Putz C, Hagmann S, Dreher T
Abteilung Kinderorthopädie, Neuroorthopädie und Fußchirurgie, Zentrum für Orthopädie und Unfallchirurgie, Orthopädische Universitätsklinik Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland.
Radiologe. 2018 May;58(5):400-405. doi: 10.1007/s00117-017-0347-3.
CLINICAL/METHODICAL ISSUE: Foot pain is in the case of long-term congenital, acquired or posttraumatic foot deformities a relevant clinical problem.
On the basis of the clinical findings and the orthopaedic question, radiographs of the foot while standing in two planes are supplemented by radiographs of the ankle in an anterior-posterior plane. The imaging diagnostics of the foot are based on the conventional X‑ray diagnostic workup and becomes even more precise and differentiated by the possibility of intersecting imaging procedures.
The diagnostic significance of imaging methods is discussed in this overview by means of clinical examples. In this context, cross-sectional imaging procedures can serve the clinician in the further decision-making process and clarify the question whether surgical treatment, for example, in the case osteoarthrosis is indicated.
Primarily, prior to any imaging procedure the appropriate medical history, inspection, clinical examination and the gait analysis in patients with foot pain are necessary. Interdisciplinary communication between orthopaedic/trauma surgeons and radiologists is necessary in order to provide the right imaging modality for difficult questions, to correctly interpret the resulting imaging findings, and to derive a therapeutic consequence from this. The decision whether conservative therapy or a surgical procedure is recommended will be made depending on the patients' prior therapies and the restriction of quality of life.
临床/方法学问题:对于长期先天性、后天性或创伤后足部畸形患者,足部疼痛是一个相关的临床问题。
根据临床检查结果和骨科问题,站立位足部双平面X线片辅以踝关节前后位X线片。足部的影像诊断基于传统的X线诊断检查,而交叉成像检查可使其更加精确和具有鉴别性。
本综述通过临床实例讨论了成像方法的诊断意义。在这种情况下,横断面成像检查可为临床医生的进一步决策提供帮助,并明确例如骨关节炎病例是否需要手术治疗的问题。
首先,对于足部疼痛患者,在进行任何成像检查之前,都需要了解适当的病史、进行体格检查、临床检查和步态分析。骨科/创伤外科医生与放射科医生之间的跨学科沟通是必要的,以便为疑难问题提供正确的成像方式,正确解读所得的影像结果,并从中得出治疗结论。建议采用保守治疗还是手术治疗,将取决于患者先前的治疗情况以及生活质量受限程度。