• Evidence and expert consensus shows an increase of musculoskeletal ultrasound indications. • Four new A evidence levels were found for the hip, knee, ankle, and foot. • There was no level A evidence for elastography.

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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.

The aim of this study was to assess whether side-to-side differences in morphology and function of the upper limbs in 11-12 year-old male baseball players with throwing-related pain (n=14) were more pronounced than that of age-matched healthy untrained subjects (n=16). Baseball players 1) had played baseball≥4.5 h·wk for ≥ 4 years and (2) suffered from moderate-intensity (3-6 points on 10-point questionnaire scale) throwing-related pain in the shoulder or elbow in at least 2 training sessions within the past month. The range of motion (ROM), function and structure of the elbows and shoulders were assessed using goniometry, isokinetic dynamometry and ultrasonography. While the ROM and eccentric external peak torque of internal shoulder rotation were lower, the thickness of the supraspinatus tendon, the ulnar collateral ligament and articular cartilage of the humeral head were larger in baseball players than controls. There were, however, no significant side-to-side differences in any parameter in either group. In conclusion, it is unlikely that side-to-side differences in shoulder and upper limb structure and function contributed to the throwing-related pain in young baseball players, but low shoulder eccentric external peak torque and range of internal rotation may predispose to throwing-related pain.