What is the best imaging modality for diagnosing foot pain (foot discomfort)?

From the Guidelines

For patients presenting with foot pain, radiography is the recommended initial imaging modality. This is based on the American College of Radiology's (ACR) appropriateness criteria for chronic foot pain, which suggests that conventional radiography can be useful to distinguish among different causes of chronic foot pain and is usually the first imaging study in evaluating patients with chronic foot pain 1. The ACR criteria note that radiography has been shown to be effective in diagnosing various conditions, including tarsal coalitions, stress fractures, and osteoarthritis, with sensitivities ranging from 80% to 100% and specificities ranging from 88% to 98% for radiographs in the diagnosis of calcaneonavicular coalitions 1.

Some of the key advantages of radiography include its ability to:

• Detect bone abnormalities, such as fractures and arthritis
• Evaluate the alignment of bone structures
• Identify structural abnormalities, such as tarsal coalitions
• Provide a cost-effective initial evaluation

While other imaging modalities, such as MRI, CT, and ultrasound, may be useful in certain situations, radiography is generally the best initial choice for evaluating foot pain. For example, MRI may be useful for evaluating soft tissue structures, such as tendons and ligaments, but it is not typically recommended as the first imaging study for chronic foot pain 1. Ultrasound may be useful for evaluating conditions such as plantar fasciitis and Achilles tendonitis, but it is not typically recommended as the first imaging study for chronic foot pain either 1. CT scans may be useful for evaluating complex fractures and subtle bone abnormalities, but they are not typically recommended as the first imaging study for chronic foot pain 1.

In terms of specific conditions, radiography has been shown to be effective in diagnosing:

• Tarsal coalitions, with sensitivities ranging from 80% to 100% and specificities ranging from 88% to 98% 1
• Stress fractures, with sensitivities ranging from 12% to 56% and specificities ranging from 88% to 96% 1
• Osteoarthritis, with radiographs representing the first imaging study usually performed to evaluate the first metatarsal sesamoids and may be useful to diagnose sesamoid dislocation and osteoarthritis 1

Overall, radiography is a useful initial imaging modality for evaluating foot pain, and it should be considered the first line of imaging for patients presenting with this symptom.

From the Research

Imaging Options for Foot Pain

• Magnetic Resonance Imaging (MRI) is a commonly used imaging modality for evaluating foot pain, particularly for conditions such as plantar fasciitis, Morton's neuroma, and Achilles tendinopathy 2.
• MRI can help identify the underlying cause of foot pain, including osseous and osteochondral injuries, ligamentous injuries, and tendon pathology 2.
• Other imaging modalities, such as X-rays and ultrasound, may also be used to evaluate foot pain, but MRI is often preferred for its high sensitivity and specificity 2.

Diagnostic Criteria for Foot Pain

• Plantar fasciitis is a common cause of heel pain, and MRI can help diagnose this condition by showing thickening of the plantar fascia and inflammation in the surrounding tissues 3, 4.
• Morton's neuroma is a condition that causes pain and numbness in the ball of the foot, and MRI can help diagnose this condition by showing interdigital neuronal thickening and fibrosis 4.
• Achilles tendinopathy is a condition that causes pain and inflammation in the Achilles tendon, and MRI can help diagnose this condition by showing tendon thickening and inflammation 4.

Treatment Options for Foot Pain

• Conservative treatment options for foot pain include rest, ice, compression, and elevation (RICE), as well as physical therapy, orthotics, and pain medication 3, 4.
• More advanced treatment options for foot pain include extracorporeal shockwave therapy, corticosteroid injections, and platelet-rich plasma injections 4, 5.
• MRI can help guide treatment decisions by providing detailed images of the affected tissues and helping to identify the underlying cause of foot pain 5, 2.