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Bone Scan results positive for stress fractures

Posted by Monica M. on 9/11/02 at 19:45 (095062)

Hello. I have had foot pain in my right foot for a year and am a marathon runner. I was told back then that I did not need an x-ray--that I had plantar faciitis. It didn't get better. It worsened. I had an x-ray that showed an old 2nd metatarsal fracture (I don't know when this happened). Then I had a bone scan done. The radiologist said that I have a stress fracture in the calcaneous and the lateral maleolus. The orthopedist said that he does not think it is a stress fracture. Since then, two other radiologists have said that based on the location on the bone scan that it is classic stress fracture. Why the discrepancy??? Can you explain any of this? Is the treatment the same??? Thank you. What a confusing mess!

Re: Bone Scan results positive for stress fractures

Dr. Z on 9/11/02 at 20:46 (095067)

Get an mri to rule out the stress fracture. The treatment will depend on the degree of displacement of the stress fractures.

Re: Bone Scan results positive for stress fractures

Ed Davis, DPM on 9/11/02 at 21:17 (095076)

Areas where bones are stressed 'light up' on bone scans. Bad cases of plantar fasciitis often light up around the insertion of the plantar fascia on the calcaneal tuberosity. It is a matter of degree-- stress fractures light up more strongly than PF. Occasionally, making that distinction only by viewing the bone scan itself can be difficult. An MRI as Dr. Z suggests would help to clarify things. Your orthopedist has the advantage of a clinical exam (correlation of clinical findings with the scan results) which is something the radiologists do not have. It is always advantageous when the parties involved talk to each other. The radiologist who performs MRIs for me often calls to discuss things, questioning me about clinical findings -- something that should happen more often.
Ed

Re: Bone Scan results positive for stress fractures

Dr. Z on 9/11/02 at 20:46 (095067)

Get an mri to rule out the stress fracture. The treatment will depend on the degree of displacement of the stress fractures.

Re: Bone Scan results positive for stress fractures

Ed Davis, DPM on 9/11/02 at 21:17 (095076)

Areas where bones are stressed 'light up' on bone scans. Bad cases of plantar fasciitis often light up around the insertion of the plantar fascia on the calcaneal tuberosity. It is a matter of degree-- stress fractures light up more strongly than PF. Occasionally, making that distinction only by viewing the bone scan itself can be difficult. An MRI as Dr. Z suggests would help to clarify things. Your orthopedist has the advantage of a clinical exam (correlation of clinical findings with the scan results) which is something the radiologists do not have. It is always advantageous when the parties involved talk to each other. The radiologist who performs MRIs for me often calls to discuss things, questioning me about clinical findings -- something that should happen more often.
Ed