MRI Foot There is no relevant literature to support the use of MRI as the first imaging study in the evaluation of chronic foot pain. Radiography Foot 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. The value of radiographs in the diagnosis of tarsal coalitions has been extensively demonstrated. Overall sensitivities range from 80% to 100% and specificities range from 97% to 98% have been reported for radiographs in the diagnosis of calcaneonavicular coalitions. Most calcaneonavicular coalitions are easily detected on lateral and oblique radiographs of the foot and confirmed on sagittal CT or MRI scans [11]. Talocalcaneal or subtalar coalition may be overlooked on standard foot radiographs due to overlapping structures; however, secondary signs on the lateral view could suggest a subtalar coalition. An overall sensitivity of 100% and a specificity of 88% have been found for radiographs in the diagnosis of talocalcaneal coalitions [12]. CT and MRI remain the most reliable methods for diagnosing subtalar coalitions. Radiographs are usually performed initially in the clinical setting of a suspected stress fracture. A systematic review by Wright et al [13] reported sensitivities ranging from 12% to 56% and specificities ranging from 88% to 96% for radiographs in the detection of lower-extremity stress fractures. Though radiography is typically insensitive in the diagnosis of fasciitis, it should be the initial imaging study in patients with a painful heel. Evidence supports the use of weightbearing radiographs in this instance [5]. The combination of thickened plantar fascia and fat pad abnormalities on radiographs has a sensitivity of 85% and a specificity of 95% for plantar fasciitis [15]. Variant 2: Persistent posttraumatic foot pain. Radiographs negative or equivocal. Clinical concern includes complex regional pain syndrome type I. Next imaging study.
Chronic Foot Pain. MRI Foot There is no relevant literature to support the use of MRI as the first imaging study in the evaluation of chronic foot pain. Radiography Foot 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. The value of radiographs in the diagnosis of tarsal coalitions has been extensively demonstrated. Overall sensitivities range from 80% to 100% and specificities range from 97% to 98% have been reported for radiographs in the diagnosis of calcaneonavicular coalitions. Most calcaneonavicular coalitions are easily detected on lateral and oblique radiographs of the foot and confirmed on sagittal CT or MRI scans [11]. Talocalcaneal or subtalar coalition may be overlooked on standard foot radiographs due to overlapping structures; however, secondary signs on the lateral view could suggest a subtalar coalition. An overall sensitivity of 100% and a specificity of 88% have been found for radiographs in the diagnosis of talocalcaneal coalitions [12]. CT and MRI remain the most reliable methods for diagnosing subtalar coalitions. Radiographs are usually performed initially in the clinical setting of a suspected stress fracture. A systematic review by Wright et al [13] reported sensitivities ranging from 12% to 56% and specificities ranging from 88% to 96% for radiographs in the detection of lower-extremity stress fractures. Though radiography is typically insensitive in the diagnosis of fasciitis, it should be the initial imaging study in patients with a painful heel. Evidence supports the use of weightbearing radiographs in this instance [5]. The combination of thickened plantar fascia and fat pad abnormalities on radiographs has a sensitivity of 85% and a specificity of 95% for plantar fasciitis [15]. Variant 2: Persistent posttraumatic foot pain. Radiographs negative or equivocal. Clinical concern includes complex regional pain syndrome type I. Next imaging study.