CT Foot CT is useful for the detection of radiographically occult fractures. Almeida et al [64] reported visualization of Chopart fractures on CT and/or MRI in one-third of cases initially not diagnosed on radiographs. CT also has utility in the diagnosis of occult fractures involving the subtalar joint as demonstrated in the study by Choi et al [65]. CT is a primary imaging technique in patients with high-energy polytrauma and complex fractures, because radiographs have only poor to moderate sensitivity in this clinical setting [66]. More recently, dual-energy CT has been reported as a useful technique in the detection of bone marrow edema, with excellent performance in the appendicular skeleton, with a sensitivity of 98% and specificity of 93% [67]. This could potentially aid in the detection of radiographically occult fractures. CT may be useful to confirm the presence of an accessory ossicle, os fragmentation or fracture, intra-articular bodies, or osteochondral abnormalities. In contrast to conventional radiographs, CT offers multiplanar capability allowing detailed characterization of the ossicle and the synchondrosis. Assessment of associated soft-tissue pathology or bone marrow edema on CT is limited when compared to MRI [68]. There is no relevant literature supporting the routine use of contrast-enhanced CT images in the diagnosis of occult fractures or symptomatic accessory ossicles, besides a possible use of CT arthrography to demonstrate disruption of the synchondrosis in the setting of os trigonum syndrome [69]. Chronic Foot Pain MRI Foot MRI allows the visualization of bone marrow edema patterns, which improves the detection of fractures in cases of negative or inconclusive radiographs [70]. The utility of MRI in the detection of radiographically occult Chopart fractures has been demonstrated by Almeida et al [64].
Chronic Foot Pain. CT Foot CT is useful for the detection of radiographically occult fractures. Almeida et al [64] reported visualization of Chopart fractures on CT and/or MRI in one-third of cases initially not diagnosed on radiographs. CT also has utility in the diagnosis of occult fractures involving the subtalar joint as demonstrated in the study by Choi et al [65]. CT is a primary imaging technique in patients with high-energy polytrauma and complex fractures, because radiographs have only poor to moderate sensitivity in this clinical setting [66]. More recently, dual-energy CT has been reported as a useful technique in the detection of bone marrow edema, with excellent performance in the appendicular skeleton, with a sensitivity of 98% and specificity of 93% [67]. This could potentially aid in the detection of radiographically occult fractures. CT may be useful to confirm the presence of an accessory ossicle, os fragmentation or fracture, intra-articular bodies, or osteochondral abnormalities. In contrast to conventional radiographs, CT offers multiplanar capability allowing detailed characterization of the ossicle and the synchondrosis. Assessment of associated soft-tissue pathology or bone marrow edema on CT is limited when compared to MRI [68]. There is no relevant literature supporting the routine use of contrast-enhanced CT images in the diagnosis of occult fractures or symptomatic accessory ossicles, besides a possible use of CT arthrography to demonstrate disruption of the synchondrosis in the setting of os trigonum syndrome [69]. Chronic Foot Pain MRI Foot MRI allows the visualization of bone marrow edema patterns, which improves the detection of fractures in cases of negative or inconclusive radiographs [70]. The utility of MRI in the detection of radiographically occult Chopart fractures has been demonstrated by Almeida et al [64].