ACR Appropriateness Criteria Acute Trauma to the Foot.
This ACR Appropriateness Criteria article offers imaging triage guidance for several variants of patients presenting with acute foot trauma. Patients meeting inclusion criteria for the Ottawa Rules should undergo a 3-view radiographic series. Diabetic patients with peripheral neuropathy should undergo radiography, even though they do not meet the Ottawa Rules inclusion criteria. Patients with suspected midfoot and/or Lisfranc injury should undergo 3-view radiographs with weight bearing on at least the anterior-posterior view. Patients with suspected Lisfranc injury and normal radiographs should be considered for MRI and CT on a case-by-case basis. MRI or ultrasound could confirm cases of suspected acute tendon rupture. Radiography is the initial imaging modality for suspected plantar plate injury after metatarsal-phalangeal joint injury. Weight-bearing anterior-posterior, lateral, and sesamoid axial views may detect proximal migration of the hallux sesamoids. Ultrasound or MRI can directly evaluate the capsuloligamentous complex, specifically the plantar plate. Radiography can detect radiopaque penetrating foreign bodies, and ultrasound can be helpful in detecting those that are nonradiopaque. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures, by the panel. In instances in which evidence is lacking or is not definitive, expert opinion may be used to recommend imaging and treatment.
Radiology Specialists of Florida, Maitland, Florida. Electronic address: laura.bancroft@flhosp.org.
Laura W
LW
Bancroft
Mayo Clinic, Phoenix, Arizona.
Mark J
MJ
Kransdorf
NYU Center for Musculoskeletal Care, New York, New York.
Ronald
R
Adler
James J. Peters VA Medical Center, Bronx, New York, American Academy of Orthopaedic Surgeons, Rosemont, Illinois.
Marc
M
Appel
University of Kentucky, Lexington, Kentucky.
Francesca D
FD
Beaman
Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania.
Stephanie A
SA
Bernard
Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania.
Michael A
MA
Bruno
Texas Scottish Rite Hospital, Dallas, Texas.
Molly E
ME
Dempsey
Bone, Spine and Hand Surgery, Chartered, Brick, New Jersey, American Academy of Orthopaedic Surgeons, Rosemont, Illinois.
Ian B
IB
Fries
Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Viviane
V
Khoury
Brigham & Women's Hospital, Boston, Massachusetts.
Bharti
B
Khurana
Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania.
Timothy J
TJ
Mosher
Mayo Clinic, Phoenix, Arizona.
Catherine C
CC
Roberts
University of Wisconsin Hospital, Madison, Wisconsin.
Michael J
MJ
Tuite
Tufts Medical Center, Boston, Massachusetts.
Robert J
RJ
Ward
Thomas Jefferson University, Philadelphia, Pennsylvania.
Adam C
AC
Zoga
Brigham & Women's Hospital, Boston, Massachusetts.
Barbara N
BN
Weissman
D000208:Acute Disease; D003952:Diagnostic Imaging / Q000592:standards*; D018409:Foot Injuries / Q000175:diagnosis*; D006801:Humans; D017410:Practice Guidelines as Topic; D011871:Radiology / Q000592:standards*; D014481:United States
Appropriateness Criteria; Ottawa Rules; acute trauma; adult; child; foot trauma