Identifying and Monitoring Deficiencies in Physical Examination of the Foot and Ankle with Diagnostic Ultrasound: Experience from a Physical Medicine and Rehabilitation Residency Training Program.Am J Phys Med Rehabil. 2020 Mar 18 [Online ahead of print]AJ
Despite the high incidence of foot and ankle injuries and their biomechanical importance to more proximal joints, the foot and ankle are some of the most daunting and underemphasized musculoskeletal structures in medical training. This study used musculoskeletal ultrasound to identify a knowledge gap in Physical Medicine and Rehabilitation (PM&R) residents in foot and ankle surface anatomy palpation and to determine if senior residents had higher examination performance compared to more junior residents. PM&R residents at different levels of training were tested cross-sectionally and palpation accuracy was compared by class year. There was a trend of improvement across class years, with significant class differences in accuracy for the talonavicular joint, calcaneocuboidal joint, and posterior tibialis and peroneal tendons (p<0.05). Despite this trend, the accuracy was not consistently higher among the senior residents considering the training they received. For all 30 residents assessed, accuracy within 1cm was highest for the tibiotalar joint (93.3%), peroneal tendons (83.3%), posterior tibialis tendon (63.3%), and talonavicular joint (50%). It was lower for the calcaneocuboidal joint (26.7%), and the second (13.3%) and fourth tarsometatarsal joints (20%). Anatomical knowledge and palpation skills of the foot and ankle, particularly at the midfoot and forefoot, may be an area of improvement for PM&R resident training.