How X-rays Can Be Used To Help Diagnose Foot Pain (And How They Can't)

As my practice adds digital x-ray capabilities, I am reminded that it may be a good idea to explain to everyone the exact role that x-rays play in helping to diagnose foot pain.  It is often assumed that x-rays can see 'everything' in the foot and make diagnosing foot conditions easy.  This is not necessarily the case, although x-rays do give us useful and important information.  X-rays help to demonstrate the following:

Fractures-
Most fractures are visible on standard x-rays of the foot.  The severity and thus the potential treatment course can be gleaned from an x-ray image.  Some deep fractures well within the foot cannot be easily visualized on x-rays due to bone overlap.  Likewise, stress fractures are not well visualized on x-rays until several months after they develop.  CT or MRI are better suited to evaluate these types of fractures.

Foot structure-
The general structure of the foot, including arch position and other variables in bone development, can be determined by evaluating a weight bearing x-ray, or one that is taken while standing.  Foot structure contributes greatly to many foot and ankle conditions, and appropriate treatment often includes measures that stabilizes or changes abnormal foot structure.  X-rays allow this to take place.

Foot deformities-
Conditions such as bunions, hammertoes, and bone spurs are best evaluated through x-rays to determine their severity.  The degree of the deformity, as well as potential ways to surgically correct the deformities are directly determined by x-ray evaluation.

Gas in soft tissue-
Gas in soft tissue is seen on x-ray as dark bubbles.  It is important to asses for this when evaluating serious foot infection, as the presence of gas can indicate a serious leg and life threatening infection that needs immediate surgical treatment.

Non-fractured bone disease-
There are many conditions that involve bone destruction or deformation.  These include systemic diseases that whittle away bone, bone destruction from lack of blood supply, bone infection, and cysts, masses, and abscesses.  These are often diagnosed on the basis of an x-ray evaluation, although additional studies like MRI and bone scans are used as additional diagnostic measures.

Arthritis-
Arthritic conditions, like common osteoarthritis, gout, rheumatoid arthritis, and other systemic arthritic conditions, can be diagnosed and monitored through x-rays.  By visualizing the degree of joint destruction, reparative options can be determined or the potential effectiveness of nonsurgical treatment can be estimated.

What x-rays do not visualize is equally as important in the realistic expectation one has with the diagnostic study.  X-rays cannot show soft tissue, such as tendon injuries, nerve inflammation, ligament damage, soft masses, and cysts.  Many people assume x-rays can show these things, when in fact they cannot.  While x-rays do offer a great deal of assistance in the evaluation of foot disease, they are not helpful in all situations.  Your doctor will make the best determination as to whether x-rays will be of  benefit in your diagnosis.

Until next time,
Scott R. Kilberg DPM

www.inpodiatrygroup.com - foot surgeon, podiatrist in Indianapolis
thediabeticfoot.blogspot.com - diabetic foot problems
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A foot doctor in Indianapolis Noblesville Fishers Carmel Westfield and Fortville Indiana.