Therefore, CT is essential for appropriate treatment planning and determining the true extent of osseous injuries in the polytrauma patient and can be used as primary imaging technique in high-energy polytrauma patients. Initial clinical experience suggests that cone-beam CT of the foot or ankle of pediatric patients is a viable lower- dose alternative to multidetector CT [26]. MRI Foot MRI is not routinely used as the first imaging study for the evaluation of acute trauma to the foot in the setting of peripheral neuropathy, penetrating trauma, or polytrauma. US Foot US is not routinely used as the first imaging study for the evaluation of acute trauma to the foot in the setting of peripheral neuropathy or polytrauma. Both radiographs and US are useful imaging tools to exclude a foreign body in the setting of penetrating trauma to the foot [24]. US is the imaging modality of choice if the foreign body is not radiopaque (eg, wood or plastic), with a reported 90% sensitivity for visualizing wooden foreign bodies in some clinical and experimental studies [27,28]. US can identify a foreign body and also help localize it and determine if it involves a tendon or a muscle and to evaluate for an abscess. Variant 4: 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. Suspected pathology in an anatomic area not addressed by Ottawa rules (not involving the midfoot; eg, metatarsal-phalangeal joint, metatarsal, toe, tendon, etc). Initial imaging. In clinical situations when Ottawa rules are applicable and negative, imaging may still be desired to evaluate for injuries not assessed by the Ottawa rules. For example, clinical scenarios of acute foot trauma not directly addressed by the Ottawa rules include trauma to the metatarsal heads and toes and acute tendon injury.
Acute Trauma to the Foot. Therefore, CT is essential for appropriate treatment planning and determining the true extent of osseous injuries in the polytrauma patient and can be used as primary imaging technique in high-energy polytrauma patients. Initial clinical experience suggests that cone-beam CT of the foot or ankle of pediatric patients is a viable lower- dose alternative to multidetector CT [26]. MRI Foot MRI is not routinely used as the first imaging study for the evaluation of acute trauma to the foot in the setting of peripheral neuropathy, penetrating trauma, or polytrauma. US Foot US is not routinely used as the first imaging study for the evaluation of acute trauma to the foot in the setting of peripheral neuropathy or polytrauma. Both radiographs and US are useful imaging tools to exclude a foreign body in the setting of penetrating trauma to the foot [24]. US is the imaging modality of choice if the foreign body is not radiopaque (eg, wood or plastic), with a reported 90% sensitivity for visualizing wooden foreign bodies in some clinical and experimental studies [27,28]. US can identify a foreign body and also help localize it and determine if it involves a tendon or a muscle and to evaluate for an abscess. Variant 4: 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. Suspected pathology in an anatomic area not addressed by Ottawa rules (not involving the midfoot; eg, metatarsal-phalangeal joint, metatarsal, toe, tendon, etc). Initial imaging. In clinical situations when Ottawa rules are applicable and negative, imaging may still be desired to evaluate for injuries not assessed by the Ottawa rules. For example, clinical scenarios of acute foot trauma not directly addressed by the Ottawa rules include trauma to the metatarsal heads and toes and acute tendon injury.