What is the difference when it comes to medical imaging using a bone scan versus an x-ray when you are looking for a second metatarsal stress fracture in a runner? Well, that is what we’re talking about today on the Doc On The Run Podcast.
If you get a metatarsal stress reaction or a stress fracture, you are trying to figure out how bad it really is, and your doctor may suggest a number of different kinds of medical imaging. A couple of these are bone scan versus x-rays. Well, the thing is your goal as a runner is to really figure out is it a stress reaction or is it a stress fracture.
The short story on this is really simple, x-rays can only see big damage. You may hear some stuff about periosteal lifting or periosteal reaction and some subtle things but that is not what typically shows up when you get an x-ray. They do things totally differently.
An x-ray basically sends radiation particles through your foot and they get absorbed in the bones and that creates sort of a shadow on the x-ray based on the amount of penetration of the x-rays and then you can see the outline of the bone, the cortex of the bone, some little ridges that we call trabeculation and some other stuff.
If you have a crack the bone actually breaks, and it moves a cart. It makes a very clear line where you have a fracture line. It’s very very easy to see a fracture line if you break it. If you have a stress fracture, meaning it’s a grade three or four stress fracture, either it’s a non-displaced or displaced stress fracture, which just means it’s in the right position or out of the right position, but there’s an actual crack then you can see that on an x-ray.
In the very early phases though the things that we call stress fractures are not actually fractures. There is no actual crack. So, in that situation it’s really a stress reaction. So, if you get an x-ray and the doctor says there’s nothing on your x-ray that doesn’t mean that you don’t have a stress reaction. You may have one.
A stress reaction means you have something that shows up on imaging that indicates there’s increased blood flow or inflammation within the bone itself. A bone scan can actually show you this because a bone scan basically you know we sort of squirt you full of radionucleotides that can show up on the bone scan and then when we actually scan you where you have increased blood flow within that bone, and you have a stress reaction it will show up on your bone scan.
You’ll see a sort of like fuzzy picture of the foot and if you have a stress reaction or you have an injury to that bone where there’s increased blood flow like an early stress fracture or a stress reaction, you’ll have increased uptake in that bone, and you get this darker spot through that area where the bone is inflamed and irritated.
That is kind of similar to the inflammation imaging that you get on an MRI but depending upon what the issue is your doctor may or may not be able to get an MRI for you, but they might be able to get a bone scan. So, the bone scan will show you a stress reaction much earlier and much better than an x-ray will. An x-ray though shows you the extent of the fracture much better than a bone scan will because the bone scan if you look at all the images that you get on a bone scan, they’re a whole bunch of fuzzy pictures of the foot and all you are looking for is this sort of splotch of increased uptake within the bone that shows you that there’s some type of reaction happening that is associated with increased blood flow in that area of that specific bone where you’ve gotten a stress-related injury.
So, hopefully this helps you understand a little bit more about these two. It’s really just what I think about is if you think you just have a stress reaction then the bone scan is better. If you think you definitely have a crack in the bone, and it might even be shifted out of position then you really would rather have an x-ray. But that is the main difference between a bone scan and an x-ray when you suspect you have a stress fracture or a stress reaction of the second metatarsal in your foot and you are trying to get back to running.
If you want to learn more about the strategies I use with runners that have metatarsal stress fractures you can get it for free. It’s all the exact same strategies that I teach to physicians at medical conferences when I lecture on running injuries. You can get it for free in the Stress Fracture Masterclass. All you have to do is go to www.docontherun.com/stressfracturemasterclass. Sign up and I’ll see you in the training.
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