The more serious potential problems in determining the need for imaging occurs in the patient who does not meet the inclusion criteria for imaging by the Ottawa rules of the foot. These inclusionary criteria are stated in the Introduction/Background section [5,6]; added criterion of swelling increases sensitivity and specificity [3,4]. One should carefully evaluate the patient to make sure they do not meet any of the exclusionary criteria before implementing the Ottawa rules. Radiographs may be appropriate in certain clinical scenarios when Ottawa rules cannot be applied. Also, trauma to the distal forefoot (metatarsal heads and toes) is not directly addressed by the Ottawa rules. In general, if a fracture of a toe is suspected, radiographs can document or rule out a fracture [11,12]. CT Foot In this clinical scenario and in absence of exclusionary criteria for the Ottawa rules, CT is not routinely used as the first imaging study for the evaluation of acute trauma to the foot. MRI Foot MRI is not routinely used as the first imaging study for the evaluation of acute trauma to the foot. US Foot A preliminary ultrasound (US) study has had less successful results compared with radiographic evaluation, with 90.9% sensitivity and specificity for detecting fracture [13]. A recent consensus paper from the European Society of Musculoskeletal Radiology [14] assigned low grading scores for US assessment of talus and bony avulsions. Variant 2: Adult or child older than 5 years of age. Acute trauma to the foot. Ottawa rules can be evaluated without exclusionary criteria. Ottawa rules are positive. Initial imaging. Radiography Foot Radiographs are indicated by positive Ottawa rules with 99% sensitivity in determining the presence of a foot fracture [1,9,10]. Radiographs are the mainstay of initial imaging in the setting of acute foot trauma. Initial imaging typically consists of a 3-view study with the possibility of additional views as indicated by the clinical setting [8].
Acute Trauma to the Foot. The more serious potential problems in determining the need for imaging occurs in the patient who does not meet the inclusion criteria for imaging by the Ottawa rules of the foot. These inclusionary criteria are stated in the Introduction/Background section [5,6]; added criterion of swelling increases sensitivity and specificity [3,4]. One should carefully evaluate the patient to make sure they do not meet any of the exclusionary criteria before implementing the Ottawa rules. Radiographs may be appropriate in certain clinical scenarios when Ottawa rules cannot be applied. Also, trauma to the distal forefoot (metatarsal heads and toes) is not directly addressed by the Ottawa rules. In general, if a fracture of a toe is suspected, radiographs can document or rule out a fracture [11,12]. CT Foot In this clinical scenario and in absence of exclusionary criteria for the Ottawa rules, CT is not routinely used as the first imaging study for the evaluation of acute trauma to the foot. MRI Foot MRI is not routinely used as the first imaging study for the evaluation of acute trauma to the foot. US Foot A preliminary ultrasound (US) study has had less successful results compared with radiographic evaluation, with 90.9% sensitivity and specificity for detecting fracture [13]. A recent consensus paper from the European Society of Musculoskeletal Radiology [14] assigned low grading scores for US assessment of talus and bony avulsions. Variant 2: Adult or child older than 5 years of age. Acute trauma to the foot. Ottawa rules can be evaluated without exclusionary criteria. Ottawa rules are positive. Initial imaging. Radiography Foot Radiographs are indicated by positive Ottawa rules with 99% sensitivity in determining the presence of a foot fracture [1,9,10]. Radiographs are the mainstay of initial imaging in the setting of acute foot trauma. Initial imaging typically consists of a 3-view study with the possibility of additional views as indicated by the clinical setting [8].