I read with interest the letter to the editor by Dr Kostas Panagiotopoulos in the November 2021 issue of the BCMJ. I would like to add another suggestion to save time, money, and resources. For 8 years I was director of St. Paul’s F.A.S.T. Clinic (Foot and Ankle Screening and Triage). I also provide lower extremity virtual consultation for GPs in BC for their patients with orthopaedic problems through The RACE Line (Rapid Access for Consultative Expertise). In most cases, imaging has already been obtained before I am consulted. For foot and ankle problems, it is often essential and critical for these issues to be evaluated with weight-bearing radiographs. Unfortunately, most preliminary imaging is done without weight-bearing stress by default. This makes many common conditions such as Lisfranc’s fracture dislocation and syndesmosis disruption accompanying ankle injuries very difficult to diagnose. The lack of appropriate imaging also necessitates additional imaging with its additional burden on resources and cost, not to mention the inconvenience to the patient to go back for more X-rays. I strongly recommend to GPs in BC that all foot and ankle radiographs be requested with weight-bearing views unless the severity of the trauma or pain precludes standing imaging.
—Jeffrey L. Nacht, MD
Clinical Professor of Orthopaedic Surgery, UBC Faculty of Medicine
This letter was submitted in response to “Unnecessary musculoskeletal MRIs.”
Comment from Dr Brian Day: Dr Nacht makes a valid point that I wholeheartedly support. I would simply add that, when possible, weight-bearing views should also be performed in the assessment of hip and knee joint pathology, especially when there is a possibility that a procedural intervention may be required. As Dr Nacht points out with the foot and ankle, acute trauma where a fracture may be present are exceptions.
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