Dr. Huppin and Dr. Hale use a number of tools for ankle and foot diagnosis to develop the most effective treatment plan.
Ankle and Foot Diagnosis: Tools Used
Digital X-ray system
We utilize a digital x-ray system in our office. Digital X-rays have a number of advantages over standard x-rays, primarily in our ability to manipulate the images so that we can better identify any problems. Dr. Huppin and Dr. Hale can zoom in on areas of interest, pinpointing any problems.
We have ultrasound examination available in our office. Ultrasound allows us to visualize soft tissue much better than we can with x-rays. We commonly use it to check the thickness of the plantar fascia which helps us determine the best treatments for heel pain. We can also use it to find neuromas and foreign bodies. You can read more on ultrasound here.
MRI (Magnetic Resonance Imaging)
MRI allows for visualization of both soft tissue and bone in three dimensions. As MRI is often the gold standard for visualizing structures of the foot and ankle, we refer patients for MRI evaluation on a regular basis. Some common uses of MRI include evaluation of tendon and ligament injuries, diagnosis of stress fractures and evaluation for soft tissue masses. Another advantage of MRIs is that they require no exposure to radiation.
CT Scan (Computed Tomagraphy)
Like MRIs, CT scans allow us to visualize your feet and ankles in three dimensions. CTs, however, are best for viewing bones in the foot and ankle. CTs do use x-rays to take their image. Compared to MRIs, CT scans are less expensive and faster (5 minutes vs. about 30 minutes).
A bone scan is one of the most effective tests to determine if you have a problem with a bone or joint of your feet. For a bone scan, we will refer you to a nuclear radiologist who will inject a dye into a vein. Several hours later you return for the scan. That dye “grabs on” to areas of injured bone or joint and helps us rule in or rule out those problems.
We will sometimes refer to a radiologist to have a “guided injection” into a joint. Some joints, particularly in the midfoot, are too small for us effectively injection. A radiologist can use a fluoroscope to visually guide the needle into a painful joint. We may use these injections to treat a painful arthritic joint. We also use them for diagnostic purposes. If a joint is injected with a local anesthetic and that completely eliminates a painful foot, then that tells us your pain is due to a problem with that particular joint. Conversely, if the injection does not eliminate your pain at all then we know that joint is not likely involved in causing your pain.
An video gait analysis system allows us to evaluate your gait in slow motion. We often use this unit when prescribing orthotic devices so that we can write the most effective orthotic prescription possible for your condition. Read more here on gait analysis.
Fungal Nail Testing
Before treating a thick nail for fungus, we want to first ensure that it is fungus causing the nail to become thick. In fact, more than 30% of the patients who come to see us for treatment of fungal nails do not have a fungal infection! To determine if you have a fungal infection of your nail, we will take a sample of the nail and send it for a “PAS test”. This is the gold standard for testing of nail fungus. You can read more nail fungus testing here.
If you present with a problem that is related to nerve entrapment or injury, we may send you for “nerve conduction testing” (NCV). In this situation, a neurologist will test the nerves of your lower extremity from your back down to see if there is any damage or disease affecting your nerves.
We may order blood work for a number of different reasons. Those include checking for conditions such as infection, inflammation or gout. We may also want to check how your liver is functioning before prescribing certain medications or check your vitamin D blood level to make sure you have enough vitamin D to allow for normal bone healing.