Other clinical scenarios of foot trauma not directly addressed by the Ottawa rules include trauma to the metatarsal heads and toes and penetrating trauma with concern for a foreign body in the soft tissues. Also, there is little in the literature on medical decision making of when to order a radiographic study of the toes [8]. Discussion of Procedures by Variant Variant 1: 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 negative. No suspected abnormalities in regions not evaluated by the Ottawa rules. Initial imaging. When assessing acute trauma to the foot, it is very important to determine that there are no exclusionary criteria for evaluation by Ottawa rules, in which case the rules cannot be applied; see Variant 3. In addition, there are clinical scenarios that are not specifically assessed by the Ottawa rules because the rules mainly address injuries to the midfoot. Such scenarios, for example, include injuries to the forefoot; see Variant 4. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document. Reprint requests to: publications@acr.org Acute Trauma to the Foot Radiography Foot The Ottawa rules were designed to minimize unnecessary radiographs for patients with acute ankle and foot injuries [6]. The Ottawa rules for acute trauma to the foot are fairly well established and have been validated by multiple institutional trials verifying the 99% sensitivity in determining the presence of a foot fracture [1,9,10].
Acute Trauma to the Foot. Other clinical scenarios of foot trauma not directly addressed by the Ottawa rules include trauma to the metatarsal heads and toes and penetrating trauma with concern for a foreign body in the soft tissues. Also, there is little in the literature on medical decision making of when to order a radiographic study of the toes [8]. Discussion of Procedures by Variant Variant 1: 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 negative. No suspected abnormalities in regions not evaluated by the Ottawa rules. Initial imaging. When assessing acute trauma to the foot, it is very important to determine that there are no exclusionary criteria for evaluation by Ottawa rules, in which case the rules cannot be applied; see Variant 3. In addition, there are clinical scenarios that are not specifically assessed by the Ottawa rules because the rules mainly address injuries to the midfoot. Such scenarios, for example, include injuries to the forefoot; see Variant 4. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document. Reprint requests to: publications@acr.org Acute Trauma to the Foot Radiography Foot The Ottawa rules were designed to minimize unnecessary radiographs for patients with acute ankle and foot injuries [6]. The Ottawa rules for acute trauma to the foot are fairly well established and have been validated by multiple institutional trials verifying the 99% sensitivity in determining the presence of a foot fracture [1,9,10].