I meet clinicians who seem unconvinced of value of B-mode high-resolution ultrasound compared to radiographic exam to investigate foot degenerative joint disease. I am posting an illustrative example for discussion. As usual I am keen to meet a contrary viewpoint; I believe that US may have greater value than CR as first line to investigate non traumatic midfoot pain.
• Referral from physiotherapist for non responsive foot pain. 60 yo female; denied prior foot surgery, persistent fairly severe bilateral dorsal midfoot pain worsening and of several years duration. Insidious onset and denied recollection of a traumatic event.
• Primary care physician ordered recent radiographic exam radiology was reported normal.
• Subsequent scintigraphy suggestive for degenerative joint disease but poorly specific for site.
• Some pain on rising from bed in morning; worsens towards end of day.
• Occupation as airport security officer requires constant standing and walking at work.
• Reported being unable to exercise because of her foot pain.
• Reported being in good general health.
• Primary care physician prescribed Celebrex; this has been used for past four weeks without significant benefits so far.
• Bilaterally some mild swelling and tenderness at dorsal midfoot, left greater than right. Provocative testing with double limb stance heel raise resulted in generalised dorsal midfoot pain
non weight-bearing CRs of this case attached as .pdfs
Point of this thread is to see if anyone can accurately detect site of degenerative joint disease from attached CR (I can't).
I will post US images as alternative to CR and scintigraphy for those interested after several days to illustrate value of US in this type of case.
Foot and Ankle Clinic
1365 Grant Ave.
Winnipeg Manitoba R3M 1Z8
phone  837 FOOT (3668)
fax  774 9918