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Misdiagnosis of Common Foot and Ankle Injuries May Result in Arthritis, Chronic Pain and Disability

A clinical review in The Journal of the American Osteopathic Association highlights the importance of additional imaging and second opinions for accurate diagnosis and treatment.

By AOA Media Team


The Journal of the American Osteopathic Association Review Highlights Importance of Additional Imaging, Second Opinions for Accurate Diagnosis and Treatment

CHICAGO—January 30, 2017Front-line physicians are advised to err on the side of caution and opt for additional imaging and second opinions when diagnosing six common foot and ankle injuries. A new study by orthopedic surgeons finds misdiagnosis often results in poor long-term patient outcomes, including arthritis and disability.

Their clinical review, published in the February edition of The Journal of the American Osteopathic Association, outlined subtleties that complicate identification and treatment of snowboarder's fracture (lateral talar process fractures) as well as os trigonum injuries, Lisfranc injuries, turf toe, navicular stress fractures and syndesmotic injuries.

More than 3 million emergency room visits in the United States each year are related to common foot and ankle injuries. The authors encourage clinicians to be suspicious and obtain 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 elite athletes. In many cases, the clinical symptoms are vague and tough to detect with standard imaging," said lead author Jessica Reissig, DO, of the Department of Orthopedics at Plainview Hospital in New York. "As an osteopathic physician, I view treatment of foot and ankle injuries as acute and preventative care because a mismanaged injury leads to so many future problems for patients."

Dr. Reissig noted that untreated snowboarder's fractures, Lisfranc injuries and turf toe have a high correlation to future arthritis, as well as the potential for severe pain and disability years after the injury. Improper treatment of other foot and ankle traumas can result in compensation injuries and other issues including tendinitis and recurrent ankle sprains.

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, said 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 explained.

About The Journal of the American Osteopathic Association

The Journal of the American Osteopathic Association (JAOA) is the official scientific publication of the American Osteopathic Association. Edited by Robert Orenstein, DO, it is the premier scholarly peer-reviewed publication of the osteopathic medical profession. The JAOA’s mission is to advance medicine through the publication of peer-reviewed osteopathic research.

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