The impact of foot and ankle radiographs in the diagnosis and management of patients with ankle pain
Authors:   , Revell Andrew 
Published: October 2021

Background: Foot and ankle problems are highly prevalent in the general population. An accurate diagnosis is often difficult despite a careful and detailed clinical history as well as physical examination. Identifying the cause of ankle pain is essential for timely and adequate treatment although it is often challenging for the physician due to the complexity of the joint. The initial assessment typically involves the use of radiographs which play a key role in the diagnosis and management of ankle pain. Although radiographs play a key role in the assessment of foot and ankle pain the overutilization of radiographs worldwide emphasises the need to investigate the correlation between clinical conditions and the outcome of the radiographic examination. Literature is currently limited on the role of foot and ankle radiographs and their influence on the diagnosis and management for patients with foot and/or ankle pain. Aim: This study aimed to investigate any correlation between clinical and radiographic diagnosis of the foot and ankle. The impact the radiological diagnosis had on the clinical diagnosis and management was determined for patients that presented with foot and/or ankle pain at the Durban University of Technology (DUT) Chiropractic Day Clinic (CDC). Method: The picture achieving and communication system (PACS) at the Radiography Department at the Durban University of Technology (DUT) was searched for all available foot and ankle radiographs with their corresponding patient files at the CDC regarding foot and/or ankle pain. The ABCS (alignment, bone, cartilage, soft tissue) system was utilized to record data of the radiographs without any knowledge of the patient’s main complaint. The corresponding patient files were then evaluated with selected clinical variables being recorded. Statistical analysis and interpretation included frequency counts, percentages, mean, standard deviation and ranges for the descriptive objectives. The radiographic and clinical diagnoses were then compared in a two-by-two table to determine any possible relationship in diagnoses of patients with foot and/or ankle pain. Results: A total of n = 26 clinical files and their corresponding foot or ankle radiographs were analysed in this study. The average age of the patients was 38.12 years with a gender distribution of 53.80% males and 46.20% females. The majority of foot and ankle radiographs (57.69%) were requested at the initial consultation. The most common reason for radiographic examination referral was trauma, check for fracture at 20.80%, pain on palpation at 16.70% and no response to conservative management at 16.70%. The primary clinical diagnosis changed in a total of 7.70% of patients following radiographic examination. Most patients were diagnosed with non-specific mechanical causes of foot and ankle pain. A wide variety of treatment modalities were utilized before and after radiographic examination, including soft tissue therapy, electro modalities, extremity manipulative therapy (EMT) and dry needling. A total of 38.00% of cases in this study had a change in management protocol post radiographic examination. Conclusion: Foot and ankle radiographs have little impact on the diagnosis and management of patients with foot and/or ankle pain as the majority of clinical diagnoses were non- specific mechanical causes of foot and ankle pain. Foot or ankle radiographs were influential in the diagnosis of 7.70% and in 38.00% of management of cases. Foot and ankle radiographs may therefore be over utilized at the DUT CDC.