Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

Why the Right Imaging Matters

Ordering the appropriate imaging study for a foot or ankle condition is a clinical skill — the wrong study can miss a diagnosis, lead to unnecessary radiation exposure, or generate costs without meaningful information. At Balance Foot & Ankle in Howell and Bloomfield Township, we select imaging carefully based on clinical presentation and the specific information we need to guide treatment. Here’s a practical guide to foot and ankle imaging.

X-Ray (Radiograph)

X-rays are the first-line imaging for most foot and ankle problems. They excel at showing bone structure, fractures, alignment, and joint space. They’re quick, inexpensive, and involve minimal radiation. We use digital X-ray in our offices and take weight-bearing views for most conditions — weight-bearing X-rays of the foot reveal pathology not visible on non-weight-bearing films, as deformities become more apparent under load.

X-rays are ideal for: diagnosing fractures, monitoring healing, assessing bunion and deformity angles, detecting arthritis (joint space narrowing, osteophytes), identifying heel spurs, and evaluating foot alignment. They are poor for: soft tissue injuries (tendons, ligaments, cartilage, nerves), early stress fractures (which are often invisible on X-ray for 2–4 weeks), and subtle osteochondral lesions.

MRI (Magnetic Resonance Imaging)

MRI is the gold standard for soft tissue imaging. It shows excellent detail of tendons, ligaments, cartilage, bone marrow, nerves, and soft tissue masses. It uses no radiation. Its limitations are cost, time (30–60 minute scans), motion sensitivity, and contraindications (certain implants, claustrophobia).

MRI is ideal for: confirming and characterizing stress fractures (positive early, when X-rays are negative), tendon tears and tendinopathy, ligament tears, osteochondral lesions of the talus, bone marrow edema (early stress response), plantar fascia tears, nerve tumors, and soft tissue masses. It’s the study of choice when clinical examination suggests pathology that X-rays can’t capture.

CT Scan (Computed Tomography)

CT provides superior bone detail compared to MRI. It shows three-dimensional bony architecture with excellent clarity. It involves significant radiation (more than X-ray) and uses contrast in some applications. It cannot adequately image soft tissue structures.

CT is ideal for: surgical planning for complex fractures (calcaneal fractures, Lisfranc injuries, ankle fractures), assessment of tarsal coalition extent, characterizing bone tumors, evaluating bony fusion procedures, and detecting subtle fractures when X-rays are inconclusive but MRI isn’t available or indicated.

Ultrasound

Diagnostic ultrasound is a real-time, radiation-free imaging modality that excels at evaluating superficial tendons, ligaments, and bursa. It can be performed dynamically — assessing structures during movement — which provides information no other modality can. It is operator-dependent (results vary with user skill) and cannot penetrate bone.

Ultrasound is ideal for: evaluating the plantar fascia (thickness, tears), tendon pathology (Achilles, peroneal, posterior tibial), Morton’s neuroma diagnosis and guided injection, bursitis, ganglion cysts, and guiding injections into joints, tendons, and nerves with real-time needle visualization. Many of our injections are performed under ultrasound guidance for improved accuracy.

Bone Scan

Nuclear medicine bone scans detect areas of increased bone metabolism and are sensitive for stress fractures, infections, and metabolic bone disease. They have lower spatial resolution than MRI and involve radioactive tracer injection. They’re used when MRI is unavailable or contraindicated and when a systemic survey of the skeleton is needed. SPECT-CT (combined nuclear medicine and CT) provides superior localization.

What to Expect When We Order Imaging

At Balance Foot & Ankle, we explain the rationale for any imaging we order. We read all imaging in the context of your clinical examination — interpreting findings in isolation from the clinical picture leads to errors. If you’re uncertain about why a particular study was ordered, please ask. Contact us with any questions about your imaging or diagnosis.

Foot or Ankle Pain? We Can Help.

Balance Foot & Ankle — Howell & Bloomfield Township, MI

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Need Foot or Ankle Imaging to Diagnose Your Condition?

From X-rays to MRI and ultrasound, advanced imaging helps accurately diagnose fractures, soft tissue injuries, arthritis, and other foot and ankle conditions. At Balance Foot & Ankle, we offer in-office imaging for fast, accurate diagnosis and treatment planning.

Learn About Our Diagnostic Services | Book Your Appointment | Call (810) 206-1402

Clinical References

1. Bencardino JT, et al. MR imaging of the ankle and foot. Radiologic Clinics of North America. 2006;44(3):381-399.
2. Khoury V, et al. Musculoskeletal sonography: a dynamic tool for usual and unusual disorders. American Journal of Roentgenology. 2007;188(1):W63-W73.
3. Resnick D. Diagnosis of bone and joint disorders. 4th ed. WB Saunders. 2002.

Dr. Tom Biernacki, DPM

Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.