MRIs: Their Usefulness in Patient Care of the Foot

     Those of you whom regularly read my blog know that I love MRIs and even serial MRIs when I am following an injury. Unfortunately, the quality of the MRIs is getting poorer, and the amount of the foot that is imaged is becoming less and less. That does not mean you can not get great MRIs but you may have to ask for the highest Tesla (magnetic strength) in your area. 

     Why is a negative MRI just as important in general as a positive MRI? Negative MRIs rule out bone injuries, ligament injuries, and cartilage injuries. Negative MRIs suggest that a patient may have nerve pain if all other causes of the problem have been ruled out. 

     In the MRI above, even though you are given only one of the 144 slices, the 2nd metatarsal phalangeal joint had a lot of inflammation. That is the white you see under the 2nd and 3rd metatarsal heads. Other slices confirmed no plantar plate injury (the ligaments under the metatarsal heads at the ball of the foot area). 

      When you see inflammation, you have to think that this area is being stressed. The inflammation is the bodies' way of healing itself. Inflammation brings in nutrients for healing, therefore very important for healing. Inflammation though is always an all or nothing response. The body feels like it is under attack, and it will send in the calvary, armed forces, and Knights Templar (even Luke Skywalker). All or nothing!! Fight or flight phenomenon. The guist is that the inflammation can be more than it needs. Chronic inflammation, still sitting around from a relatively minor injury, still hurts alot. The patient then wonders why they have not healed, even when they have. I see this phenomenon over and over.

     Inflammation also means something may be happening internally, like micro-tearing in the ligaments. I can not see it in the MRI, but the patient can not get rid of the inflammation by any means (PT, contrast bathing, ice massage, acupuncture). 

     In this individual, negative MRI except some inflammation (radiologists call this edema). Initial treatment to address the inflammation alone was nonproductive. Treatment switched to restricting joint motion with Budin Splints, and the pain got better real quickly from there. 

     I tell my patients that positive or negative MRIs are data points in their treatment plan. We have to react to the information, make changes when they are not improving, and follow the progress month by month.