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acr-appropriateness-criteria--chronic-foot-pain
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<h1>ACR Appropriateness Criteria® chronic foot pain.</h1>
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<table><tr><td>Wise JN, Weissman BN, Appel M, Arnold E, Bancroft L, Bruno MA, Fries IB, Hayes CW, Jacobson JA, Kransdorf MJ, Luchs JS, Morrison WB, Mosher TJ, Murphey MD, Palestro CJ, Roberts CC, Rubin DA, Tuite MJ, Ward RJ, Zoga AC, Expert Panel on Musculoskeletal Imaging. ACR Appropriateness Criteria® chronic foot pain. [online publication]. Reston (VA): American College of Radiology (ACR); 2013. 10 p. [45 references]</td></tr></table> <p><a href="/web/20180712205457/https://www.guideline.gov/Home/Disclaimer?id=47669&contentType=fulltextlink&redirect=https%253a%252f%252facsearch.acr.org%252fdocs%252f69424%252fNarrative">View the original guideline documentation</a> <img alt="External Web Site Policy" src="/web/20180712205457im_/https://www.guideline.gov/UI/images/icon_externallink.gif"/></p>
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<p><div class="content_para"><p>This is the current release of the guideline.</p>
<p>This guideline updates a previous version: Wise JN, Daffner RH, Weissman BN, Arnold E, Bennett DL, Blebea JS, Jacobson JA, Morrison WB, Payne WK III, Resnik CS, Roberts CC, Schweitzer ME, Seeger LL, Taljanovic MS, Expert Panel on Musculoskeletal Imaging. ACR Appropriateness Criteria® chronic foot pain. [online publication]. Reston (VA): American College of Radiology (ACR); 2008. 8 p.</p></div></p>
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<h4>UMLS Concepts <a href="/web/20180712205457/https://www.guideline.gov/help-and-about/search-browse/umls-concepts" class="what-is">(what is this?)</a></h4>
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<h5 class="field-label">ICD9CM</h5>
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<a href="/web/20180712205457/https://www.guideline.gov/search?f_ICD9CM_CUI=C0203668&fLockTerm=Bone+scan">Bone scan</a>
(92.14) </div>
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<h5 class="field-label">MSH</h5>
<div class="field-content">
<a href="/web/20180712205457/https://www.guideline.gov/search?f_MSH_CUI=C0008679&fLockTerm=Chronic+Disease">Chronic Disease</a>
, <a href="/web/20180712205457/https://www.guideline.gov/search?f_MSH_CUI=C0150055&fLockTerm=Chronic+Pain">Chronic Pain</a>
, <a href="/web/20180712205457/https://www.guideline.gov/search?f_MSH_CUI=C0009924&fLockTerm=Contrast+Media">Contrast Media</a>
, <a href="/web/20180712205457/https://www.guideline.gov/search?f_MSH_CUI=C0011906&fLockTerm=Diagnosis%2c+Differential">Diagnosis, Differential</a>
, <a href="/web/20180712205457/https://www.guideline.gov/search?f_MSH_CUI=C0016510&fLockTerm=Foot+Diseases">Foot Diseases</a>
, <a href="/web/20180712205457/https://www.guideline.gov/search?f_MSH_CUI=C0024485&fLockTerm=Magnetic+Resonance+Imaging">Magnetic Resonance Imaging</a>
, <a href="/web/20180712205457/https://www.guideline.gov/search?f_MSH_CUI=C0030193&fLockTerm=Pain">Pain</a>
, <a href="/web/20180712205457/https://www.guideline.gov/search?f_MSH_CUI=C1962945&fLockTerm=Radiography">Radiography</a>
, <a href="/web/20180712205457/https://www.guideline.gov/search?f_MSH_CUI=C0034606&fLockTerm=Radionuclide+Imaging">Radionuclide Imaging</a>
, <a href="/web/20180712205457/https://www.guideline.gov/search?f_MSH_CUI=C0206057&fLockTerm=Technetium+Compounds">Technetium Compounds</a>
, <a href="/web/20180712205457/https://www.guideline.gov/search?f_MSH_CUI=C0936234&fLockTerm=Tomography+Scanners%2c+X-Ray+Computed">Tomography Scanners, X-Ray Computed</a>
, <a href="/web/20180712205457/https://www.guideline.gov/search?f_MSH_CUI=C0040405&fLockTerm=Tomography%2c+X-Ray+Computed">Tomography, X-Ray Computed</a>
, <a href="/web/20180712205457/https://www.guideline.gov/search?f_MSH_CUI=C0041618&fLockTerm=Ultrasonography">Ultrasonography</a>
</div>
<!-- /.field-content -->
</div>
<!-- /.field -->
<div class="field">
<h5 class="field-label">MTH</h5>
<div class="field-content">
<a href="/web/20180712205457/https://www.guideline.gov/search?f_MTH_CUI=C0008679&fLockTerm=Chronic+disease">Chronic disease</a>
, <a href="/web/20180712205457/https://www.guideline.gov/search?f_MTH_CUI=C0150055&fLockTerm=Chronic+pain">Chronic pain</a>
, <a href="/web/20180712205457/https://www.guideline.gov/search?f_MTH_CUI=C0936234&fLockTerm=Computed+Tomography+Scanning+Systems">Computed Tomography Scanning Systems</a>
, <a href="/web/20180712205457/https://www.guideline.gov/search?f_MTH_CUI=C0009924&fLockTerm=Contrast+Media">Contrast Media</a>
, <a href="/web/20180712205457/https://www.guideline.gov/search?f_MTH_CUI=C0043299&fLockTerm=Diagnostic+radiologic+examination">Diagnostic radiologic examination</a>
, <a href="/web/20180712205457/https://www.guideline.gov/search?f_MTH_CUI=C0011906&fLockTerm=Differential+Diagnosis">Differential Diagnosis</a>
, <a href="/web/20180712205457/https://www.guideline.gov/search?f_MTH_CUI=C0016510&fLockTerm=Foot+Diseases">Foot Diseases</a>
, <a href="/web/20180712205457/https://www.guideline.gov/search?f_MTH_CUI=C0016512&fLockTerm=Foot+pain">Foot pain</a>
, <a href="/web/20180712205457/https://www.guideline.gov/search?f_MTH_CUI=C0024485&fLockTerm=Magnetic+Resonance+Imaging">Magnetic Resonance Imaging</a>
, <a href="/web/20180712205457/https://www.guideline.gov/search?f_MTH_CUI=C0030193&fLockTerm=Pain">Pain</a>
, <a href="/web/20180712205457/https://www.guideline.gov/search?f_MTH_CUI=C1962945&fLockTerm=Radiographic+imaging+procedure">Radiographic imaging procedure</a>
, <a href="/web/20180712205457/https://www.guideline.gov/search?f_MTH_CUI=C0203668&fLockTerm=Radioisotope+scan+of+bone">Radioisotope scan of bone</a>
, <a href="/web/20180712205457/https://www.guideline.gov/search?f_MTH_CUI=C0034606&fLockTerm=Radionuclide+Imaging">Radionuclide Imaging</a>
, <a href="/web/20180712205457/https://www.guideline.gov/search?f_MTH_CUI=C0303611&fLockTerm=Technetium+99m">Technetium 99m</a>
, <a href="/web/20180712205457/https://www.guideline.gov/search?f_MTH_CUI=C0041618&fLockTerm=Ultrasonography">Ultrasonography</a>
, <a href="/web/20180712205457/https://www.guideline.gov/search?f_MTH_CUI=C0040405&fLockTerm=X-Ray+Computed+Tomography">X-Ray Computed Tomography</a>
</div>
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</div>
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<div class="field">
<h5 class="field-label">PDQ</h5>
<div class="field-content">
<a href="/web/20180712205457/https://www.guideline.gov/search?f_PDQ_CUI=C0040405&fLockTerm=computed+tomography">computed tomography</a>
, <a href="/web/20180712205457/https://www.guideline.gov/search?f_PDQ_CUI=C0043299&fLockTerm=diagnostic+radiology">diagnostic radiology</a>
, <a href="/web/20180712205457/https://www.guideline.gov/search?f_PDQ_CUI=C0024485&fLockTerm=magnetic+resonance+imaging">magnetic resonance imaging</a>
, <a href="/web/20180712205457/https://www.guideline.gov/search?f_PDQ_CUI=C0030193&fLockTerm=pain">pain</a>
, <a href="/web/20180712205457/https://www.guideline.gov/search?f_PDQ_CUI=C0034606&fLockTerm=radionuclide+imaging">radionuclide imaging</a>
, <a href="/web/20180712205457/https://www.guideline.gov/search?f_PDQ_CUI=C0041618&fLockTerm=ultrasonography">ultrasonography</a>
</div>
<!-- /.field-content -->
</div>
<!-- /.field -->
<div class="field">
<h5 class="field-label">SNOMEDCT_US</h5>
<div class="field-content">
<a href="/web/20180712205457/https://www.guideline.gov/search?f_SNOMEDCT_US_CUI=C0303611&fLockTerm=%5e99m%5eTechnetium">^99m^Technetium</a>
(353687008), <a href="/web/20180712205457/https://www.guideline.gov/search?f_SNOMEDCT_US_CUI=C0303611&fLockTerm=%5e99m%5eTechnetium">^99m^Technetium</a>
(72454006), <a href="/web/20180712205457/https://www.guideline.gov/search?f_SNOMEDCT_US_CUI=C0008679&fLockTerm=Chronic+disease">Chronic disease</a>
(27624003), <a href="/web/20180712205457/https://www.guideline.gov/search?f_SNOMEDCT_US_CUI=C0150055&fLockTerm=Chronic+pain">Chronic pain</a>
(82423001), <a href="/web/20180712205457/https://www.guideline.gov/search?f_SNOMEDCT_US_CUI=C0040405&fLockTerm=Computerized+axial+tomography">Computerized axial tomography</a>
(77477000), <a href="/web/20180712205457/https://www.guideline.gov/search?f_SNOMEDCT_US_CUI=C0009924&fLockTerm=Contrast+media">Contrast media</a>
(385420005), <a href="/web/20180712205457/https://www.guideline.gov/search?f_SNOMEDCT_US_CUI=C0009924&fLockTerm=Contrast+media">Contrast media</a>
(407935004), <a href="/web/20180712205457/https://www.guideline.gov/search?f_SNOMEDCT_US_CUI=C0011906&fLockTerm=Differential+diagnosis">Differential diagnosis</a>
(47965005), <a href="/web/20180712205457/https://www.guideline.gov/search?f_SNOMEDCT_US_CUI=C0016510&fLockTerm=Disorder+of+foot">Disorder of foot</a>
(118932009), <a href="/web/20180712205457/https://www.guideline.gov/search?f_SNOMEDCT_US_CUI=C0016512&fLockTerm=Foot+pain">Foot pain</a>
(47933007), <a href="/web/20180712205457/https://www.guideline.gov/search?f_SNOMEDCT_US_CUI=C0024485&fLockTerm=Magnetic+resonance+imaging">Magnetic resonance imaging</a>
(113091000), <a href="/web/20180712205457/https://www.guideline.gov/search?f_SNOMEDCT_US_CUI=C0024485&fLockTerm=Magnetic+resonance+imaging">Magnetic resonance imaging</a>
(312250003), <a href="/web/20180712205457/https://www.guideline.gov/search?f_SNOMEDCT_US_CUI=C0336660&fLockTerm=Magnetic+resonance+imaging+unit">Magnetic resonance imaging unit</a>
(90003000), <a href="/web/20180712205457/https://www.guideline.gov/search?f_SNOMEDCT_US_CUI=C0034606&fLockTerm=Nuclear+medicine+imaging+procedure">Nuclear medicine imaging procedure</a>
(373205008), <a href="/web/20180712205457/https://www.guideline.gov/search?f_SNOMEDCT_US_CUI=C0030193&fLockTerm=Pain">Pain</a>
(22253000), <a href="/web/20180712205457/https://www.guideline.gov/search?f_SNOMEDCT_US_CUI=C1962945&fLockTerm=Radiographic+imaging+procedure">Radiographic imaging procedure</a>
(363680008), <a href="/web/20180712205457/https://www.guideline.gov/search?f_SNOMEDCT_US_CUI=C0203668&fLockTerm=Radioisotope+scan+of+bone">Radioisotope scan of bone</a>
(41747008), <a href="/web/20180712205457/https://www.guideline.gov/search?f_SNOMEDCT_US_CUI=C0206057&fLockTerm=Technetium+compound">Technetium compound</a>
(47379009), <a href="/web/20180712205457/https://www.guideline.gov/search?f_SNOMEDCT_US_CUI=C0041618&fLockTerm=Ultrasonography">Ultrasonography</a>
(16310003), <a href="/web/20180712205457/https://www.guideline.gov/search?f_SNOMEDCT_US_CUI=C0041618&fLockTerm=Ultrasonography">Ultrasonography</a>
(278292003) </div>
<!-- /.field-content -->
</div>
<!-- /.field -->
<div class="field">
<h5 class="field-label">SPN</h5>
<div class="field-content">
<a href="/web/20180712205457/https://www.guideline.gov/search?f_SPN_CUI=C0302622&fLockTerm=SYSTEM%2c+IMAGING%2c+PULSED+DOPPLER%2c+ULTRASONIC">SYSTEM, IMAGING, PULSED DOPPLER, ULTRASONIC</a>
, <a href="/web/20180712205457/https://www.guideline.gov/search?f_SPN_CUI=C0336660&fLockTerm=SYSTEM%2c+NUCLEAR+MAGNETIC+RESONANCE+IMAGING">SYSTEM, NUCLEAR MAGNETIC RESONANCE IMAGING</a>
, <a href="/web/20180712205457/https://www.guideline.gov/search?f_SPN_CUI=C0936234&fLockTerm=SYSTEM%2c+X-RAY%2c+TOMOGRAPHY%2c+COMPUTED">SYSTEM, X-RAY, TOMOGRAPHY, COMPUTED</a>
</div>
<!-- /.field-content -->
</div>
<!-- /.field -->
<div class="field">
<h5 class="field-label">UMD</h5>
<div class="field-content">
<a href="/web/20180712205457/https://www.guideline.gov/search?f_UMD_CUI=C0009924&fLockTerm=Contrast+Media">Contrast Media</a>
(16-573), <a href="/web/20180712205457/https://www.guideline.gov/search?f_UMD_CUI=C0492899&fLockTerm=Radiographic+Systems">Radiographic Systems</a>
(18-429), <a href="/web/20180712205457/https://www.guideline.gov/search?f_UMD_CUI=C0936234&fLockTerm=Scanning+Systems%2c+Computed+Tomography">Scanning Systems, Computed Tomography</a>
(13-469), <a href="/web/20180712205457/https://www.guideline.gov/search?f_UMD_CUI=C0336660&fLockTerm=Scanning+Systems%2c+Magnetic+Resonance+Imaging">Scanning Systems, Magnetic Resonance Imaging</a>
(16-260), <a href="/web/20180712205457/https://www.guideline.gov/search?f_UMD_CUI=C0302622&fLockTerm=Scanning+Systems%2c+Ultrasonic">Scanning Systems, Ultrasonic</a>
(14-278) </div>
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<p class="text-label"><label for="citation">Citation: </label></p>
<textarea id="citation">National Guideline Clearinghouse (NGC). Guideline summary: ACR Appropriateness Criteria® chronic foot pain. In: National Guideline Clearinghouse (NGC) [Web site]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2013 Jan 01. [cited 2018 Jul 12]. Available: https://www.guideline.gov</textarea>
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<h2 id="420" class="accordion-title section-420 is-active" role="tab" aria-expanded="true"><a href="#">Recommendations</a></h2>
<div class="accordion-panel is-active" role="tabpanel">
<h3><a href="#">Major Recommendations</a></h3>
<p><div class="content_para"><p><strong>ACR Appropriateness Criteria®</strong></p>
<p><strong><span style="text-decoration: underline;">Clinical Condition:</span> Chronic Foot Pain</strong></p>
<p><strong><span style="text-decoration: underline;">Variant 1:</span> Chronic foot pain of unknown etiology. First study.</strong></p>
<table style="cellspacing: 1;" border="1" cellpadding="5" summary="Table: Variant 1: Chronic foot pain of unknown etiology. First study">
<thead>
<tr>
<th width="30%" class="Center" valign="bottom" scope="col">Radiologic Procedure</th>
<th width="20%" class="Center" valign="bottom" scope="col">Rating</th>
<th width="40%" class="Center" valign="bottom" scope="col">Comments</th>
<th width="25%" class="Center" valign="bottom" scope="col">RRL*</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="top">X-ray foot</td>
<td class="Center" valign="top">9</td>
<td valign="top">See the text below for information on views.</td>
<td class="Center" valign="top"><img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/></td>
</tr>
<tr>
<td valign="top">CT foot without contrast</td>
<td class="Center" valign="top">1</td>
<td valign="top"> </td>
<td class="Center" valign="top"><img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/></td>
</tr>
<tr>
<td valign="top">CT foot with contrast</td>
<td class="Center" valign="top">1</td>
<td valign="top"> </td>
<td class="Center" valign="top"><img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/></td>
</tr>
<tr>
<td valign="top">CT foot without and with contrast</td>
<td class="Center" valign="top">1</td>
<td valign="top"> </td>
<td class="Center" valign="top"><img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/></td>
</tr>
<tr>
<td valign="top">MRI foot without contrast</td>
<td class="Center" valign="top">1</td>
<td valign="top"> </td>
<td class="Center" valign="top">O</td>
</tr>
<tr>
<td valign="top">MRI foot without and with contrast</td>
<td class="Center" valign="top">1</td>
<td valign="top"> </td>
<td class="Center" valign="top">O</td>
</tr>
<tr>
<td valign="top">Tc-99m bone scan foot</td>
<td class="Center" valign="top">1</td>
<td valign="top"> </td>
<td class="Center" valign="top"><img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/> <img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/> <img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/></td>
</tr>
<tr>
<td valign="top">US foot</td>
<td class="Center" valign="top">1</td>
<td valign="top"> </td>
<td class="Center" valign="top">O</td>
</tr>
</tbody>
<tfoot>
<tr>
<th valign="top" colspan="3"><span style="text-decoration: underline;">Rating Scale</span>: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate</th>
<th class="Center" valign="top">*Relative Radiation Level</th>
</tr>
</tfoot>
</table>
<p>Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.</p>
<p><strong><span style="text-decoration: underline;">Variant 2:</span> Adult or child. Painful rigid flat foot. Radiographs unremarkable or equivocal and clinical concern for tarsal coalition.</strong></p>
<table border="1" cellspacing="1" cellpadding="5" summary="Table: Variant 2: Adult or child. Painful rigid flat foot. Radiographs unremarkable or equivocal and clinical concern for tarsal coalition">
<thead>
<tr>
<th width="30%" class="Center" valign="bottom" scope="col">Radiologic Procedure</th>
<th width="20%" class="Center" valign="bottom" scope="col">Rating</th>
<th width="40%" class="Center" valign="bottom" scope="col">Comments</th>
<th width="25%" class="Center" valign="bottom" scope="col">RRL*</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="top">CT foot without contrast</td>
<td class="Center" valign="top">9</td>
<td valign="top">CT and MRI are alternative examinations. The RRL for the adult procedure is <img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/>.</td>
<td class="Center" valign="top"><img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/> <img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/></td>
</tr>
<tr>
<td valign="top">MRI foot without contrast</td>
<td class="Center" valign="top">9</td>
<td valign="top">CT and MRI are alternative examinations.</td>
<td class="Center" valign="top">O</td>
</tr>
<tr>
<td valign="top">Tc-99m bone scan foot</td>
<td class="Center" valign="top">2</td>
<td valign="top"> </td>
<td class="Center" valign="top"><img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/> <img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/> <img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/></td>
</tr>
<tr>
<td valign="top">US foot</td>
<td class="Center" valign="top">2</td>
<td valign="top"> </td>
<td class="Center" valign="top">O</td>
</tr>
<tr>
<td valign="top">MRI foot without and with contrast</td>
<td class="Center" valign="top">1</td>
<td valign="top"> </td>
<td class="Center" valign="top">O</td>
</tr>
<tr>
<td valign="top">CT foot with contrast</td>
<td class="Center" valign="top">1</td>
<td valign="top">The RRL for the adult procedure is <img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/>.</td>
<td class="Center" valign="top"><img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/> <img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/></td>
</tr>
<tr>
<td valign="top">CT foot without and with contrast</td>
<td class="Center" valign="top">1</td>
<td valign="top">The RRL for the adult procedure is <img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/>.</td>
<td class="Center" valign="top"><img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/> <img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/></td>
</tr>
</tbody>
<tfoot>
<tr>
<th valign="top" colspan="3"><span style="text-decoration: underline;">Rating Scale</span>: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate</th>
<th class="Center" valign="top">*Relative Radiation Level</th>
</tr>
</tfoot>
</table>
<p>Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.</p>
<p><strong><span style="text-decoration: underline;">Variant 3:</span> Radiographs unremarkable or equivocal and clinical concern for complex regional pain syndrome type I.</strong></p>
<table border="1" cellspacing="1" cellpadding="5" summary="Table: Variant 3: Radiographs unremarkable or equivocal and clinical concern for complex regional pain syndrome type I">
<thead>
<tr>
<th width="30%" class="Center" valign="bottom" scope="col">Radiologic Procedure</th>
<th width="20%" class="Center" valign="bottom" scope="col">Rating</th>
<th width="40%" class="Center" valign="bottom" scope="col">Comments</th>
<th width="25%" class="Center" valign="bottom" scope="col">RRL*</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="top">Tc-99m 3-phase bone scan foot</td>
<td class="Center" valign="top">8</td>
<td valign="top"> </td>
<td class="Center" valign="top"><img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/> <img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/> <img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/></td>
</tr>
<tr>
<td valign="top">US foot</td>
<td class="Center" valign="top">2</td>
<td valign="top"> </td>
<td class="Center" valign="top">O</td>
</tr>
<tr>
<td valign="top">MRI foot without contrast</td>
<td class="Center" valign="top">2</td>
<td valign="top"> </td>
<td class="Center" valign="top">O</td>
</tr>
<tr>
<td valign="top">CT foot without contrast</td>
<td class="Center" valign="top">2</td>
<td valign="top"> </td>
<td class="Center" valign="top"><img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/></td>
</tr>
<tr>
<td valign="top">MRI foot without and with contrast</td>
<td class="Center" valign="top">1</td>
<td valign="top"> </td>
<td class="Center" valign="top">O</td>
</tr>
<tr>
<td valign="top">CT foot with contrast</td>
<td class="Center" valign="top">1</td>
<td valign="top"> </td>
<td class="Center" valign="top"><img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/></td>
</tr>
<tr>
<td valign="top">CT foot without and with contrast</td>
<td class="Center" valign="top">1</td>
<td valign="top"> </td>
<td class="Center" valign="top"><img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/></td>
</tr>
</tbody>
<tfoot>
<tr>
<th valign="top" colspan="3"><span style="text-decoration: underline;">Rating Scale</span>: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate</th>
<th class="Center" valign="top">*Relative Radiation Level</th>
</tr>
</tfoot>
</table>
<p>Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.</p>
<p><strong><span style="text-decoration: underline;">Variant 4:</span> Adult or child. Radiographs noncontributory. Pain and tenderness over head of second metatarsal and clinical concern for Freiberg infraction.</strong></p>
<table border="1" cellspacing="1" cellpadding="5" summary="Table: Variant 4: Adult or child. Radiographs noncontributory. Pain and tenderness over head of second metatarsal and clinical concern for Freiberg infraction">
<thead>
<tr>
<th width="30%" class="Center" valign="bottom" scope="col">Radiologic Procedure</th>
<th width="20%" class="Center" valign="bottom" scope="col">Rating</th>
<th width="40%" class="Center" valign="bottom" scope="col">Comments</th>
<th width="25%" class="Center" valign="bottom" scope="col">RRL*</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="top">X-ray foot</td>
<td class="Center" valign="top">9</td>
<td valign="top">Perform AP and lateral views, with or without oblique views.</td>
<td class="Center" valign="top"><img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/></td>
</tr>
<tr>
<td valign="top">MRI foot without contrast</td>
<td class="Center" valign="top">2</td>
<td valign="top"> </td>
<td class="Center" valign="top">O</td>
</tr>
<tr>
<td valign="top">MRI foot without and with contrast</td>
<td class="Center" valign="top">2</td>
<td valign="top"> </td>
<td class="Center" valign="top">O</td>
</tr>
<tr>
<td valign="top">CT foot without contrast</td>
<td class="Center" valign="top">2</td>
<td valign="top">The RRL for the adult procedure is <img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/>.</td>
<td class="Center" valign="top"><img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/> <img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/></td>
</tr>
<tr>
<td valign="top">CT foot with contrast</td>
<td class="Center" valign="top">2</td>
<td valign="top">The RRL for the adult procedure is <img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/>.</td>
<td class="Center" valign="top"><img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/> <img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/></td>
</tr>
<tr>
<td valign="top">CT foot without and with contrast</td>
<td class="Center" valign="top">2</td>
<td valign="top">The RRL for the adult procedure is <img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/>.</td>
<td class="Center" valign="top"><img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/> <img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/></td>
</tr>
<tr>
<td valign="top">Tc-99m bone scan foot</td>
<td class="Center" valign="top">2</td>
<td valign="top"> </td>
<td class="Center" valign="top"><img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/> <img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/> <img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/></td>
</tr>
<tr>
<td valign="top">US foot</td>
<td class="Center" valign="top">2</td>
<td valign="top"> </td>
<td class="Center" valign="top">O</td>
</tr>
</tbody>
<tfoot>
<tr>
<th valign="top" colspan="3"><span style="text-decoration: underline;">Rating Scale</span>: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate</th>
<th class="Center" valign="top">*Relative Radiation Level</th>
</tr>
</tfoot>
</table>
<p>Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.</p>
<p><strong><span style="text-decoration: underline;">Variant 5:</span> Pain and tenderness over tarsus, unresponsive to conservative therapy. Radiographs showed accessory ossicle.</strong></p>
<table border="1" cellspacing="1" cellpadding="5" summary="Table: Variant 5: Pain and tenderness over tarsus, unresponsive to conservative therapy. Radiographs showed accessory ossicle">
<thead>
<tr>
<th width="30%" class="Center" valign="bottom" scope="col">Radiologic Procedure</th>
<th width="20%" class="Center" valign="bottom" scope="col">Rating</th>
<th width="40%" class="Center" valign="bottom" scope="col">Comments</th>
<th width="25%" class="Center" valign="bottom" scope="col">RRL*</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="top">MRI foot without contrast</td>
<td class="Center" valign="top">9</td>
<td valign="top"> </td>
<td class="Center" valign="top">O</td>
</tr>
<tr>
<td valign="top">Tc-99m bone scan foot</td>
<td class="Center" valign="top">5</td>
<td valign="top">High-resolution techniques are preferred with this procedure.</td>
<td class="Center" valign="top"><img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/> <img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/> <img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/></td>
</tr>
<tr>
<td valign="top">CT foot with contrast</td>
<td class="Center" valign="top">3</td>
<td valign="top"> </td>
<td class="Center" valign="top"><img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/></td>
</tr>
<tr>
<td valign="top">CT foot without and with contrast</td>
<td class="Center" valign="top">3</td>
<td valign="top"> </td>
<td class="Center" valign="top"><img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/></td>
</tr>
<tr>
<td valign="top">MRI foot without and with contrast</td>
<td class="Center" valign="top">2</td>
<td valign="top"> </td>
<td class="Center" valign="top">O</td>
</tr>
<tr>
<td valign="top">CT foot without contrast</td>
<td class="Center" valign="top">2</td>
<td valign="top"> </td>
<td class="Center" valign="top"><img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/></td>
</tr>
<tr>
<td valign="top">US foot</td>
<td class="Center" valign="top">2</td>
<td valign="top"> </td>
<td class="Center" valign="top">O</td>
</tr>
</tbody>
<tfoot>
<tr>
<th valign="top" colspan="3"><span style="text-decoration: underline;">Rating Scale</span>: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate</th>
<th class="Center" valign="top">*Relative Radiation Level</th>
</tr>
</tfoot>
</table>
<p>Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.</p>
<p><strong><span style="text-decoration: underline;">Variant 6:</span> Radiographs unremarkable, equivocal, or further diagnostic information needed. Clinical concern for inflammatory arthropathy, including rheumatoid arthritis.</strong></p>
<table border="1" cellspacing="1" cellpadding="5" summary="Table: Variant 6: Radiographs unremarkable, equivocal, or further diagnostic information needed. Clinical concern for inflammatory arthropathy, including rheumatoid arthritis">
<thead>
<tr>
<th width="30%" class="Center" valign="bottom" scope="col">Radiologic Procedure</th>
<th width="20%" class="Center" valign="bottom" scope="col">Rating</th>
<th width="40%" class="Center" valign="bottom" scope="col">Comments</th>
<th width="25%" class="Center" valign="bottom" scope="col">RRL*</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="top">MRI foot without and with contrast</td>
<td class="Center" valign="top">9</td>
<td valign="top">See statement regarding contrast in text below under "Anticipated Exceptions."</td>
<td class="Center" valign="top">O</td>
</tr>
<tr>
<td valign="top">MRI foot without contrast</td>
<td class="Center" valign="top">8</td>
<td valign="top"> </td>
<td class="Center" valign="top">O</td>
</tr>
<tr>
<td valign="top">US foot</td>
<td class="Center" valign="top">5</td>
<td valign="top">This procedure should be performed with power Doppler.</td>
<td class="Center" valign="top">O</td>
</tr>
<tr>
<td valign="top">Tc-99m bone scan foot</td>
<td class="Center" valign="top">1</td>
<td valign="top"> </td>
<td class="Center" valign="top"><img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/> <img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/> <img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/></td>
</tr>
<tr>
<td valign="top">CT foot without and with contrast</td>
<td class="Center" valign="top">1</td>
<td valign="top"> </td>
<td class="Center" valign="top"><img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/></td>
</tr>
<tr>
<td valign="top">CT foot with contrast</td>
<td class="Center" valign="top">1</td>
<td valign="top"> </td>
<td class="Center" valign="top"><img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/></td>
</tr>
<tr>
<td valign="top">CT foot without contrast</td>
<td class="Center" valign="top">1</td>
<td valign="top"> </td>
<td class="Center" valign="top"><img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/></td>
</tr>
</tbody>
<tfoot>
<tr>
<th valign="top" colspan="3"><span style="text-decoration: underline;">Rating Scale</span>: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate</th>
<th class="Center" valign="top">*Relative Radiation Level</th>
</tr>
</tfoot>
</table>
<p>Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.</p>
<p><strong><span style="text-decoration: underline;">Variant 7:</span> Localized pain at the plantar aspect of the heel. Radiographs unremarkable or equivocal. Clinical concern for plantar fasciitis.</strong></p>
<table border="1" cellspacing="1" cellpadding="5" summary="Table: Variant 7: Localized pain at the plantar aspect of the heel. Radiographs unremarkable or equivocal. Clinical concern for plantar fasciitis">
<thead>
<tr>
<th width="30%" class="Center" valign="bottom" scope="col">Radiologic Procedure</th>
<th width="20%" class="Center" valign="bottom" scope="col">Rating</th>
<th width="40%" class="Center" valign="bottom" scope="col">Comments</th>
<th width="25%" class="Center" valign="bottom" scope="col">RRL*</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="top">MRI foot without contrast</td>
<td class="Center" valign="top">9</td>
<td valign="top"> </td>
<td class="Center" valign="top">O</td>
</tr>
<tr>
<td valign="top">US foot</td>
<td class="Center" valign="top">6</td>
<td valign="top"> </td>
<td class="Center" valign="top">O</td>
</tr>
<tr>
<td valign="top">CT foot without and with contrast</td>
<td class="Center" valign="top">3</td>
<td valign="top"> </td>
<td class="Center" valign="top"><img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/></td>
</tr>
<tr>
<td valign="top">MRI foot without and with contrast</td>
<td class="Center" valign="top">2</td>
<td valign="top"> </td>
<td class="Center" valign="top">O</td>
</tr>
<tr>
<td valign="top">Tc-99m bone scan foot</td>
<td class="Center" valign="top">2</td>
<td valign="top"> </td>
<td class="Center" valign="top"><img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/> <img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/> <img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/></td>
</tr>
<tr>
<td valign="top">CT foot without contrast</td>
<td class="Center" valign="top">1</td>
<td valign="top"> </td>
<td class="Center" valign="top"><img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/></td>
</tr>
<tr>
<td valign="top">CT foot with contrast</td>
<td class="Center" valign="top">1</td>
<td valign="top"> </td>
<td class="Center" valign="top"><img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/></td>
</tr>
</tbody>
<tfoot>
<tr>
<th valign="top" colspan="3"><span style="text-decoration: underline;">Rating Scale</span>: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate</th>
<th class="Center" valign="top">*Relative Radiation Level</th>
</tr>
</tfoot>
</table>
<p>Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.</p>
<p><strong><span style="text-decoration: underline;">Variant 8:</span> Burning pain and paresthesias along the plantar surface of the foot and toes. Radiographs unremarkable or equivocal. Clinical concern for tarsal tunnel syndrome.</strong></p>
<table border="1" cellspacing="1" cellpadding="5" summary="Table: Variant 8: Burning pain and paresthesias along the plantar surface of the foot and toes. Radiographs unremarkable or equivocal. Clinical concern for tarsal tunnel syndrome">
<thead>
<tr>
<th width="30%" class="Center" valign="bottom" scope="col">Radiologic Procedure</th>
<th width="20%" class="Center" valign="bottom" scope="col">Rating</th>
<th width="40%" class="Center" valign="bottom" scope="col">Comments</th>
<th width="25%" class="Center" valign="bottom" scope="col">RRL*</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="top">MRI foot without contrast</td>
<td class="Center" valign="top">9</td>
<td valign="top"> </td>
<td class="Center" valign="top">O</td>
</tr>
<tr>
<td valign="top">MRI foot without and with contrast</td>
<td class="Center" valign="top">7</td>
<td valign="top">See statement regarding contrast in text below under "Anticipated Exceptions."</td>
<td class="Center" valign="top">O</td>
</tr>
<tr>
<td valign="top">US foot</td>
<td class="Center" valign="top">5</td>
<td valign="top">There is limited data on this procedure.</td>
<td class="Center" valign="top">O</td>
</tr>
<tr>
<td valign="top">CT foot without and with contrast</td>
<td class="Center" valign="top">3</td>
<td valign="top"> </td>
<td class="Center" valign="top"><img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/></td>
</tr>
<tr>
<td valign="top">Tc-99m bone scan foot</td>
<td class="Center" valign="top">2</td>
<td valign="top"> </td>
<td class="Center" valign="top"><img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/> <img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/> <img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/></td>
</tr>
<tr>
<td valign="top">CT foot without contrast</td>
<td class="Center" valign="top">1</td>
<td valign="top"> </td>
<td class="Center" valign="top"><img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/></td>
</tr>
<tr>
<td valign="top">CT foot with contrast</td>
<td class="Center" valign="top">1</td>
<td valign="top"> </td>
<td class="Center" valign="top"><img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/></td>
</tr>
</tbody>
<tfoot>
<tr>
<th valign="top" colspan="3"><span style="text-decoration: underline;">Rating Scale</span>: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate</th>
<th class="Center" valign="top">*Relative Radiation Level</th>
</tr>
</tfoot>
</table>
<p>Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.</p>
<p><strong><span style="text-decoration: underline;">Variant 9:</span> Pain in the 3–4 web space with radiation to the toes. Radiographs unremarkable or equivocal. Clinical concern for Morton neuroma.</strong></p>
<table border="1" cellspacing="1" cellpadding="5" summary="Table: Variant 9: Pain in the 3-4 web space with radiation to the toes. Radiographs unremarkable or equivocal. Clinical concern for Morton neuroma">
<thead>
<tr>
<th width="30%" class="Center" valign="bottom" scope="col">Radiologic Procedure</th>
<th width="20%" class="Center" valign="bottom" scope="col">Rating</th>
<th width="40%" class="Center" valign="bottom" scope="col">Comments</th>
<th width="25%" class="Center" valign="bottom" scope="col">RRL*</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="top">MRI foot without and with contrast</td>
<td class="Center" valign="top">9</td>
<td valign="top">MRI and US are alternative examinations. See statement regarding contrast in text below under "Anticipated Exceptions."</td>
<td class="Center" valign="top">O</td>
</tr>
<tr>
<td valign="top">US foot</td>
<td class="Center" valign="top">9</td>
<td valign="top">MRI and US are alternative examinations.</td>
<td class="Center" valign="top">O</td>
</tr>
<tr>
<td valign="top">MRI foot without contrast</td>
<td class="Center" valign="top">7</td>
<td valign="top"> </td>
<td class="Center" valign="top">O</td>
</tr>
<tr>
<td valign="top">CT foot without and with contrast</td>
<td class="Center" valign="top">2</td>
<td valign="top"> </td>
<td class="Center" valign="top"><img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/> <img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/></td>
</tr>
<tr>
<td valign="top">CT foot with contrast</td>
<td class="Center" valign="top">2</td>
<td valign="top"> </td>
<td class="Center" valign="top"><img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/> <img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/></td>
</tr>
<tr>
<td valign="top">Tc-99m bone scan foot</td>
<td class="Center" valign="top">2</td>
<td valign="top"> </td>
<td class="Center" valign="top"><img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/> <img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/> <img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/></td>
</tr>
<tr>
<td valign="top">CT foot without contrast</td>
<td class="Center" valign="top">1</td>
<td valign="top"> </td>
<td class="Center" valign="top"><img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/> <img alt="radioactive" src="https://web.archive.org/web/20180712205457im_/http://guideline.gov/images/image_radioactive.gif"/></td>
</tr>
</tbody>
<tfoot>
<tr>