Guidelines
Guidelines Summary
The American College of Radiology Appropriateness Criteria for acute trauma to the foot include the following [44] :
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If a patient with acute foot trauma does not meet the inclusion criteria to be evaluated by the Ottawa Rules (such as a diabetic with peripheral neuropathy involving the foot), then imaging should be obtained. The first imaging study in this scenario should be a 3-view radiographic series of the foot.
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If there is clinical concern for a midfoot injury (such as a Lisfranc injury), then imaging should be performed. The first imaging study in this situation is usually a 3-view radiographic series of the foot with weight bearing on at least the AP view, if possible. If there is continued clinical concern for a Lisfranc injury in the setting of a normal radiograph, then advanced imaging (MRI or CT) should be considered and performed on a case-by-case basis. Likewise, when there is clinical concern for an acute tendon rupture, further imaging with MRI or US would be confirmatory.
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If there is clinical suspicion for plantar plate injury after MTP joint injury, radiography is the initial imaging modality. Weight-bearing AP, lateral, and sesamoid axial views may detect proximal migration of one or both hallux sesamoids with great toe injuries. US and MRI can directly evaluate the soft-tissue structures of the capsuloligamentous complex, specifically the plantar plate.
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In the setting of penetrating trauma to the foot with a possible foreign body, radiography (if the foreign body is radiopaque) or US (with nonradiopaque foreign bodies) should be used to determine if a foreign body is indeed present.
Media Gallery
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Fractures, foot. Proximal fifth metatarsal avulsion fracture (also termed pseudo-Jones, tennis, or dancer fracture).
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Fractures, foot. Jones fracture of the fifth metatarsal.
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Fractures, foot. Lisfranc fracture-dislocation.
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Fractures, foot. Calcaneal fracture with intraarticular involvement and joint depression.
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Fractures, foot. Calcaneal fracture with intraarticular involvement and joint depression with Böehler angle imposed. Reduced angle of 16 degrees is pathologic.
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Fractures, foot. Subtle fracture of the first cuneiform at the Lisfranc joint. Another fracture at the base of the first metatarsal is not seen here but was found on subsequent computed tomography.
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Fractures, foot. CT scan showing fracture of first cuneiform and proximal first metatarsal.
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Fractures, foot. Spiral fracture of the shaft of the fifth metatarsal. This fracture was treated conservatively with immobilization.
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Fractures, foot. Minimally displaced fracture of the distal fifth metatarsal. This fracture was treated conservatively with immobilization in a rigid flat bottom shoe.
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Fractures, foot. Two fractures of the proximal phalanx of the great toe. The fracture at the base is obvious, but the fracture at the head is more subtle. Make certain to examine every bone on the radiograph to avoid being distracted by obvious finding.
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Comminuted navicular fracture in a young drunk driver involved in a motor vehicle crash. The patient sustained no other injuries and was discharged in a plaster splint with strict nonweightbearing. The patient subsequently had a computerized tomography (CT) scan and underwent open reduction and internal fixation 9 days after the injury. A standard anteroposterior (AP) view is shown here.
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An added oblique view of this same patient with a navicular fracture was performed in the ED to help verify the absence of other significant fractures. Obtaining views that are not part of the routine foot series can be helpful and should be added when needed.
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