Variant 1: Chronic foot pain of unknown etiology. First study.
Variant 2: Adult or child. Painful rigid flat foot. Radiographs unremarkable or equivocal and clinical concern for tarsal coalition.
Variant 3: Radiographs unremarkable or equivocal and clinical concern for complex regional pain syndrome type I.
Variant 4: Adult or child. Radiographs noncontributory. Pain and tenderness over head of second metatarsal and clinical concern for Freiberg infraction.
Variant 5: Pain and tenderness over tarsus, unresponsive to conservative therapy. Radiographs showed accessory ossicle.
Variant 6: Radiographs unremarkable, equivocal, or further diagnostic information needed. Clinical concern for inflammatory arthopathy, including rheumatoid arthritis.
Variant 7: Localized pain at the plantar aspect of the heel. Radiographs unremarkable or equivocal. Clinical concern for plantar fasciitis.
Variant 8: Burning pain and paresthesias along the plantar surface of the foot and toes. Radiographs unremarkable or equivocal. Clinical concern for tarsal tunnel syndrome.
Variant 9: Pain in the 3-4 web space with radiation to the toes. Radiographs unremarkable or equivocal. Clinical concern for Morton neuroma.
Variant 10: Athlete with pain and tenderness over tarsal navicular. Radiographs unremarkable or equivocal. Clinical concern for stress injury or occult fracture.
Variant 11: Radiographs unremarkable or equivocal and with persistent clinical concern for tendinopathy.
Appendix Key

A more complete discussion of the items presented below can be found by accessing the supporting documents at the designated hyperlinks.

Appropriateness Category:The panel’s recommendation for a procedure based on the assessment of the risks and benefits of performing the procedure for the specified clinical scenario.

SOE: Strength of Evidence. The assessment of the amount and quality of evidence found in the peer reviewed medical literature for an appropriateness recommendation.

  • References: The citation number and PMID for the reference(s) associated with the recommendation.
  • Study Quality: The assessment of the quality of an individual reference based on the number of study quality elements described in the reference.

RRL: Relative Radiation Level. A population based assessment of the amount of radiation a typical patient may be exposed to during the specified procedure.

Rating: The final rating (1-9 scale) for the procedure as determined by the panel during rating rounds.

Median: The median rating (1-9 scale) for the procedure as determined by the panel during rating rounds.

Final tabulations: A histogram showing the number of panel members who rated the procedure as noted in the column heading (ie, 1, 2, 3, etc.).

Additional supporting documents about the AC methodology and processes can be found at www.acr.org/ac.