Clinical indications for image-guided interventional procedures in the musculoskeletal system: a Delphi-based consensus paper from the European Society of Musculoskeletal Radiology (ESSR)-part VI, foot and ankle

Luca Maria Sconfienza, Miraude Adriaensen, Domenico Albano, Andrea Alcala-Galiano, Georgina Allen, Maria Pilar Aparisi Gómez, Giacomo Aringhieri, Alberto Bazzocchi, Ian Beggs, Vito Chianca, Angelo Corazza, Danoob Dalili, Miriam De Dea, Jose Luis Del Cura, Francesco Di Pietto, Elena Drakonaki, Fernando Facal de Castro, Dimitrios Filippiadis, Salvatore Gitto, Andrew J Grainger, Simon Greenwood, Harun Gupta, Amanda Isaac, Slavcho Ivanoski, Monica Khanna, Andrea Klauser, Ramy Mansour, Silvia Martin, Vasco Mascarenhas, Giovanni Mauri, Catherine McCarthy, David McKean, Eugene McNally, Kalliopi Melaki, Carmelo Messina, Rebeca Mirón Mombiela, Ricardo Moutinho, Cyprian Olchowy, Davide Orlandi, Raquel Prada González, Mahesh Prakash, Magdalena Posadzy, Saulius Rutkauskas, Žiga Snoj, Alberto Stefano Tagliafico, Alexander Talaska, Xavier Tomas, Violeta Vasilevska Nikodinovska, Jelena Vucetic, David Wilson, Federico Zaottini, Marcello Zappia, Marina Obradov, Luca Maria Sconfienza, Miraude Adriaensen, Domenico Albano, Andrea Alcala-Galiano, Georgina Allen, Maria Pilar Aparisi Gómez, Giacomo Aringhieri, Alberto Bazzocchi, Ian Beggs, Vito Chianca, Angelo Corazza, Danoob Dalili, Miriam De Dea, Jose Luis Del Cura, Francesco Di Pietto, Elena Drakonaki, Fernando Facal de Castro, Dimitrios Filippiadis, Salvatore Gitto, Andrew J Grainger, Simon Greenwood, Harun Gupta, Amanda Isaac, Slavcho Ivanoski, Monica Khanna, Andrea Klauser, Ramy Mansour, Silvia Martin, Vasco Mascarenhas, Giovanni Mauri, Catherine McCarthy, David McKean, Eugene McNally, Kalliopi Melaki, Carmelo Messina, Rebeca Mirón Mombiela, Ricardo Moutinho, Cyprian Olchowy, Davide Orlandi, Raquel Prada González, Mahesh Prakash, Magdalena Posadzy, Saulius Rutkauskas, Žiga Snoj, Alberto Stefano Tagliafico, Alexander Talaska, Xavier Tomas, Violeta Vasilevska Nikodinovska, Jelena Vucetic, David Wilson, Federico Zaottini, Marcello Zappia, Marina Obradov

Abstract

Objectives: Clarity regarding accuracy and effectiveness for interventional procedures around the foot and ankle is lacking. Consequently, a board of 53 members of the Ultrasound and Interventional Subcommittees of the European Society of Musculoskeletal Radiology (ESSR) reviewed the published literature to evaluate the evidence on image-guided musculoskeletal interventional procedures around this anatomical region.

Methods: We report the results of a Delphi-based consensus of 53 experts from the European Society of Musculoskeletal Radiology who reviewed the published literature for evidence on image-guided interventional procedures offered around foot and ankle in order to derive their clinical indications. Experts drafted a list of statements and graded them according to the Oxford Centre for evidence-based medicine levels of evidence. Consensus was considered strong when > 95% of experts agreed with the statement or broad when > 80% but < 95% agreed. The results of the Delphi-based consensus were used to write the paper that was shared with all panel members for final approval.

Results: A list of 16 evidence-based statements on clinical indications for image-guided musculoskeletal interventional procedures in the foot and ankle were drafted after a literature review. The highest level of evidence was reported for four statements, all receiving 100% agreement.

Conclusion: According to this consensus, image-guided interventions should not be considered a first-level approach for treating Achilles tendinopathy, while ultrasonography guidance is strongly recommended to improve the efficacy of interventional procedures for plantar fasciitis and Morton's neuroma, particularly using platelet-rich plasma and corticosteroids, respectively.

Key points: • The expert panel of the ESSR listed 16 evidence-based statements on clinical indications of image-guided musculoskeletal interventional procedures in the foot and ankle. • Strong consensus was obtained for all statements. • The highest level of evidence was reached by four statements concerning the effectiveness of US-guided injections of corticosteroid for Morton's neuroma and PRP for plantar fasciitis.

Keywords: Achilles tendon; Ankle; Foot; Interventional radiology; Ultrasonograph.

Conflict of interest statement

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

© 2021. The Author(s).

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