Point-of-care ultrasonography in a physiatric foot clinic

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. AIM: 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. DESIGN: Retrospective chart review. SETTING: Outpatient clinic. POPULATION: 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. MAIN OUTCOME MEASURES: 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. CLINICAL REHABILITATION IMPACT: These new findings will enhance the selective application of POC US and improve its clinical utility in physiatric practice.