mary, Fla (C.C.M.)
| | - Christopher C Mason
- From the Department of Radiology, Florida Hospital, 601 E Rollins St, Orlando, FL 32803 (G.M.L., K.F.S., D.R.W., C.W.W., C.R.P., L.W.B.); Department of Radiology, University of Washington, Seattle, Wash (M.L.R., J.A.P.); Department of Podiatry, University of Central Florida, Orlando, Fla (G.L.); and Department of Podiatry, Florida Foot and Ankle Specialist, Lake Mary, Fla (C.C.M.)
| | - Laura W Bancroft
- From the Department of Radiology, Florida Hospital, 601 E Rollins St, Orlando, FL 32803 (G.M.L., K.F.S., D.R.W., C.W.W., C.R.P., L.W.B.); Department of Radiology, University of Washington, Seattle, Wash (M.L.R., J.A.P.); Department of Podiatry, University of Central Florida, Orlando, Fla (G.L.); and Department of Podiatry, Florida Foot and Ankle Specialist, Lake Mary, Fla (C.C.M.)
| |
Collapse
|
12
|
Sirlyn Q. Ultrasound evaluation of adult-acquired flatfoot deformity: Emphasis on the involvement of spring ligament. Australas J Ultrasound Med 2017; 20:83-90. [PMID: 34760477 PMCID: PMC8409874 DOI: 10.1002/ajum.12050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Adult-acquired flatfoot deformity (AAFD), a condition commonly caused by tibialis posterior tendon (TPT) dysfunction, has recently been recognised to encompass a spectrum of other deformities, including the disruption of the spring ligament complex. This case series reviews eight examples of chronic AAFD, outlines the sonographic assessment of the TPT and spring ligament and depicts various abnormalities of the TPT and spring ligament that are relevant to AAFD. The importance to always include the spring ligament during the assessment of AAFD will be addressed, as misdiagnosis of the involvement of the spring ligament could lead to inappropriate operative management.
Collapse
|
13
|
|
14
|
Bancroft LW, Kransdorf MJ, Adler R, Appel M, Beaman FD, Bernard SA, Bruno MA, Dempsey ME, Fries IB, Khoury V, Khurana B, Mosher TJ, Roberts CC, Tuite MJ, Ward RJ, Zoga AC, Weissman BN. ACR Appropriateness Criteria Acute Trauma to the Foot. J Am Coll Radiol 2015; 12:575-81. [DOI: 10.1016/j.jacr.2015.02.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 02/18/2015] [Indexed: 12/23/2022]
|
15
|
Abstract
Sports injuries of the foot can occur as sequelae of acute trauma or chronic overuse. Besides clinical examination, imaging plays a major role in the detection of structural abnormalities and the differential diagnostics. This article reviews the most important sports-related soft tissue and bone pathologies of the forefoot and midfoot together with their typical findings on radiography, ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI).
Collapse
|
16
|
Is Dedicated Extremity 1.5-T MRI Equivalent to Standard Large-Bore 1.5-T MRI for Foot and Knee Examinations? AJR Am J Roentgenol 2014; 203:1293-302. [DOI: 10.2214/ajr.14.12738] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
17
|
Hayter CL, Linklater JM, Man KH. State of the Art MR Imaging Techniques for the Foot and Ankle. CURRENT RADIOLOGY REPORTS 2014. [DOI: 10.1007/s40134-014-0042-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|
18
|
|