With improvements in imaging technology, more and more abnormalities are being visualised in the body. Many of these abnormalities however cause no discomfort to the patient and their detection does not necessarily benefit the patient. It may in fact make it more difficult for the referring clinician, who has to decide which abnormality to treat.
MRI scanning has exacerbated this problem. In the great majority of cases the reporting radiologist has no contact with the patient. Any abnormality detected therefore is recorded regardless and it is left to the referring clinician to sort the wheat from the chaff.
An ultrasound examination, where the examining sonographer/sonologist can palpate any visible abnormality and determine its clinical significance leads to a much more useful report.
The author has been involved in a study assessing the forefoot for the presence of Morton's neuromata in patients with no symptoms in this region. All were assessed before the ultrasound scan by a foot and ankle surgeon. The results, to be given in the presentation, confirm the findings of other studies based on MRI scan findings: asymptomatic Morton's neuromata are very common and are often multiple. It is therefore important to evaluate at the time of scanning whether any neuroma is sensitive to pressure and whether this reproduces the patient's symptoms.
Other forefoot lesions such as 'intermetatarsal bursitis' have been overcalled on MRI scanning. Plantar plate tears are often under called.
How to assess those lesions which are clinically significant will be emphasised.