Effective imaging is vital to properly diagnosing foot and ankle disorders. The technology at Froedtert & The Medical College of Wisconsin is state-of-the-science, with virtually every radiological test at our disposal to aid in diagnosing and treating foot and ankle disorders. But beyond technology, our physicians and staff have the experience and expertise to ask the right questions, request the right scans and read and interpret the results to make a more precise diagnosis. Just as our surgeons specialize in foot and ankle disorders, we have three dedicated bone radiologists and a dedicated fellow in bone radiology who focus almost entirely on bone and joint diseases.
As an academic medical center, Froedtert & The Medical College of Wisconsin see more complex cases, and radiologists have a breadth of experience not found elsewhere. The level of staff expertise and the volume of patients seen in the Foot and Ankle Program make it a leader in the diagnosis of complex foot and ankle disorders.
Radiology
Foot and ankle disorders can be caused by many things, including degenerative disease, trauma or abnormal development that, over time, has changed the shape of the bones. The more precisely a disorder can be defined, the more accurately it can be treated. From traditional X-rays to ultrasound, CT and MRI technology, Froedtert & The Medical College of Wisconsin offer the complete spectrum of diagnostic imaging services to achieve the most precise diagnosis possible. Beyond diagnostics, these technologies can also play a role in interventional procedures, joint injections, image-guided procedures and more. The quality of images produced by these technologies improves continually, and we stay on the forefront as new technologies develop.
For example, today’s CT scanners can produce extremely detailed images from many directions, which results in a more precise views of the bones. This kind of detail aids in the diagnosis and treatment of foot and ankle disorders. Modern MRI scanners allow us to see not only bones but soft tissue, including tendons and ligaments, which gives physicians an added level of detail.
Fluoroscopy
Fluoroscopy is essentially a continuous X-ray and with two different applications for treating foot and ankle disorders. Fluoroscopes are used during surgery to show the surgeons exactly where they are in the body and where plates, pins and screws need to be placed.
Fluoroscopy is also used to guide injections in the small joints of the foot and ankle. Surgeons use the results of the injections to see which joints may be painful to better determine which ones may require surgery and whether surgery will be an effective treatment.
Foot EMG and Nerve Conduction Studies
Patients who experience pain, numbness, tingling or weakness in the foot or ankle may have an electrodiagnostic study. Such studies can detect the presence, location and extent of diseases and in some cases can determine the actual site of nerve damage.
An electrodiagnostic study has two parts — a nerve conduction study and an EMG (electromyogram). Although it is sometimes referred to as just an EMG, the two tests are almost always done together and both are necessary to make an accurate diagnosis.
During a nerve conduction study, nerves in the foot and ankle are stimulated with mild electrical impulses usually through an electrode patch placed on the skin over the nerve or the muscle. The impulses go through the nerves and the results are measured and recorded on a computer.
An EMG measures the electrical activity of muscles. A small, thin wire needle, similar to an acupuncture needle, is placed in the muscle to pick up its electrical activity. That information is relayed from the needle electrode to a computer.
In conjunction with a medical history, physical exam and information from referring physician, the electrodiagnostic studies can provide valuable information that helps determine the patient’s course of treatment. Experienced electromyographers use their experience and knowledge of the nerves in the legs and feet to determine if there is a nerve or muscle problem or if something else is the cause.
While many doctors may conduct electrodiagnostic studies of the foot and ankle, our physicians are among the most highly trained in conducting foot EMGs and nerve conduction studies. Although the equipment may be similar, not all foot EMGs are the same. A proper foot EMG should test enough muscles to achieve an accurate diagnosis; testing only one or two muscles is not enough. The same is true of nerve conduction studies. In fact, our physicians teach other doctors across the country about the need for more thorough electrodiagnostic studies. Because we see a higher volume of patients and more complex cases, we have the expertise to identify problems more accurately.
For example, eight different nerve studies can be done in the foot, and more thorough studies can be especially helpful for patients with symptoms in both feet. Two conditions — peripheral poly neuropathy and tarsal tunnel syndrome (TTS) — can have similar symptoms, but only TTS can be helped by surgery. Incomplete electrodiagnostic studies could lead to an incorrect diagnosis, which could result in unnecessary surgery.