MRI's can identify small areas of bone edema suggestive of a fracture. ![]() MRI's are also helpful in differentiating calcaneal fractures from plantar fasciitis. Although not considered the best testing modality for calcaneal stress fractures (Sanders Stage I), CT scanning is the best tool for displaced calcaneal fractures (Sanders stage II-IV.) CT scanning is particularly useful for defining contrast. Computer software organizes these images in such a way that we can see a series or progression of change through the heel. ĬT (computerized tomography) scanning is a test that performs a series of x-ray slices, or cuts, through the calcaneus.An old injury, on the other hand, will not "light up" on the scan due to its lack of current inflammation. The bone scan will help us in that a new injury will "light up" on the scan due to its current inflammation. For instance, we may see a questionable area on an x-ray but we will not be able to tell whether the suspected injury is old or new. Lastly, a scan can help to determine the acuteness of the injury. Second, the bone scan will help to differentiate between other potential problems of the heel such as plantar fasciitis. First, the scan will locate the area of the fracture based upon the inflammation seen in fracture healing. In the case of a calcaneal fracture, a bone scan can help in two ways. Each of the scans shows a different degree of inflammation based upon the increased blood flow to the inflamed area. A scan is taken of the injured area three times over the course of three hours. Bone scans are tests that utilize a radioactive nucleotide injected into the patient to identify areas of inflammation. Ī three-phase technetium bone scan can help differentiate the location and degree of inflammation in the calcaneus, thereby helping to diagnose a calcaneal stress fracture.Additional findings of a stress fracture may include radiolucency (darkening) of the x-ray in the early stages of fracture repair. The formation of bone callus takes 4-6 weeks to see on plain x-ray, therefore, periodic follow-up x-rays may aid in diagnosing a stress fracture of the heel. This increase in calcium is called bone callus. The healing process will increase the amount of calcium surrounding the fracture. As fractures heal, many times the healing process can be seen on plain x-ray films. Plain x-rays may be used to diagnose a calcaneal stress fracture, but often, with lack of disruption of the bone, plain films lack the ability to identify the fracture. These tools include plain x-ray, bone scans, CT scanning, and MRI. If the initial clinical findings of heel pain seem suggestive of a stress fracture, there are several tests that can be used to help determine the diagnosis. ![]() The initial fracture may not be visualized, but the healing bone will show evidence of a fracture 4-6 weeks after the onset of the injury. Quite often, the only x-ray findings seen are those signs that show up towards the end of the healing process, sometimes as long as several months after the onset of the injury. The appearance of a stress fracture on x-ray is not always evident. The diagnosis of calcaneal stress fractures can be difficult at times. A calcaneal stress fracture is most often the result of a sudden, abrupt injury but can occur without a history of trauma. A stress fracture is a nondisplaced defect in a bone that occurs due to repetitive load or trauma.
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