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RE: Which test?

Posted by Mar on 6/28/03 at 08:41 (123108)

Docs --

In my quest to continually try to understand exactly what is causing my pain, I have a question. I think the PF pain (or even the ball of foot pain for that matter) can be caused by microtears, scar tissue, or tightness of the fascia. Which of the tests (xray, CT, MRI, ultrasound, bone scan, etc), if any, shows the microtears, which shows the scar tissue?? Would it help if I knew which of these things was the real culprit? Thanks - Mar

Re: RE: Which test?

Dr. David S. Wander on 6/29/03 at 09:10 (123143)

Mar,

X-ray, CT, and bone scans will not show soft tissue irregularities, microtears or scar tissue. MRI and ultrasound would be the modalities of choice, IF read by a radiologist well versed in musculoskeletal MRI or diagnostic ultrasound. The advantage of ultrasound is that it can give a 'real time' image, meaning that the ultrasound probe can be in place and the soft tissue can be moved which often helps detect tears. You should discuss this with your doctor and he/she may want to consider both an MRI and an ultrasound since your problem has been so persistent.

Re: RE: Which test?

Dr. Z on 6/29/03 at 10:52 (123149)

Hi

I really feel the cause of your foot problems are the elevation of your first metatarsal head and the hallux limitus. The compensation from your big toe joint not functioning properly is the cause

Re: RE: Which test?

Mar on 6/29/03 at 15:17 (123154)

Hi Dr Z -

I do intend to go for that second opinion that you suggested sometime in July. My pod disagrees with you but agrees that another opinion is wise. My reservation about this is that the left heel is as painful or more so and i do a lot of resting. As soon as I stand for a minute or two or walk a little, the pain escalates in both heels, as well as that right ball of foot. If the left foot is compensatory pain, why hasn;t it eased up with so much rest? I cannot imagine what another surgery would do to my feet...But I will be in touch when I make that other appointment. Thanks - Mar

Re: RE: Which test?

Mar on 6/29/03 at 15:26 (123155)

Dr W --

Would the radiologist have to be specifically looking for microtears and scar tissue (positioning the machine a certain way?) or would it show up automatically? I had an MRI last December and it says ...edema...may represent bone contusions or microfractures. It doesn;t say anything about microtears or scar tissue. I never had a diagnostic ultrasound except with the ESWT machine! Mar

Re: RE: Which test?

Mar on 6/29/03 at 15:31 (123156)

Dr Z / Dr W --

I was just rereading the first CT report I had in November 2001. It says a there is a 3mm bony fragment at the plantar-medial juxta-articular aspect of the first MT head. Could that be causing the chronic inflamation? Also - it says the first distal metatarsal is healed, in normal anatomic alignment. Mar

Re: RE: Which test?

Dr. Z on 6/29/03 at 18:27 (123159)

One of the complications of having bunion surgery with cutting of the first metatarsal bone is weight bearing shift to the less metatarsal heads
thus your pain in the ball of your right foot. The heel pain can be from compensation or it could be separate. Hallux limitus is known to cause plantar fasciitis due to the abnormal pulling of the pf during the gait cycle. There is no question that you have hallux limitus is it is causing the other problem is my opinion. Lets see what Dr. Tursi has to say about all of your foot pain.

Re: RE: Which test?

Mar on 6/30/03 at 07:49 (123178)

What about this bony fragment??? That doesn;t sound good, although no one ever said anything about it. Mar

Re: RE: Which test?

Dr. David S. Wander on 6/30/03 at 21:03 (123270)

It always helps for the radiologist to have a solid history with a differential diagnosis (ie rule out tear of plantar fascia, rule out scar tissue formation,etc.), though a good radiologist will look at the symptomatic area and find any abnormalities.