X-Ray or MRI/CT for ankle/foot injury

What should you do to investigate a fracture to your ankle or foot. From clinical experience an MRI or CT scan is warranted, time and time again we see people post x-ray been advised "no fracture" and continue to mobilize, but yet when MRI or CT scan is conducted a fracture or fractures are identified. X-Rays have a high incidence rate of not detecting fractures.

When to investigate with MRI/CT

• mechanism what happened to cause the injury.

• Did you feel or hear a noise or crack

• Were you unable to weight bear on it soon after or into the next day

• Bone point of tenderness

From recent personal experience an MRI was warranted. Tuesday the 8th of April I was out for a run and my left foot twisted in a pot hole. At the time I felt immediate pain only for about a minute, I felt a crack on the outside and inside of my ankle, was unable to put immediate weight on it but then after a minute I was. Instead of stopping I completed 5k after the incident (athlete mindset rather than clinical physiotherapist mindset, this was not the right thing to do I should have stopped)

When I got home I knew something was not right, I could start to see and feel the foot swelling. Next morning I was unable to put any pressure through the left foot and my mid foot was significantly swollen (significant pitting was evident).

I got a donjo boot and went to work and booked an x-ray for that evening (main reason for x-ray was to get new boot) . According to the doctor the x-ray was clear and I was prescribed a prescription of anti inflammatories and pain medication (which I did not take). I asked for a boot but was not given an ankle boot. Lucky I had one and continued to use this. I requested the doctor that read my x-ray to refer me for MRI as I was not convinced by the x-ray.

Luckily enough Ennis alliance got me in asap, we are very lucky to have such a great service. Unfortunately the referral letter was not informative (twisted foot) nothing about the areas of discomfort I had described which is important for the radiographer to both take MRI scan and read MRI scan. The more detail in a referral letter generally the more detail in the radiographers report.

The findings of the MRI were of the inside of the ankle, but no reference of the bones to the outside where the main pain is and the mechanism of injury would suggest that the lateral aspect would have a greater injury than the medial aspect.

The findings on the MRI scan were two fractures to the talus and calcaneus. After these findings I then rang the x-ray department who advised that I will not get to discuss with orthopedics until 30th of April. So 9th to the 30th of April before formally been advised about treatment. It is important not to miss a talus fracture as "talar fractures not correctly diagnosed and treated can lead to avascular necrosis of the astragalus, pseudoarthrosis, early osteoarthrisis and ankle instability, declining the quality of life of patients" (Giuseppe Caracchini et al 2018)

I will take the next 6 weeks in the boot, before possible re-MRI scan or CT scan to assess the progress. Will be seen Mr Stephen Kearns around then all going well I will not need to avail of his services of surgery. I have increased Vitamin D intake and calcium intake to help bone repair.

So after you get an x-ray make sure you seek physiotherapy/GP advise as a possible fracture can be missed and you may further cause injury to the fracture.