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Appropriateness Criteria

Reference Study Type Patients/Events Study Objective(Purpose of Study) Study Results Study Quality
1. Joong MA, El-Khoury GY. Radiologic evaluation of chronic foot pain. [Review] [32 refs]. Am Fam Physician. 76(7):975-83, 2007 Oct 01. Review/Other-Dx 2 case reports To discuss causes of chronic foot pain, their clinical presentations and their radiologic findings and explain the American College of Radiology (ACR) Appropriateness Criteria scale for chronic foot pain imaging. No results stated in abstract 4
2. Hawke F, Burns J. Understanding the nature and mechanism of foot pain. Journal of Foot & Ankle Research. 2:1, 2009 Jan 14.J. foot ankle res.. 2:1, 2009 Jan 14. Review/Other-Dx N/A To comprehensively review the literature on foot pain, with specific reference to its definition, prevalence, aetiology and predictors, classification, measurement and impact. No results stated in abstract 4
3. Hawke F, Burns J, Radford JA, du Toit V. Custom-made foot orthoses for the treatment of foot pain. [Review] [80 refs]. Cochrane Database of Systematic Reviews. (3)CD006801, 2008 Jul 16.Cochrane Database Syst Rev. (3)CD006801, 2008 Jul 16. Review/Other-Dx 11 trials, 1332 participants To evaluate the effectiveness of custom foot orthoses for different types of foot pain. Eleven trials involving 1332 participants were included: five trials evaluated custom-made foot orthoses for plantar fasciitis (691 participants); three for foot pain in rheumatoid arthritis (231 participants); and one each for foot pain in pes cavus (154 participants), hallux valgus (209 participants) and juvenile idiopathic arthritis (JIA) (47 participants). Comparisons to custom-made foot orthoses included sham orthoses; no intervention; standardised interventions given to all participants; non-custom (prefabricated) foot orthoses; combined manipulation, mobilisation or stretching; night splints; and surgery. Follow up ranged from one week to three years. Custom-made foot orthoses were effective for painful pes cavus (NNTB:5), rearfoot pain in rheumatoid arthritis (NNTB:4), foot pain in JIA (NNTB:3) and painful hallux valgus (NNTB:6); however, surgery was even more effective for hallux valgus and non-custom foot orthoses appeared just as effective for JIA but the analysis may have lacked sufficient power to detect a difference in effect. It is unclear if custom-made foot orthoses were effective for plantar fasciitis or metatarsophalangeal joint pain in rheumatoid arthritis. Custom-made foot orthoses were a safe intervention in all studies. 4
4. Menz HB.. Chronic foot pain in older people. [Review]. Maturitas. 91:110-4, 2016 Sep.Maturitas. 91:110-4, 2016 Sep. Review/Other-Dx N/A To provide an overview of (i) the prevalence and risk factors for foot pain, (ii) the impact of foot pain on mobility and quality of life, and (iii) the conservative management of foot pain. No results stated in abstract 4
5. Thomas JL, Christensen JC, Kravitz SR, et al. The diagnosis and treatment of heel pain: a clinical practice guideline-revision 2010. [Review] [462 refs]. J Foot Ankle Surg. 49(3 Suppl):S1-19, 2010 May-Jun. Review/Other-Dx N/A A revision guideline of the original 2001 document developed by the American College of Foot and Ankle surgeons (ACFAS) heel pain committee. No results stated in abstract 4
6. Walker EA, Beaman FD, Wessell DE, et al. ACR Appropriateness Criteria® Suspected Osteomyelitis of the Foot in Patients With Diabetes Mellitus. J Am Coll Radiol 2019;16:S440-S50. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for suspected osteomyelitis of the foot in patients wit diabetes mellitus. No results stated in abstract. 4
7. Chang EY, Tadros AS, Amini B, et al. ACR Appropriateness Criteria® Chronic Ankle Pain. J Am Coll Radiol 2018;15:S26-S38. Review/Other-Dx NA Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for Chronic Ankle Pain. No results stated in abstract. 4
8. Expert Panel on Musculoskeletal Imaging:, Beaman FD, von Herrmann PF, et al. ACR Appropriateness Criteria R Suspected Osteomyelitis, Septic Arthritis, or Soft Tissue Infection (Excluding Spine and Diabetic Foot). [Review]. J. Am. Coll. Radiol.. 14(5S):S326-S337, 2017 May. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for suspected osteomyelitis, septic arthritis, or soft tissue infection (excluding spine and diabetic foot). No results stated in abstract. 4
9. Jacobson JA, Roberts CC, Bencardino JT, et al. ACR Appropriateness Criteria® Chronic Extremity Joint Pain-Suspected Inflammatory Arthritis. J Am Coll Radiol 2017;14:S81-S89. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for chronic extremity joint pain. No results stated in abstract. 4
10. American College of Radiology. ACR Appropriateness Criteria®: Acute Trauma to the Foot. Available at: https://acsearch.acr.org/docs/70546/Narrative/. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for Acute Trauma to the Foot. No results stated in abstract. 4
11. Harris RI, Beath T. Etiology of peroneal spastic flat foot. 1948;30B(4):624-634. Review/Other-Dx N/A To demonstrate that most cases of peroneal spastic flat foot are due to tarsal anomalies. Lipping of the upper margin of the talonavicular joint strongly suggests the existence of one or other of the congenital anomalies. Both anomalies are visualized only by special radiological projections. 4
12. Taylor JA, Sartoris DJ, Huang GS, Resnick DL. Painful conditions affecting the first metatarsal sesamoid bones. Radiographics. 13(4):817-30, 1993 Jul.Radiographics. 13(4):817-30, 1993 Jul. Review/Other-Dx N/A To review painful conditions affecting the first metatarsal sesamoid bones. No results stated in abstract. 4
13. Wright AA, Hegedus EJ, Lenchik L, Kuhn KJ, Santiago L, Smoliga JM. Diagnostic Accuracy of Various Imaging Modalities for Suspected Lower Extremity Stress Fractures: A Systematic Review With Evidence-Based Recommendations for Clinical Practice. Am J Sports Med 2016;44:255-63. Review/Other-Dx 21 studies To determine the diagnostic accuracy statistics of imaging modalities used to diagnose lower extremity stress fractures and to synthesize evidence-based recommendations for clinical practice. Reported sensitivity and specificity (95% CI) were as follows: For conventional radiography, sensitivity ranged from 12% (0%-29%) to 56% (39%-72%) and specificity ranged from 88% (55%-100%) to 96% (87%-100%). For nuclear scintigraphy (NS), sensitivity ranged from 50% (23%-77%) to 97% (90%-100%) and specificity from 33% (12%-53%) to 98% (93%-100%). For magnetic resonance imaging (MRI), sensitivity ranged from 68% (45%-90%) to 99% (95%-100%) and specificity from 4% (0%-11%) to 97% (88%-100%). For computed tomography, sensitivity ranged from 32% (8%-57%) to 38% (16%-59%) and specificity from 88% (55%-100%) to 98% (91%-100%). For ultrasound, sensitivity ranged from 43% (26%-61%) to 99% (95%-100%) and specificity from 13% (0%-45%) to 79% (61%-96%). 4
14. Jain S, Mannan K. The diagnosis and management of Morton's neuroma: a literature review. [Review]. Foot ankle spec.. 6(4):307-17, 2013 Aug. Review/Other-Dx N/A To review the published literature to evaluate the outcomes of the available diagnostic modalities and treatment options for Morton's Neuroma and present an algorithm for clinical practice. No results stated in abstract 4
15. Osborne HR, Breidahl WH, Allison GT. Critical differences in lateral X-rays with and without a diagnosis of plantar fasciitis. J Sci Med Sport. 9(3):231-7, 2006 Jun. Experimental-Dx 21 cases and 78 controls To examine the sensitivity and specificity of key features observed on the lateral X-ray for plantar fasciitis. In this study 106 (27 plantar fasciitis (PF) and 79 controls) plain non-weight bearing lateral X-rays were examined by a blind examinerto document the key features of the lateral X-ray between images of individuals with and without plantar fasciitis. As expected calcaneal spurs were observed in both groups (85% PF and 46% controls). However, plantar fascia thickness and fat pad abnormalities resulted in the best group differentiation (p < 0.0001) with sensitivity of 85% and specificity of 95% for plantar fasciitis. 2
16. Holder LE, Cole LA, Myerson MS. Reflex sympathetic dystrophy in the foot: clinical and scintigraphic criteria. Radiology. 1992;184(2):531-535. Observational-Dx 151 patients To establish strict clinical criteria for RSD of the foot and to characterize any associated scintigraphic pattern, the authors performed three-phase radionuclide bone scanning in 51 patients prospectively referred because RSD was a diagnostic consideration. To establish sensitivity and specificity data, the cases of an additional 100 consecutive patients referred for a variety of foot problems were retrospectively reviewed. Overall, sensitivity was 100%; specificity, 80%; PPV, 54%; and NPV, 100%. False-positive images were obtained in patients with infection, diabetes, and chronic pain. Specificity was 66% in the subgroup of patients who underwent sympathetic block, with a PPV of 88%. There were no differences in scan pattern related to duration of symptoms prior to imaging. 3
17. Cappello ZJ, Kasdan ML, Louis DS. Meta-analysis of imaging techniques for the diagnosis of complex regional pain syndrome type I. [Review]. J Hand Surg [Am]. 37(2):288-96, 2012 Feb. Meta-analysis 24 studies, 1916 participants To compare the effectiveness of imaging techniques in aiding and confirming the diagnosis of complex regional pain syndrome (CRPS) type I. To determine the effectiveness of each imaging technique, we determined the average specificity, sensitivity, negative predictive value, and positive predictive value and then statistically compared them using the analysis of variance statistical test, which indicated that compared with magnetic resonance imaging and plain film radiography, triple-phase bone scan had a significantly better sensitivity and negative predictive values. However, there appeared to be no statistical significance between imaging techniques when we evaluated specificity and positive predictive value using the analysis of variance test. Inadequate
18. Borchers AT, Gershwin ME. Complex regional pain syndrome: a comprehensive and critical review. [Review]. Autoimmun Rev. 13(3):242-65, 2014 Mar. Review/Other-Dx N/A To provide a detailed critical overview of the history of complex regional pain syndrome (CRPS), the epidemiology, the clinical features, the pathophysiological studies, the proposed criteria, the therapy and, in particular, an emphasis that future research should apply more rigorous standards to allow a better understanding of CRPS, i.e. what it is, if it is, and when it is. No results stated in abstract. 4
19. Schurmann M, Zaspel J, Lohr P, et al. Imaging in early posttraumatic complex regional pain syndrome: a comparison of diagnostic methods. Clin J Pain. 23(5):449-57, 2007 Jun. Observational-Dx 175 To compare the diagnostic power of the aforementioned methods (x-ray, thermography, 3-phase bone scans, and MRI) in identifying patients with clinically diagnosed CRPS I in a group of patients with distal radial fracture. We evaluated the changes on TPBS according to clinical stages based on time course. In the early acute stage within 6 weeks, minimal uptake on all TPBS phases was observed in the 90% of the patients in the CRPS-I group and in 75% of the patients in the non-CRPS group. In the acute stage of CRPS in the range of 2 to 20 weeks, moderately increased uptake was seen for 78%, 83%, and 83% of the patients in the CRPS group for the 3 phases, respectively. However, only 16% of the patients in the non-CRPS group had moderately increased uptake as seen on all TPBS phases. In the late stage of more than 21 weeks, there was no distinct difference in uptake between the 2 groups. A sequential change during the time course for the CPRS-I group was statistically significant (P < 0.05). 2
20. Schweitzer ME, Mandel S, Schwartzman RJ, Knobler RL, Tahmoush AJ. Reflex sympathetic dystrophy revisited: MR imaging findings before and after infusion of contrast material. Radiology. 1995;195(1):211-214. Observational-Dx 51 patients To determine the appearance of RSD at MRI. RSD was confirmed in 45 patients. In 35 patients with stage 1 RSD, skin thickening (31 patients), tissue enhancement with contrast material (31 patients), and soft-tissue edema (6 patients) were demonstrated. In 5 patients with stage 2 RSD, skin thickening (2 patients), skin thinning (2 patients), and infrequent contrast material enhancement (1 patient) were demonstrated. There was no edema in this group of patients. In 5 patients with stage 3 RSD, inconsistent skin changes were also demonstrated; however, muscle atrophy (4 patients) was demonstrated in this stage only. 3
21. Garwood ER, Duarte A, Bencardino JT. MR Imaging of Entrapment Neuropathies of the Lower Extremity. [Review]. Radiol Clin North Am. 56(6):997-1012, 2018 Nov. Review/Other-Dx N/A To review MR Imaging of entrapment neuropathies of the lower extremity. No results stated in abstract. 4
22. Nazarian LN, Schweitzer ME, Mandel S, et al. Increased soft-tissue blood flow in patients with reflex sympathetic dystrophy of the lower extremity revealed by power Doppler sonography. AJR. 1998;171(5):1245-1250. Observational-Dx 30 patients and 26 controls To evaluate the ability of power Doppler US to show increased soft-tissue blood flow in patients with RSD of the lower extremity. More power Doppler flow was seen in the patients with RSD than in the control subjects (P<.005). In addition, side-to-side asymmetry of flow was seen in patients, but this trend was not statistically significant (P<.20). ROC analysis showed that combined flow and asymmetry were more related to RSD than either parameter alone (area under the ROC curve: for flow, 0.748; for asymmetry, 0.566; for both, 0.799). The authors found that when the sum of power Doppler flow in both feet was =5, and asymmetry of flow was =1, the sensitivity of power Doppler US for RSD was 73% and the specificity was 92%. 4
23. De Maeseneer M, Madani H, Lenchik L, et al. Normal Anatomy and Compression Areas of Nerves of the Foot and Ankle: US and MR Imaging with Anatomic Correlation. [Review]. Radiographics. 35(5):1469-82, 2015 Sep-Oct. Observational-Dx N/A To review the normal anatomy and common variants of the nerves of the foot and ankle, with use of dissected specimens and correlative US andMR imaging findings. No results stated in abstract. 4
24. Chisin R, Peyser A, Milgrom C. Bone scintigraphy in the assessment of the hallucal sesamoids. Foot & Ankle International. 16(5):291-4, 1995 May.Foot Ankle Int. 16(5):291-4, 1995 May. Observational-Dx 314 patients To report the results of an epidemiological study of the prevalence of increased scintigraphic activity over the hallucal sesamoids in a group of infantry recruits without foot or ankle symptoms and in a group of sedentary adults without foot or ankle symptoms Using a 0 to 2 bone scintigraphic rating system, 25 of 86 (29%) asymptomatic infantry recruits and 7 of 27 (26%) asymptomatic sedentary adults were found to have grade 1 or grade 2 activity. 2
25. Arican P, Okudan B, Sefizade R, Naldoken S. Diagnostic Value of Bone SPECT/CT in Patients with Suspected Osteomyelitis. Mol Imaging Radionucl Ther. 28(3):89-95, 2019 09 06. Observational-Dx 85 patients To evaluate the contribution of single photon emission computed tomography/computed tomography (SPECT/CT) to three phase bone scintigraphy/SPECT for the assessment of osteomyelitis (OM) and patient’s management. SPECT/CT changed the diagnosis and treatment planning in 14/85 (16.5%) patients. SPECT/CT was significantly superior to planar scan/SPECT imaging for determining OM (kappa value was 0.626 for planar scan/SPECT, 0.929 for SPECT/CT). SPECT/CT was statistically more successful in detection of chronic OM, and useful in differentiating chronic OM from acute OM (kappa value was 0.541 for planar scan/SPECT, 0.944 for SPECT/CT). 3
26. Georgoulias P, Georgiadis I, Dimakopoulos N, Mortzos G. Scintigraphy of stress fractures of the sesamoid bones. Clinical Nuclear Medicine. 26(11):944-5, 2001 Nov.Clin Nucl Med. 26(11):944-5, 2001 Nov. Review/Other-Dx N/A No abstract available. No abstract available. 4
27. Mandell GA, Harcke HT. Scintigraphic manifestations of infraction of the second metatarsal (Freiberg's disease). Journal of Nuclear Medicine. 28(2):249-51, 1987 Feb.J Nucl Med. 28(2):249-51, 1987 Feb. Review/Other-Dx 2 case reports To present two patients with Friberg's infraction of the second metatarsal. No results stated in abstract. 4
28. Biedert R, Hintermann B. Stress fractures of the medial great toe sesamoids in athletes. Foot & Ankle International. 24(2):137-41, 2003 Feb.Foot Ankle Int. 24(2):137-41, 2003 Feb. Review/Other-Dx 6 feet, 5 patients To determine whether specific symptoms and findings are present in patients with symptomatic stress fractures of the sesamoids of the great toe and, if so, whether partial sesamoidectomy is sufficient for successful treatment. Five consecutive athletes (five females; mean age 16.8 years [range, 13 to 22 years]) with six feet that were treated for symptomatic stress fractures of the sesamoids of the great toe were included in this study. Four athletes (five feet) performed rhythmic sports gymnastics; the fifth athlete was a longjumper. Some swelling to the forefoot and activity related pain that increased in forced dorsiflexion, but disappeared at rest was found in all patients. While plainX-rays evidenced fragmentation of the medial sesamoid, MRI (n=2) and frontal plane CT scan (n=3) did not always confirm the diagnosis, but bone scan (n=3) and axial as well as sagittal CT scan were useful to detect the pathology. After failure of conservative treatment measures, surgical excision of the proximal fragment was successful in all patients, and there were no complications. All patients were pain free and regained full sports activity within six months (range, 2.5 to six months). At final follow-up which averaged 50.6 months (range, 20 to 110 months), the overall clinical results were graded as good/excellent in all patients, and there was only one patient with of restriction sports activities. The obtained AOFAS-Hallux-Score was 95.3 (75 to 100) points. Apparently, stress fractures occurmore often at the medial sesamoid, and females are mainly involved. When a stress fracture is suspected, bone scan and CT scan are suggested as more reliable in confirming the diagnosis than other imaging methods. When conservative treatment has failed, surgical excision of the proximal fragment is recommended. 4
29. Sanders TG, Rathur SK. Imaging of painful conditions of the hallucal sesamoid complex and plantar capsular structures of the first metatarsophalangeal joint. [Review] [37 refs]. Radiol Clin North Am. 46(6):1079-92, vii, 2008 Nov. Review/Other-Dx N/A To review the normal anatomy of the hallucal sesamoidal complex and the plantar capsular structures of the first metatarsophalangeal joint. No results stated in abstract 4
30. Chun KA, Oh HK, Wang KH, Suh JS. Freiberg's disease: quantitative assessment of osteonecrosis on three-dimensional CT. J Am Podiatr Med Assoc. 101(4):335-40, 2011 Jul-Aug. Observational-Dx 10 patients To determine the reliability and prognostic ability of a new method for measurement of the extent of osteonecrosis in Freiberg’s disease on three-dimensional computed tomography. One patient presented with stage I disease (Smillie staging), one with stage II, two with stage III, five with stage IV, and two with stage V, respectively. The necrotic angle ratio of the metatarsal head was 14% in stage I, 21% in stage II, 34% in stage III, 43% in stage IV, and 53% in stage V. The interobserver reliability for computed tomography measurement was high (Cronbach a=0.96). We found the increase of the necrotic extent in proportion to the Smillie stage. The Smillie staging using radiographs and the necrotic angle ratio on computed tomography were significantly correlated. (P<0.05) 3
31. Yao L, Do HM, Cracchiolo A, Farahani K. Plantar plate of the foot: findings on conventional arthrography and MR imaging. AJR Am J Roentgenol. 163(3):641-4, 1994 Sep. Review/Other-Dx N/A To review findings on conventional arthrography and MR imaging of plantar plate of the foot. No results stated in abstract. 4
32. Ashman CJ, Klecker RJ, Yu JS. Forefoot pain involving the metatarsal region: differential diagnosis with MR imaging. [Review] [58 refs]. Radiographics. 21(6):1425-40, 2001 Nov-Dec. Review/Other-Dx N/A To review the MR imaging appearances of disorders that are capable of producing pain in the forefoot proximal to the phalanges. No results stated in abstract. 4
33. Karasick D, Schweitzer ME. Disorders of the hallux sesamoid complex: MR features. [Review] [30 refs]. Skeletal Radiology. 27(8):411-8, 1998 Aug.Skeletal Radiol. 27(8):411-8, 1998 Aug. Review/Other-Dx N/A To review MR features of disorders of the hallux sesamoid complex. No results stated in abstract. 4
34. Zanetti M, Strehle JK, Kundert HP, Zollinger H, Hodler J. Morton neuroma: effect of MR imaging findings on diagnostic thinking and therapeutic decisions. Radiology. 213(2):583-8, 1999 Nov.Radiology. 213(2):583-8, 1999 Nov. Observational-Dx 49 patients To determine the effect of magnetic resonance (MR) imaging results on diagnostic thinking and therapeutic decisions by orthopedic surgeons in cases of a possible Morton neuroma. After MR imaging, the clinical diagnosis of Morton neuroma was withdrawn in 15 of 54 (28%) feet. In 14 of 39 maintained diagnoses, the location ornumber of neuromas was changed after MR imaging. Confidence levels for Morton neuroma increased substantially after MR imaging. In 31 (57%) feet, a change in treatment plan resulted after MR imaging. Diameters of neuromas on MR images were significantly larger (P = .003) in surgically treated feet than in conservatively treated feet. MR imaging diagnoses were correct in all 23 revised intermetatarsal spaces. 3
35. Zanetti M, Ledermann T, Zollinger H, Hodler J. Efficacy of MR imaging in patients suspected of having Morton's neuroma. AJR. American Journal of Roentgenology. 168(2):529-32, 1997 Feb.AJR Am J Roentgenol. 168(2):529-32, 1997 Feb. Observational-Dx 32 patients To evaluate the role of MR imaging in patients with suspected Morton’s neuroma and to assess the value of various MR sequences in this diagnosis. In 15 of 18 intermetatarsal spaces, a Morton’s neuroma was surgically proven. Thirteen true-positive, two false-negative, three true-negative, and no false-positiveMR diagnoses were given. In six of 15 proven neuromas, the clinical examiner was not able to identify the correct intermetatarsal space. The MR diagnoses in the 16 remaining patients who did not undergo surgery were Morton’s neuroma (n = 8), stress fracture (n = 1 ), foreign body reaction (n = 1), tendon sheath ganglion (n = 1), postoperative changes (n = 2), and no abnormality (n = 3). Standardized contrast-to-noise ratios (± SD) were 2.42 ± 0.72 for TI weighted images; 1.43 ± 1.13 for T2-weighted images; 1.26 ± I .47 for short inversion time inversion recovery images; and 0.83 ± 0.59 gadolinium-enhanced fat-suppressed images. The differences were statistically significant for the TI-weighted spin-echo images versus the three other sequences (p = .001-018), but not among the other sequences (p = .209-710). 3
36. Bignotti B, Signori A, Sormani MP, Molfetta L, Martinoli C, Tagliafico A. Ultrasound versus magnetic resonance imaging for Morton neuroma: systematic review and meta-analysis. [Review]. Eur Radiol. 25(8):2254-62, 2015 Aug. Meta-analysis 14 studies To compare ultrasound (US) and magnetic resonance imaging (MRI) in the diagnosis of Morton's neuroma. 277 studies were initially found, and the meta-analysis was conducted on 14 studies. US sensitivity was studied in five studies, MRI sensitivity in three studies, and bothin six studies. All studies used surgery as the reference standard. A high sensitivity (SE) of diagnostic testing was observed for both US (SE (95 % CI)?=?0.91 (0.83-0.96)) and MRI (SE (95 % CI)?=?0.90 (0.82-0.96)) with no significant differences between the two modalities in diagnosis (Q test p?=?0.88). For MRI, specificity of test was 1.00 with a pooled estimation of 1.00 (0.73-1.00), while the pooled specificity was 0.854 (95 % CI: 0.41-1.00) for US. No differences were observed between US and MRI in study design (p?=?0.76). Good
37. Zanetti M, Strehle JK, Zollinger H, Hodler J. Morton neuroma and fluid in the intermetatarsal bursae on MR images of 70 asymptomatic volunteers. Radiology. 1997;203(2):516-520. Observational-Dx 70 asymptomatic subjects; 16 symptomatic subjects To determine the prevalence and size of presumed Morton neuromas and fluid in the intermetatarsal bursae on MRIs. 24 Morton neuromas were diagnosed in 21 subjects (prevalence, 30%). The transverse diameter of the neuromas was 3-7 mm (mean, 4.5 mm) vs 4-8 mm (mean, 5.6 mm) in symptomatic subjects; this difference was significant (P=.0075). The prevalence of fluid in the intermetatarsal bursa was 20%, 47%, 49%, and 0% for the first through fourth intermetatarsal spaces. The transverse diameter of the fluid collection was 1-4 mm. 3
38. Lee MJ, Kim S, Huh YM, et al. Morton neuroma: evaluated with ultrasonography and MR imaging. Korean J Radiol. 8(2):148-55, 2007 Mar-Apr. Observational-Dx 20 neuromas from 17 patients To compare the diagnostic accuracy of both US and MRI for the assessment of Morton neuroma and to evaluate whether or not the gadolinium contrast enhanced T1-weighted image increases the conspicuity of the lesion. The detection rate of Morton neuroma was 79% for 14 neuromas from 11 patients who had undergone US followed by an operation. The detection rate was 76% for 17 neuromas from 15 patients who had undergone MRI and a subsequent operation. The mean size of the examined neuromas was 4.9 mm on the US images and it was 5.1 mm on the MRI studies. Ten neuromas (71%) were =5 mm as measured by US, and 3 neuromas were not detected, whereas on the MRI analysis, 10 neuromas (59%) were =5 mm and 4 neuromas were not visualized. Among the patients examined during postoperative follow-up, symptoms were completely relieved in 85% and the symptoms were partially relieved in 15%. 3
39. Terk MR, Kwong PK, Suthar M, Horvath BC, Colletti PM. Morton neuroma: evaluation with MR imaging performed with contrast enhancement and fat suppression. Radiology. 1993;189(1):239-241. Review/Other-Dx 15 patients To evaluate clinically suspected Morton neuroma with contrast material-enhanced MRIs. In 6 patients, a tumor that conformed to the clinical findings was seen in the interdigital space; surgical findings in these patients correlated closely with the imaging findings in all patients. Patients without positive findings on MRIs tended to have less typical clinical findings and received nonsurgical treatment. In all patients, the lesions were best depicted with the combination of contrast-enhanced imaging and fat suppression; conventional MRIs either entirely failed to demonstrate the lesions or demonstrated the lesions less clearly. 4
40. Sung W, Weil L Jr, Weil LS Sr, Rolfes RJ. Diagnosis of plantar plate injury by magnetic resonance imaging with reference to intraoperative findings. J Foot Ankle Surg. 51(5):570-4, 2012 Sep-Oct. Observational-Dx 41 patients To assess the utility of magnetic resonance imaging in evaluating injury to the plantar plate and to determine whether conventional low-field magnetic resonance imaging is a valid tool for diagnostic evaluation. Intraoperatively, 41 plantar plate tears and 4 intact ligaments were found. The accuracy, sensitivity, specificity, positive predictive value, and negative predictivevalue was 96%, 95%, 100%, 100%, and 67%, respectively. The clinical diagnosis of plantar plate injury was also highly accurate in our study population (41/45, 91%). Moderate concordance between the magnetic resonance imaging grade and surgical grade of plantar plate tear (28/45, 62%), with greater concordance occurring at higher grades. 2
41. Duan X, Li L, Wei DQ, et al. Role of magnetic resonance imaging versus ultrasound for detection of plantar plate tear. [Review]. J. ORTHOP. SURG.. 12(1):14, 2017 Jan 21. Review/Other-Dx 7 studies To find out the diagnostic accuracy of Magnetic resonance imaging (MRI) versus ultrasound (US) for plantar plate tears. Seven studies involving 246 plantar plate tears were included. The MRI showed more diagnostic accuracythan US for the detection of plantar plate tears. The sensitivity, specificity, positive likelihood ratio, and negativelikelihood ratio of MRI were 95%, 54%, 2.08, and 0.08, respectively, while the same values for US were 93%, 33%,1.20, and 0.35, respectively. And the sROC showed more superior diagnostic accuracy than the US. 4
42. Kier R, Abrahamian H, Caminear D, et al. MR arthrography of the second and third metatarsophalangeal joints for the detection of tears of the plantar plate and joint capsule. AJR. American Journal of Roentgenology. 194(4):1079-81, 2010 Apr.AJR Am J Roentgenol. 194(4):1079-81, 2010 Apr. Review/Other-Dx 41 patients To evaluate MR arthrography for evaluation of tears of the plantar plate and joint capsule of the metatarsophalangeal joint in 45 metatarsophalangeal joints in 41 patients. No results stated in abstract. 4
43. Mohana-Borges AV, Theumann NH, Pfirrmann CW, Chung CB, Resnick DL, Trudell DJ. Lesser metatarsophalangeal joints: standard MR imaging, MR arthrography, and MR bursography--initial results in 48 cadaveric joints. Radiology. 227(1):175-82, 2003 Apr. Observational-Dx 48 lesser MTP joints of 12 cadaveric feet To delineate the normal magnetic resonance (MR) imaging anatomy of the lesser metatarsophalangeal (MTP) joints in a cadaveric model and compare the MR arthrographic and MR bursographic findings with the standard MR imaging findings. The coronal plane was best for simultaneous depiction of the fibrous capsule, plantar plate, and collateral ligament complex and for assessment of the relationship between the CLC and the plantar plate. The sagittal plane was best for analysis of the bone attachments of the plantar plate and the transverse plane for evaluation of the CLC attachment sites in the phalanges. MR arthrography enabled identification of the bare areas and recesses of the joints, better delineation of the plantar plate articular surface, and better evaluation of the integrity of the soft-tissue components of the joints. Compared with the other examinations, MR bursography did not help improve these evaluations. 4
44. Gregg JM, Schneider T, Marks P. MR imaging and ultrasound of metatarsalgia--the lesser metatarsals. [Review] [50 refs]. Radiol Clin North Am. 46(6):1061-78, vi-vii, 2008 Nov. Review/Other-Dx N/A To review the Magnetic Resonance imaging and Ultrasound of metatarsalgia. No results stated in abstract. 4
45. Couturier S, Gold G. Imaging Features of Avascular Necrosis of the Foot and Ankle. [Review]. Foot & Ankle Clinics. 24(1):17-33, 2019 Mar. Review/Other-Dx N/A To understand key radiographic findings in the management of lesions due to avascular necrosis of the foot and ankle. No results stated in abstract. 4
46. Feuerstein CA, Weil L Jr, Weil LS Sr, Klein EE, Fleischer A, Argerakis NG. Static Versus Dynamic Musculoskeletal Ultrasound for Detection of Plantar Plate Pathology. Foot & Ankle Specialist. 7(4):259-265, 2014 Jul 15.Foot ankle spec.. 7(4):259-265, 2014 Jul 15. Observational-Dx 36 patients To prospectively compare the value of using preoperative static and dynamic ultrasound findings to diagnose plantar plate pathology using intraoperative inspection as the standard of reference. Of the 36 patients, 29 were females and 7 were males with average age of 57.9 ± 7.8 years (range, 38-73). There were 38 plantar plate tears (84.4%) notedon intraoperative examination. The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value for the static US exam were 80.0%, 81.6%, 71.4%, 93.9%, and 41.7%, respectively. The same values for the dynamic US exam were 88.9%, 100%, 28.6%, 88.3%, and 100%, respectively. 2
47. Xu Z, Duan X, Yu X, Wang H, Dong X, Xiang Z. The accuracy of ultrasonography and magnetic resonance imaging for the diagnosis of Morton's neuroma: a systematic review. [Review]. Clin Radiol. 70(4):351-8, 2015 Apr. Review/Other-Dx 12 studies To determine the accuracy of MRI versus ultrasound for Morton’s neuroma. The study included 12 studies; 217 patients underwent MRI and 241 underwent ultrasound examinations. There appeared greater diagnostic accuracy for ultrasound than MRI for the diagnosis of Morton’s neuroma (ultrasound sensitivity 90%, specificity 88%, positive likelihood ratio 2.77, negative likelihood ratio 0.16 versus MRI sensitivity 93%, specificity 68%, positive likelihood ratio 1.89, negative likelihood ratio 0.19). 4
48. Stone M, Eyler W, Rhodenizer J, van Holsbeeck M. Accuracy of Sonography in Plantar Plate Tears in Cadavers. Journal of Ultrasound in Medicine. 36(7):1355-1361, 2017 Jul.J Ultrasound Med. 36(7):1355-1361, 2017 Jul. Observational-Dx 6 cadavers To assess the accuracy of sonography in the diagnosis of plantar plate tears of the lesser digits using gross dissection as the reference standard. Ten plantar plates were graded as torn by sonography, all occurring in the distal plate near the phalangeal insertion. Seven of these plates were identified as torn on direct inspection. Fourteen plantar plates were found to be intact on sonography, 12 of which were intact on gross inspection. Overall, the accuracy, sensitivity, and specificity of sonography were 79.2%, 77.8%, and 80.0%, respectively. No correlation was seen between the accuracy of sonography and plate size, using plate number as a surrogate marker for plate size (P=.822). 2
49. Gregg J, Silberstein M, Schneider T, Marks P. Sonographic and MRI evaluation of the plantar plate: A prospective study. Eur Radiol. 2006; 16(12):2661-2669. Observational-Dx 160 asymptomatic and 160 symptomatic plantar plates To establish the accuracy of US in the examination of the plantar plate by comparing it with MRI, or if available, surgical findings. US detected 75/160 and 139/160 plantar plates torn in the asymptomatic and symptomatic groups, respectively. MRI detected 56/160 and 142/160 tears in the symptomatic and asymptomatic groups, respectively. The sensitivity of MRI and US with surgical correlation was calculated to be 87 and 96%, respectively, with poor specificity. US correlates moderately with MRI in the evaluation of the plantar plate. Surgical correlations, although limited (n=10), indicate US is superior to MRI with more accurate detection of tears. 3
50. Breunung N, Barwick T, Fernando R, et al. Additional benefit of SPECT-CT in investigating heel pain. Clinical Nuclear Medicine. 33(10):705-6, 2008 Oct.Clin Nucl Med. 33(10):705-6, 2008 Oct. Review/Other-Dx N/A No abstract available. No abstract available. 4
51. Intenzo CM, Wapner KL, Park CH, Kim SM. Evaluation of plantar fasciitis by three-phase bone scintigraphy. Clinical Nuclear Medicine. 16(5):325-8, 1991 May.Clin Nucl Med. 16(5):325-8, 1991 May. Review/Other-Dx 15 patients To present a prospective analysis in which 15 consecutive patients with chronic heel pain are evaluated by bone scintigraphy to diagnose or exclude plantar pasciitis (PF). Fifteen patients complaining of chronic heel pain underwent three-phase Tc-99m MDP bone scintigraphy. Ten patients demonstrated abnormal scan findings consistent with plantar fasciitis (PF) and had responded to conventional therapy. Two patients were found to have calcaneal stress fractures, and one patient demonstrated a calcaneal spur that required no treatment. The remaining two patients had normal scans and did not appear clinically to have PF. 4
52. Grasel RP, Schweitzer ME, Kovalovich AM, et al. MR imaging of plantar fasciitis: edema, tears, and occult marrow abnormalities correlated with outcome. AJR. 1999;173(3):699-701. Review/Other-Dx 25 patients To evaluate various MRI signs of plantar fasciitis and to determine if a difference in these findings exists between clinically typical and atypical patients with chronic symptoms resistant to conservative treatment. The authors found signs on MRI that have not been described in the scientific literature for patients with plantar fasciitis. These signs included occult marrow edema and fascial tears. Patients with these manifestations seemed to respond to treatment in a manner similar to that of patients in whom MRI revealed more benign findings. 4
53. Chimutengwende-Gordon M, O'Donnell P, Singh D. Magnetic resonance imaging in plantar heel pain. Foot Ankle Int. 31(10):865-70, 2010 Oct. Observational-Dx 112 patients To evaluate a series of MRI scans from patients with persistent or atypical plantar heel pain. Of the 50 patients with persistent heel pain, 38 (76%) of MRIs confirmed the diagnosis of plantar fasciitis. Of the 62 patients who had presented with atypical symptoms or signs, 21 patients had presented with night pain and the remaining 41 had presented with acute pain, tenderness of the lateral or medial aspect of the heel, significant swelling, neurological features or pain posterior to the insertion of the plantar fascia. Patients with night pain were shown to have plantar fasciitis associated with calcaneal marrow edema in 15 (71.4%) cases (p < 0.05). One patient presenting with night pain was found to have a plantar arterio-venous malformation. Acute pain was associated with plantar fascia tears in 4 out of 9 (p < 0.05). 3
54. Sabir N, Demirlenk S, Yagci B, Karabulut N, Cubukcu S. Clinical utility of sonography in diagnosing plantar fasciitis. J Ultrasound Med. 24(8):1041-8, 2005 Aug. Observational-Dx 77 patients and 77 controls To investigate the efficacy of sonography in the detection of plantar fasciitis (PF) compared with magnetic resonance imaging (MRI) findings in subjects with inferior heel pain. Compared with MRI, sonography showed 80% sensitivity and 88.5% specificity in assessing PF. A strong correlation was found between plantar fascia and fat pad thickness measurements done by sonography (P < .001; r = 0.854) and MRI (P < .001; r = 0.798). Compared with the asymptomatic volunteers, patients with PF had significant increases in plantar fascia and heel pad thicknesses, weight, and body mass index (P = .0001). Heel pad thickness was also significantly increased with pain duration (P = .021). 1
55. Abdel-Wahab N, Fathi S, Al-Emadi S, Mahdi S. High-resolution ultrasonographic diagnosis of plantar fasciitis: A correlation of ultrasound and magnetic resonance imaging. Int J Rheum Dis 2008;11:279-86. Observational-Dx 23 symptomatic heels as cases and 22 heels as controls To compare high-resolution ultrasound to MRI to assess its value as an alternative modality to confirm a clinical diagnosis of plantar fasciitis. The plantar fascia was thickened in symptomatic feet. The thickness of the plantar fascia in symptomatic feet was (3.0–7.0 mm; 4.9 ± 1.3) measured by ultrasound which was significantly thicker than in the control group (1.1–2.4 mm; 1.7 ± 0.06); P < 0.05. Other sonographic signs used for the diagnosis of plantar fasciitis in the study were compared to MRI findings. The diagnostic accuracy was 69.5% for abnormal focal echogenicity within the plantar fascia, 60.8% for edema around the plantar fascia, 78.2% for perifascial edema, 69.5% for rupture of the plantar fascia and the lowest diagnostic accuracy of ultrasound was in detection of associated calcaneal spur (56.5%). The findings were tabulated and discussed in relation to other literature. 3
56. Kapoor A, Sandhu HS, Sandhu PS, Kapoor A, Mahajan G, Kumar A. Realtime elastography in plantar fasciitis: comparison with ultrasonography and MRI. Current Orthopaedic Practice 2010;21:600-08. Observational-Dx 25 patients To evaluate the role of elastography in the evaluation of plantar fasciitis and to compare it with ultrasound and MRI. Elastography showed a 95% sensitivity and 100% specificity in the diagnosis of plantar fasciitis while ultrasound was 65.8% sensitive and 75% specific with the differences being statistically significant (P=0.009). Elastography was shown to detect early stages I and II plantar fasciitis in 10 of 12 and in 15 of 16 patients, respectively, while ultrasound only detected four of 12 patients with stage I disease (P=0.001). 2
57. Draghi F, Gitto S, Bortolotto C, Draghi AG, Ori Belometti G. Imaging of plantar fascia disorders: findings on plain radiography, ultrasound and magnetic resonance imaging. [Review]. Insights Into Imaging. 8(1):69-78, 2017 Feb.Insights imaging. 8(1):69-78, 2017 Feb. Review/Other-Dx N/A To provide simple and systematic guidelines for imaging assessment of Plantar fascia (PF) disease, focussing on key findings detectable on plain radiography, ultrasound and magnetic resonance imaging (MRI). No results stated in abstract 4
58. Jeswani T, Morlese J, McNally EG. Getting to the heel of the problem: plantar fascia lesions. [Review] [26 refs]. Clin Radiol. 64(9):931-9, 2009 Sep. Review/Other-Dx N/A To present a review describing the common lesions of the plantar fascia, including plantar fasciitis, plantar fascia rupture, plantar fibromatosis, and plantar xanthoma, and illustrate them with appropriate magnetic resonance imaging (MRI) and ultrasound imaging. No results stated in abstract. 4
59. Angoules AG, Angoules NA, Georgoudis M, Kapetanakis S. Update on diagnosis and management of cuboid fractures. [Review]. World j. orthop.. 10(2):71-80, 2019 Feb 18. Review/Other-Tx N/A To provide an update on diagnosis and management of cuboid fractures. No results stated in abstract. 4
60. Hirschmann MT, Davda K, Rasch H, Arnold MP, Friederich NF. Clinical value of combined single photon emission computerized tomography and conventional computer tomography (SPECT/CT) in sports medicine. [Review]. Sports med. arthrosc. rev.. 19(2):174-81, 2011 Jun. Review/Other-Dx N/A To illustrate the clinical value and future perspectives of SPECT/CT in sports medicine. No results stated in abstract. 4
61. Romanowski CA, Barrington NA. The accessory navicular--an important cause of medial foot pain. Clin Radiol. 1992;46(4):261-264. Review/Other-Dx 10 patients To present a group of patients with a symptomatic accessory navicular in whom bone scans were performed. Plain radiography reveals an accessory navicular united to the navicular by a synchondrosis (Type II). The diagnosis can be confirmed by showing increased localized uptake of isotope on a Tc-99m methylene diophosphate bone scan. In some cases, the accessory navicular is mistaken for a fracture. Awareness of this accessory ossicle causing such symptoms should lead to the correct diagnosis. 4
62. Mosel LD, Kat E, Voyvodic F. Imaging of the symptomatic type II accessory navicular bone. Australas Radiol. 48(2):267-71, 2004 Jun. Review/Other-Dx 2 case reports Case reports of symptomatic type II accessory navicular bone. No results stated in abstract 4
63. Jain S, Karunanithi S, Agarwal KK, Kumar G, Roy SG, Tripathi M. Incremental value of single photon emission tomography/computed tomography in 3-phase bone scintigraphy of an accessory navicular bone. Indian Journal of Nuclear Medicine. 29(3):191-2, 2014 Jul.Indian J. Nucl. Med.. 29(3):191-2, 2014 Jul. Review/Other-Dx N/A To report a case highlighting the significance of single photon emission tomography/computed tomography in methylene diphosphonate bonescan in the evaluation of symptomatic accessory navicular bone where three phase bone scan is equivocal. No results stated in abstract. 4
64. Almeida RR, Mansouri M, Tso DK, et al. The added value of cross-sectional imaging in the detection of additional radiographically occult fractures in the setting of a Chopart fracture. EMERG. RADIOL.. 25(5):513-520, 2018 Oct. Observational-Dx 108 patients To determine the sensitivity of radiographs for detecting additional foot and ankle fractures related to Chopart fracture using CT or MRI as the reference standard. One hundred eight patients met the inclusion criteria. The calcaneocuboid articulation was the most commonly involved type of Chopart fracture, seen in 75% of cases (81/108). Chopart fractures were detected on the initial radiographs in 67.6% of cases (73/108). Additional fractures of the ankle and midfoot were diagnosed in 34.2% of cases (37/108), with 56.7% (21/37) of these cases having at least one additional fracture seen on CT or MRI that was not seen on the initial radiographs, with fractures of the midfoot most often missed. In 56.7% (17/30) patients whose radiographs detected Chopart fractures, at least one additional fracture was missed; 30% of them demonstrated intra-articular extension and 56.7% were considered displaced. High-energy trauma was related to higher incidence of additional fractures. There was no significant difference in the sensitivity of radiographs to detect additional fractures between high versus low-energy trauma (p?=?0.3) and WB versus non-WB radiographs (p?=?0.5). Most patients were treated nonoperatively (56.5%, 61/108), with surgical intervention more frequent in patients with a high energy of trauma (51.7% versus 33.3%, p?=?0.05). 3
65. Choi CH, Ogilvie-Harris DJ. Occult osteochondral fractures of the subtalar joint: a review of 10 patients. J Foot Ankle Surg. 41(1):40-3, 2002 Jan-Feb. Review/Other-Dx 10 patients To report a series of patients with occult injuries to the subtalar joint that occurred without dislocation. 9 osteochondral fractures involved the posterior facet. 7 patients had a stiff and painful subtalar joint, and an arthrodesis was performed. 3 patients presented with adequate subtalar joint motion and were treated with physiotherapy. Detection of osteochondral fractures of the subtalar joint is difficult. The "early warning" signs are massive swelling without definitive bone injury on radiographic examination, and a failure to regain subtalar motion after a period of immobilization. Confirmatory evidence is obtained from CT scans or MRI. Initially, aggressive physiotherapy should be considered. Arthrodesis should be used for patients who remain symptomatic. 4
66. Haapamaki VV, Kiuru MJ, Koskinen SK. Ankle and foot injuries: analysis of MDCT findings. AJR Am J Roentgenol. 183(3):615-22, 2004 Sep. Observational-Dx 388 patients Retrospective study to assess MDCT findings and the advantages of MDCT compared with radiography in patients referred to a level 1 trauma center for diagnostic evaluation of acute ankle and foot trauma. 344 (89%) of the 388 patients had one or more fractures in the ankle or foot. Calcaneus was the most commonly fractured bone, and the sensitivity of radiography in the detection of calcaneal fractures was 87%. The sensitivity of radiography in the detection of talar fractures was 78%, whereas it was only 25%-33% in the detection of midfoot fractures. A Lisfranc fracture-dislocation was not detected on primary radiography in 5 (24%) of 21 cases. The 3 main injury mechanisms were falling from a height (164 patients [48%]), a simple fall (68 patients [20%]), and a traffic accident (47 patients [14%]). In patients with injuries from high-energy polytrauma and in those with complex ankle and foot fractures, the sensitivity of radiography is only moderate to poor; in these cases, MDCT is recommended as the primary imaging technique. 3
67. Suh CH, Yun SJ, Jin W, Lee SH, Park SY, Ryu CW. Diagnostic performance of dual-energy CT for the detection of bone marrow oedema: a systematic review and meta-analysis. [Review]. Eur Radiol. 28(10):4182-4194, 2018 Oct. Meta-analysis 12 Studies To assess the sensitivity and specificity of dual-energy CT (DECT) for the detection of bone marrow oedema (BME). Twelve eligible studies (1901 lesions, 450 patients) were included. DECT exhibited a pooled sensitivity of 0.85 [95% confidence interval (CI): 0.78–0.90] and a pooled specificity of 0.97 (95% CI: 0.92–0.98) for BME detection. In addition, the diagnostic performance of qualitative assessment (sensitivity, 0.85; specificity, 0.97) was higher than that of quantitative assessment (sensitivity, 0.84; specificity, 0.88) of DECT findings. The diagnostic performance of DECT for the spine (sensitivity, 0.84; specificity, 0.98) and appendicular skeleton (sensitivity, 0.84; specificity, 0.93) were excellent. According to meta-regression analysis, the use of a tin filter, = 2 image planes, and a slice thickness < 1 mm tended to exhibit higher sensitivity and hyperacute stage BME (< 24 h) tended to exhibit lower sensitivity. Good
68. Mellado JM, Ramos A, Salvado E, Camins A, Danus M, Sauri A. Accessory ossicles and sesamoid bones of the ankle and foot: imaging findings, clinical significance and differential diagnosis. [Review] [30 refs]. Eur Radiol. 13 Suppl 4:L164-77, 2003 Dec. Review/Other-Dx N/A to review, illustrate and discuss the imaging findings of some of the more frequent accessory ossicles and sesamoid bones of the ankle and foot region, with particular emphasis on those that may be of clinical significance or simulate fractures. No results stated in abstract. 4
69. Karasick D, Schweitzer ME. The os trigonum syndrome: imaging features. AJR. 1996;166(1):125-129. Review/Other-Dx N/A Pictorial essay is used to explore the role of imaging modalities in the diagnosis and treatment of the os trigonum syndrome, a symptom complex that may present difficult diagnostic problems. The roles of different imaging modalities are presented in this essay. 4
70. Sadineni RT, Pasumarthy A, Bellapa NC, Velicheti S. Imaging Patterns in MRI in Recent Bone Injuries Following Negative or Inconclusive Plain Radiographs. J Clin Diagn Res. 9(10):TC10-3, 2015 Oct. Observational-Dx 75 patients To determine the MRI imaging patterns in recent bone injuries (less than 4 weeks) following negative or inconclusive plain radiographs and to demonstrate the efficacy of MRI over conventional radiography in the detection of occult fractures. Out of the 75 individuals with history of recent injury of less than 4 weeks duration, fracture line was demonstrated in 16 patients (21%) who had no obvious evidence of bone injury on plain radiographs. Bone contusion or bruising of the bone was demonstrated in 39 (52%) patients. This was the commonest abnormality detected in MRI. The remaining 20 patients did not show any obvious injury to the bone on MR imaging however, soft tissue injury could be demonstrated in 12 (16%) patients which show that the extent of soft tissue injury was relatively well demonstrated by MR imaging. The present study showed that occult injuries commonly occur at the Knee followed by Ankle, Wrist, Foot, Elbow, Leg, Hands, Hips & Spine. 3
71. Baker JC, Hoover EG, Hillen TJ, Smith MV, Wright RW, Rubin DA. Subradiographic Foot and Ankle Fractures and Bone Contusions Detected by MRI in Elite Ice Hockey Players. Am J Sports Med. 44(5):1317-23, 2016 May. Observational-Dx 27 participants To study foot and ankle bone injuries detected with magnetic resonance imaging (MRI) that occurred in elite hockey players. The observers identified at least 1 bone injury in 27 of the 31 MRI examinations, including 10 with radiographically occultfractures. Agreement among the 3 observers for injury categorization was substantial (k = 0.76). Seventeen injuries were causedby a direct blow (15 from a moving puck, 2 from an uncertain source), resulting in 6 fractures and 6 high-grade bone contusions,with 14 of the 17 involving a medial bone (medial malleolus, navicular, or first metatarsal base). Compared with other mechanisms,direct impaction was statistically more likely to result in a severe bone injury and to involve the medial foot and ankle. In 20 injurieswhere return-to-play information was available, players with severe bone injuries missed a mean of 10.6 games compared with2.4 games for other players (P = .05). 2
72. Pierre-Jerome C, Reyes EJ, Moncayo V, Chen ZN, Terk MR. MRI of the cuboid bone: analysis of changes in diabetic versus non-diabetic patients and their clinical significance. Eur J Radiol. 81(10):2771-5, 2012 Oct. Experimental-Tx 237 patients To investigate the association between diabetes and marrow changes in the cuboid; and (2) to evaluate the influence of age, gender, body mass index (BMI) and use of insulin in the occurrence of marrow changes in the cuboid. Two hundred and forty two feet - 69 diabetic and 173 non-diabetic - were retrospectively evaluated. There was a higher prevalence of marrow edema and fractures in the diabetic cuboid (n=31, 45%) compared to non-diabetic cuboid (n=25, 14%, p=0.02). A fracture line was seen in fourteen (20%) diabetic cuboid bones compared to 4 (2%) in non-diabetic cuboid bones (p<0.0001). Eleven (79%) cases of cuboid fractures in the diabetic population were radiographically occult. Multivariate data analysis revealed an adjusted odds ratio of 4.416 (95% CI; 2.307, 8.454) for the relationship between marrow changes (edema and fractures) in the cuboid and diabetes. For each year of age, the odds of changes in the cuboid increased by 2.2% (95% CI; 1.001, 1.044). 4
73. Porter DA.. Fifth Metatarsal Jones Fractures in the Athlete. Foot Ankle Int. 39(2):250-258, 2018 02. Review/Other-Dx N/A To review all aspects of the Jones fracture, including all 3 types of Jones fractures (Torg types I, II, and III) and its etiology, operative and nonoperative treatment, rehabilitation, return-to-play criterion, prevention, refracture, nonunion, augmentation, and orthobiologics. No results stated in abstract. 4
74. Tafur M, Rosenberg ZS, Bencardino JT. MR Imaging of the Midfoot Including Chopart and Lisfranc Joint Complexes. [Review]. Magn Reson Imaging Clin N Am. 25(1):95-125, 2017 Feb. Review/Other-Dx N/A To provide brief description of the normal anatomy and biomechanics of the midfoot, focussing on imaging features, with emphasis on MR imaging of common osseous, tendon, and ligament abnormalities that affect the midfoot. No results stated in abstract 4
75. Berman Z, Tafur M, Ahmed SS, Huang BK, Chang EY. Ankle impingement syndromes: an imaging review. [Review]. British Journal of Radiology. 90(1070):20160735, 2017 Feb. Review/Other-Dx N/A To review the relevant anatomy of the different compartments, describe the mechanisms of injury with common imaging findings, differential diagnoses when applicable and to review the different treatments options for ankle impingement syndromes. No results stated in abstract. 4
76. Wang CL, Shieh JY, Wang TG, Hsieh FJ. Sonographic detection of occult fractures in the foot and ankle. J Clin Ultrasound. 27(8):421-5, 1999 Oct. Observational-Dx 24 patients To determine whether high-resolution sonography can aid in the diagnosis of radiographically occult fractures in the foot and ankle. Twenty-four patients had occult fractures demonstrated by sonography. On sonography, the occult fractures appeared as a discontinuity of cortex echogenicity. The fractures were found at the calcaneus (n = 8), metatarsus (n = 6), talus (n = 3), navicular bone (n = 3), cuboid bone (n = 2), cuneiform bone (n = 1), and lateral malleolus (n = 1). Review of the patients' radiographs revealed tiny fractures at the sonographically identified locations in 2 patients. The first 5 patients underwent bone scans, which confirmed the presence of the fractures. The first 11 patients received follow-up sonographic examination 6 weeks after diagnosis; in all 11, an echogenic line over the previous fracture site, presumably representing callus formation, was noted. 4
77. Oh SJ, Kim YH, Kim SK, Kim MW. Painful os peroneum syndrome presenting as lateral plantar foot pain. Annals of Rehabilitation Medicine. 36(1):163-6, 2012 Feb.Ann. rehabil. med.. 36(1):163-6, 2012 Feb. Review/Other-Dx 1 case report To report the rare condition painful os peroneum syndrome and review the relevant literature. No results stated in abstract 4
78. Cochet H, Pele E, Amoretti N, Brunot S, Lafenetre O, Hauger O. Anterolateral ankle impingement: diagnostic performance of MDCT arthrography and sonography. AJR Am J Roentgenol. 194(6):1575-80, 2010 Jun. Observational-Dx 51 consecutive patients Prospective study to compare the diagnostic performance of CT arthrography and sonography in the diagnosis of anterolateral ankle impingement. The sensitivity and specificity of sonography were respectively 77% and 57% before joint injection and 85% and 71% after joint injection. Positive Doppler masses were found to be anterolateral impingements at arthroscopy in all cases (10/10), and masses of hyperechoic appearance were found not to be anterolateral impingements in all cases (3/3). The sensitivity and specificity of CT arthrography in the diagnosis of anterolateral impingement were respectively 97% and 71%. The performances of CT arthrography and ankle sonography in the diagnosis of anterolateral ankle impingement were significantly different (p = 0.006). CT arthrography is quite accurate and superior to ankle sonography in the diagnosis of anterolateral impingement. The diagnostic performance of sonography is limited, but positive Doppler appearance and hyperechogenicity, when present, could help to exclude or confirm the diagnosis. 2
79. McCarthy CL, Wilson DJ, Coltman TP. Anterolateral ankle impingement: findings and diagnostic accuracy with ultrasound imaging. Skeletal Radiol. 37(3):209-16, 2008 Mar. Observational-Dx 17 footballers ; clinical diagnosis of ALI (n = 8) or control condition (n = 9) To evaluate the findings and diagnostic accuracy of US in ALI. US findings were correlated with subsequent arthroscopic appearance. US detected a synovitic mass in the antero-lateral gutter in all 8 footballers with clinical ALI (100%) and in 2 patients with a control diagnosis (22%). US is accurate in detecting synovitic lesions within the antero-lateral gutter, demonstrating associated ligamentous injuries and in differentiating soft tissue from osseous impingement. 3
80. Schmid DT, Hodler J, Mengiardi B, Pfirrmann CW, Espinosa N, Zanetti M. Fatty muscle atrophy: prevalence in the hindfoot muscles on MR images of asymptomatic volunteers and patients with foot pain. Radiology. 253(1):160-6, 2009 Oct. Observational-Dx 80 volunteers and 80 patients To determine prevalence and degree of fatty muscle atrophy in plantar foot muscles in asymptomatic volunteers and in patients with foot pain. Readers 1 and 2 found substantial fatty atrophy of the ADM muscle in four (5%) and five (6%) volunteers, respectively, and in three (4%) and nine (11%) patients,respectively. One reader diagnosed substantial fatty atrophy of the AH muscle in three (4%) volunteers and of the FDB muscle in two (2%) volunteers. Prevalence for the QP muscle varied between 0% and 1%. An association between age and degree of fatty atrophy of the ADM muscle was found for volunteers by both readers and for patients by reader 1 (P < .01). 2
81. Presley JC, Maida E, Pawlina W, Murthy N, Ryssman DB, Smith J. Sonographic visualization of the first branch of the lateral plantar nerve (baxter nerve): technique and validation using perineural injections in a cadaveric model. J Ultrasound Med. 32(9):1643-52, 2013 Sep. Experimental-Dx 12 unembalmed cadaveric ankle-foot specimens To document the ability of high-resolution sonography to accurately identify the first branch of the lateral plantar nerve (FBLPN) using sonographically guided perineural injections in an unembalmed cadaveric model. All 12 injections accurately placed latex onto the FBLPN within the AH-QP interval, with 11 of 12 (91%) resulting in complete nerve coverage. Proximal latex overflow to the lateral plantar nerve occurred in 82% of cases (10 of 12). The average distance between the plantar fascia and injected latex was 1.2 cm (range, 1.0–1.75 cm). No vascular injury was seen in any specimen. The average nerve conspicuities were 3.7 (range, 3–4) using the cart-based US machine and 1.8 (range, 1–4) using the portable US machine. 3
82. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. Review/Other-Dx N/A To provide evidence-based guidelines on exposure of patients to ionizing radiation. No abstract available. 4
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