Diagnostic Exams

When you are suffering from pain or discomfort in your feet, ankles,  or lower legs, you need to visit your doctor to determine the source of  the pain. With a series of tests and examinations available, your doctor  can better diagnose your condition and prescribe the best method of  treatment.

Depending on your specific symptoms, your doctor may use one or more  of the following diagnostic tools to identify your condition:

CAT Scans

If you are experiencing foot or ankle pain and your podiatrist cannot  determine the cause through a physical examination, you may need a  computerized axial tomography scan or CAT scan. (This test is also  called a computer tomography or CT scan.)

Need for CAT scans

Some conditions that a CAT scan may diagnose include:

  • Arch deformities.
  • Arthritis, both degenerative and rheumatoid.
  • Bone tumors.
  • Cysts.
  • Flat feet.
  • Other foot and bone deformities.
  • Foreign bodies.
  • Fractures, including stress fractures.
  • Infection.
  • Osteonecrosis (bone death).

Overview of CAT scans

A CAT scan uses x-ray technology, but is often considered more  advanced than a conventional x-ray since it can create a  three-dimensional picture that allows your doctor to more accurately  assess the problem.

During a CAT scan, your foot will pass through a doughnut-shaped  x-ray machine. This machine will rotate and take internal pictures of  your foot and/or ankle. Using computer technology, the machine combines  numerous x-ray images to generate cross-sectional views and  three-dimensional images of the inside of your foot and ankle.

The detail of these images will give your doctor a clear picture of  your foot. This clarity will help your doctor better diagnose your  problem. For example, an image from a CAT scan will show a difference  between a simple cyst and a solid tumor.

CAT Scan Restrictions

The amount of radiation that you are exposed to during a CAT scan is  minimal, so typically there are no restrictions for having this exam.  However, if you are pregnant, especially in your first trimester, it is  not recommended that you undergo a CAT scan due to potential adverse  effects on the fetus.

Disease Screenings

Although symptoms may not appear as dramatic as those from a fracture  or other trauma, diseases and disorders can have an adverse effect on  your feet, ankles, and lower legs. Some conditions are specific to your  feet or lower legs, where other diseases, like diabetes, do not relate  to your feet but can create feet and leg problems (i.e. diabetic  neuropathy).

Screenings for these diseases and disorders can assist in determining proper treatment.

Importance of disease screenings

The sooner you are diagnosed with a disease or foot disorder, the  more effective your treatment can be. Also, if caught early enough, you  can reduce the severity of some complications that affect your feet and  legs.

If you develop symptoms of any type of disease or foot disorder, you  should be tested. You can be screened for various diseases, including  arthritis and peripheral arterial disease, at your doctor's office.

Diseases and disorders affecting your feet, ankles, and lower legs

There are many diseases and disorders that can affect your feet. Some  disorders are specific to the foot, ankle, or lower leg while others  are diseases that can affect your entire body, and also can cause  foot-related issues. Some diseases and disorders than can have an impact  on your foot health include:

  • Arthritis.
  • Cancer.
  • Diabetes.
  • Fibromyalgia.
  • Freiberg's Disease.
  • Gout.
  • Kaposi's Sarcoma.
  • Kohler's Disease.
  • Maffucci's Syndrome.
  • Ollier's Disease.
  • Peripheral Arterial Disease.
  • Raynaud's Disease.
  • Seiver's Disease.
  • Sever's Disease.

Overview of disease screenings

Not all diseases and disorders have specific medical screenings. For  example, Freiberg's disease is often discovered after an x-ray is taken  for another foot ailment.

However, there are numerous disease screening processes, including:

  • Ankle-brachial index (ABI): A simple test that can be performed in your doctor's office, ABI is a reliable way to diagnose peripheral artery disease (PAD).
  • Rheumatoid arthritis screening: Rheumatoid arthritis (RA) is often diagnosed through a series of checks, including:
    • Your medical history.
    • Lab tests.
    • X-rays.
    • Physical examination.
    • Ruling out other possible conditions (i.e. Lyme disease, osteoarthritis, and viruses).
  • Diabetes tests: Various laboratory tests,  including fasting plasma glucose (FPG) tests, tests for blood levels of  glycated hemoglobin, and insulin resistance tests, can be used to  diagnose diabetes. Because diabetic neuropathy can affect the nerve  functioning in feet, it is important to tell your podiatrist if you are  diabetic.
  • Gout screening: Blood tests and lab tests to analyze joint fluid can help diagnose gout.
  • Fibromyalgia testing: Fibromyalgia can be  confused with other illnesses including rheumatoid arthritis, lupus,  chronic fatigue syndrome, and Lyme disease, so these and other disorders  need to be ruled out. Imaging tests and nerve and muscle studies may  help with this diagnosis.

Other diseases and disorders can be found through physical examinations when symptoms manifest themselves.

If you are concerned that you may be affected by one of these  disorders, or if you are suffering from pain and discomfort in your  feet, ankles, or lower legs, visit your doctor for a medical screening.

Podiatric Physical Examination

Pain and discomfort in your feet and lower legs can hinder your  ability to perform simple daily activities like walking, standing, and  even sleeping. Through a series of tests and assessments, a podiatrist  can determine the cause of the pain and recommend treatment.

Need for physical exams

Persistent pain and discomfort in your feet, ankle, or lower legs is  not a normal occurrence. It is important to undergo a physical  examination not only to determine the underlying cause of the pain and  discomfort, but also to find suitable treatment. Because some conditions  can worsen if not properly treated, it is important to have a podiatric  examination when you notice pain, discomfort, and other symptoms of  foot and ankle disorders.

Overview of podiatric physical exam

During a routine podiatric physical examination, your doctor will  complete various checks of your feet and ankles. A basic routine will  most likely include:

  • Hands-on examination - Doctor will feel feet for abnormalities and tender areas.
  • Movement assessment - Mobility of the feet and ankle will be checked.
  • Muscle appraisal - Through various tests, doctor will check for muscle strength.
  • Other tests - If the doctor suspects a particular condition, additional condition-specific tests may be performed.
  • Stability evaluation - The stability of the ankle will be tested.
  • Visual inspection of:
    • Shoes for abnormal wear patterns.
    • Walking gait to check for abnormal step patterns.
    • Overall foot shape to look for deformity or other abnormality.
    • Skin condition.
    • Health of toe nails.
    • Limb alignment.

If you are suffering from continual pain or discomfort in your  ankles, feet, or lower legs, schedule an appointment for a podiatric  examination as soon as possible.

Magnetic Resonance Imaging (MRI)

Physical examinations and X-rays are great diagnostic tools, but in  some cases, magnetic resonance imaging (MRI) is needed to better  diagnose pain, discomfort, or swelling in your feet, ankles, and lower  legs. Unlike conventional X-rays or CAT scans, MRI scans do not use  radiation, which makes this a valuable tool for patients who cannot  undergo radiation-related tests. Also, MRIs are better at detecting  soft-tissue conditions than X-rays.

Need for MRI diagnostic testing

In a podiatric setting, MRIs are often used as a non-invasive tool to  better examine the internal workings of feet and ankles. Your doctor  may use magnetic resonance imaging to diagnose:

  • Arthritis and other joint damage.
  • Bone injury, including fractures.
  • Cartilage damage.
  • Infection.
  • Ligament injury, including sprains and tears.
  • Soft tissue tumors.
  • Tendon damage, including Achilles tendon tear.

Overview of MRIs

Instead of using radiation like X-rays, MRI exams utilize a  combination of a magnetic field and radio waves to produce images of the  soft tissue and bones in your feet and ankles.

During an MRI scan, your foot (or whichever body part is being  examined) is placed inside an MRI machine, which has a strong magnet.  Similar to an X-ray, you should not experience any unusual sensations  during the scan. After the scan, your doctor will be able to review the  images and discuss any findings with you.

MRI Restrictions

Because MRI scans use a magnetic field to create images, there are  some limitations to who can undergo these scans. You may not be a good  candidate for an MRI if you have any of the following conditions:

  • Artificial heart valves.
  • Artificial limbs or metal prostheses.
  • Brain aneurysms clips.
  • Cardiac pacemaker or defibrillator.
  • Electronic inner ear (cochlear) implants for hearing impairment.
  • Implanted medical devices with metal, including IUDs.
  • Implanted nerve stimulators (TENS implants).
  • Implanted pump for insulin or narcotics.

Although some of the above conditions may not hinder you from having  an MRI scan, be sure your doctor is aware of the condition before  undergoing the scan.

Ultrasound

Physical podiatric examinations and x-rays can help determine the  cause of problems with feet, ankles, and lower legs. Sometimes however,  these tools cannot give a clear glimpse of the issues. When these  initial diagnostic tools cannot diagnose the condition, an ultrasound is  used to help a doctor evaluate pain, swelling, infection, and other  symptoms.

Why an ultrasound may be needed

An ultrasound can be very helpful in diagnosing various conditions.  Many soft-tissue problems and bone injuries can be seen more clearly  using an ultrasound instead of a conventional X-ray system. Some of the  many conditions that can be discovered using an ultrasound include:

  • Bursitis.
  • Cartilage injury.
  • Foreign bodies.
  • Heel spurs.
  • Ligament/tendon tears and ruptures.
  • Muscle sprains and strains.
  • Neuroma.
  • Plantar fasciitis.
  • Rheumatoid arthritis.
  • Soft tissue masses and certain tumors.
  • Stress fracture.
  • Tarsal Tunnel Syndrome.
  • Tendonitis.

In some cases, ultrasounds may also be used as a treatment for the relief of:

  • Bursitis.
  • Sprains.
  • Tendonitis.

Ultrasound overview

Ultrasounds work by using the same principles involved in sonar. The  ultrasound sends sound waves and records the echoing waves while a  computer turns the waves into a real-time picture.

The steps of an ultrasound procedure include:

  • Applying a water-based gel to the foot, ankle, or lower leg (whichever body part is being examined).
  • Pressing a sensor (called a transducer) against the skin – angling and sweeping the sensor to get best view of area.
  • Reviewing findings.

In many cases, the ultrasound can be completed in about 30 minutes to an hour.

X-rays

If you are suffering pain or discomfort in your foot, ankle, or lower  leg, you should visit your doctor as soon as possible. After an initial  physical examination, your doctor may suggest an X-ray to determine if  your foot is broken or if there is another issue that is causing the  pain.

Why X-rays may be needed

Although not as helpful for diagnosing soft tissue or ligament  problems, X-rays are very useful when dealing with foot and ankle pain  related to bones or other solid objects. A foot, ankle, or lower-leg  X-ray may be needed to detect:

  • Abnormal bone growths.
  • Arthritis.
  • Bone cancer and tumors.
  • Broken bones and fractures.
  • Bunions.
  • Infection of bone.
  • Joint dislocation.
  • Normal growth of child's bones.
  • Presence of foreign object.
  • Proper alignment of bones after treatment.

Overview of X-rays

An X-ray uses beams of low-level radiation to create a picture of the  inside of your body. Bones and other dense materials (including foreign  objects) reflect the rays differently and appear white on the X-ray  picture. The produced image allows the doctor to see any breaks,  growths, or abnormalities.

Although the amount of radiation from a single X-ray scan is not  considered harmful to adults, pregnant women should avoid X-rays when  possible and should use a lead apron to shield the fetus when necessary.

Don't ignore pain, swelling, or discomfort in your feet, ankles, or  legs. Schedule an appointment for a diagnostic examination today and get  started on the road to recovery.