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Review highlights importance of accurate diagnosis and treatment of foot and ankle injuries

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Misdiagnosis of six common foot and ankle injuries often results in poor long-term patient outcomes, including arthritis and disability, according to a new study by orthopaedic surgeons.

The clinical review, published in the Journal of the American Osteopathic Association, focuses on subtleties that complicate the 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.

Because physicians may have difficulty detecting snowboarder’s fracture on plain radiographs and patients present with lateral ankle pain and swelling, these injuries are frequently misdiagnosed as severe ankle sprains, the authors explain. However, untreated lateral talar process fractures have a high likelihood for development of subtalar osteoarthritis, causing severe pain and disability years after injury.

Os trigonum injuries are often confused with Achilles tendon and flexor hallucis longus injuries because of the proximity of the os trigonum to these structures. But if these conditions are undiagnosed, athletes compensate by rotating the hindfoot and ankle into a varus position, leading to other conditions such as peroneal tendinitis, recurrent ankle sprains, and sinus tarsi syndrome.

The review states that healthcare professionals dealing with foot and ankle injuries must have a firm understanding of injury anatomy, diagnoses and management, and should consider the use of additional imaging and second opinions to ensure accurate diagnosis and treatment.

“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,” explained lead author Dr Jessica Reissig, of the Department of Orthopaedics 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.”