08/16/2013    Bill Greco, DPM

Diagnostic Ultrasound ( Bryan C. Markinson, DPM

Is the example of ten ultrasound-guided steroid
injections an example of the fallibility of
ultrasound or the incompetence of care, bordering
on malpractice, of one individual?

Ultrasound as a practice adjunct will provide the
practitioner valuable information. Is the mass
cellular or fluid? Is it lobulated or a single
chamber? Are there extensions of the mass beyond
the palpable boundaries? Is it extending from a
tendon sheath or a joint capsule? Ultrasound can
be a valuable tool in the armamentarium of
podiatric medicine. It can often be the
difference between a successful outcome or a
reoccurrence.

That is not to say that aspiration and cytology
is not applicable. That is another valuable tool
in assisting our diagnostic regimen. From the
insurance perspective, it is a low cost
diagnostic tool that can assist is the diagnosis
and treatment of many podiatric conditions. Can
it be abused? Yes, as can every other diagnostic
modality.

Are more studies needed? Yes, as with many other
modalities ongoing studies on outcome based
medicine and efficacy are always welcome. Does
this make it a poor tool? In the wrong hands any
tool can be used improperly? If ultrasound
improves a clinician’s outcomes and improves
his/her overall confidence in their diagnostic
decisions and treatment protocols, how can you
find fault in the modality?

We should be promoting improved education in
proper use of the modality, CME and or
Certification in its use and continued research
and scientific study into its capabilities and
limitations. Podiatry needs to raise the bar of
understanding in every aspect of medicine and
surgery in our scope of our practice. As my
father once told me to my annoyance, “ do not
throw the baby out with the bath water.” Improve
our understanding and use of ultrasound as a
profession rather than harp on its flaws. That
is how we will grow, in spite of the one who
thinks ten ultrasound-guided steroid injections
is proper medicine.

Bill Greco, DPM, New Rochelle , NY,
William.Greco@va.gov

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