title: Point-of-care ultrasonography in a physiatric foot clinic.
abstract: BACKGROUND
  Few reports are available for the utility of diagnostic point-of-care (POC) ultrasonography for foot and ankle pain and diagnostic POC ultrasonography in physiatric practice has not yet been demonstrated.
  
  
  OBJECTIVE
  To describe POC musculoskeletal ultrasonographic (US) findings by location of pain among patients presenting to a foot pain clinic and to evaluate the concordance rate between clinical diagnoses and US findings by region of the foot.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Outpatient clinic.
  
  
  METHODS
  A total of 111 patients with foot and ankle pain.
  
  
  METHODS
  Retrospective chart review of clinical notes and data from POC US evaluation of patients who presented to the foot pain clinic between November 2013 and January 2015. US evaluations were performed by two physiatric ultrasonographers.
  
  
  METHODS
  The concordance rate of clinical diagnosis and findings from US imaging based on the location of foot pain.
  
  
  RESULTS
  One hundred eleven patients out of 205 patients who presented to the foot clinic (54.1%) had POC US evaluation during the initial visit. The data was analyzed for patients with a single location of pain excluding 21 patients with pain more than one location. The mean age was 55.1±14.3 years with 86.5% being female. The most common location of pain was the hindfoot/ankle (N.=71), followed by forefoot (N.=13) and midfoot (N.=6). The overall concordance rate between clinical and ultrasonographic diagnoses was 62.2% (56/90) with a higher concordance rate in the hindfoot (67.6%) compared to the rest of the foot (50% in midfoot, 38.5% in the forefoot, P=0.042). The most common reasons for discordance (N.=34) were failure to reveal abnormality on US (N.=20, 58%) followed by unexpected US findings (N.=7, 20.6%).
  
  
  CONCLUSIONS
  Concordance between clinical evaluation and POC US findings varies depending on the location of foot pain and often no US abnormalities were found in spite of clinical symptoms particularly in forefoot region.
  
  
  CONCLUSIONS
  These new findings will enhance the selective application of POC US and improve its clinical utility in physiatric practice.
authors.affiliation: Montefiore Medical Center, New York City, NY, USA - sewlee@montefiore.org.
authors.forename: Se W
authors.initials: SW
authors.lastname: Lee
authors.affiliation: Montefiore Medical Center, New York City, NY, USA.
authors.forename: Dennis D
authors.initials: DD
authors.lastname: Kim
authors.affiliation: Montefiore Medical Center, New York City, NY, USA.
authors.forename: Phuong
authors.initials: P
authors.lastname: LE
authors.affiliation: Montefiore Medical Center, New York City, NY, USA.
authors.forename: Mathew N
authors.initials: MN
authors.lastname: Bartels
authors.affiliation: Kessler Institute for Rehabilitation, Rutgers New Jersey Medical School, West Orange, NJ, USA.
authors.forename: Mooyeon
authors.initials: M
authors.lastname: Oh-Park
mesh_terms: D000554:Ambulatory Care Facilities; D000842:Ankle / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D005260:Female; D005528:Foot / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000000981:diagnostic imaging* / Q000209:etiology; D019095:Point-of-Care Systems; D012189:Retrospective Studies; D014463:Ultrasonography / Q000295:instrumentation / Q000379:methods*