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Misdiagnosis of foot and ankle injuries may result in complications

JAOA review highlights importance of additional imaging, second opinions for accurate diagnosis and treatment.

The misdiagnosis of common foot and ankle injuries may result in poor long-term patient outcomes including arthritis, chronic pain and disability, according to the findings of a clinical review in The Journal of the American Osteopathic Association (JAOA).

The review outlines subtleties that complicate identification and treatment of common foot and ankle injuries, including snowboarder’s fracture (lateral talar process fractures) as well as os trigonum injuries, Lisfranc injuries, turf toe, navicular stress fractures and syndesmotic injuries. The authors encourage physicians treating these injuries to err on the side of caution and opt for additional imaging or a second opinion from an orthopedic surgeon to confirm the initial diagnosis.

“These types of trauma are a clinically significant source of morbidity and long-term disability among patients, not just those who are in elite athletes. In many cases, the clinical symptoms are vague and tough to detect with standard imaging,” says lead author Jessica Reissig, DO, of the Department of Orthopedics at Plainview Hospital in New York.

Left untreated, snowboarder’s fractures, Lisfranc injuries and turf toe could lead to arthritis and have the potential to cause severe pain and disability years after the injury, Dr. Reissig says. Improper treatment of other foot and ankle traumas can result in compensation injuries and other issues, including tendinitis and recurrent ankle sprains.

Seeking relief

While in many cases these injuries can be resolved with a combination of medication, immobilization, ice and rest, some require surgical intervention. Elite athletes may also opt for surgery in order to resume their sport sooner, says co-author Adam Bitterman, DO, of the Hofstra Northwell School of Medicine.

“Once the diagnosis is confirmed, in many cases patients can be offered a range of treatment options, from conservative to surgical. Choosing the best treatment for the individual can prevent the injury from decreasing the patient’s future quality of life,” Dr. Bitterman explains.

See the JAOA clinical review for more information about the findings.

    2 comments

    1. As a (retired) radiologist, disappointing not to see any images in the article. I believe these would have been of assistance to all physicians, no matter the specialty.

      1. My thoughts as well. Not only lack of radiographs, but lack of specificity of data. It’s written too general and broad, like a CNN article, not a medical journal for physicians. Great subject! Wish it were more complete.

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