Previous Investigations & Imaging

Please bring to the clinic any blood tests, scans (eg. X-rays, ultrasounds, MRI, CT) and reports as these will assist your surgeon Mr Malik in assessing your condition.

General Information

Blood Tests

Infection and inflammation cause certain markers in the blood to be elevated. Testing for these markers can aid in the diagnosis and monitoring of a Foot & Ankle condition.

Your surgeon will discuss this with you if it is necessary.

Plain Radiographs (X-rays)

Investigations - Plain Radiographs pic 1

Plain radiographs are the commonest investigation. They give detailed information about the bony architecture and state of the joints in the foot and ankle. They are done very quickly and whenever possible are undertaken prior to the clinic consultation to allow your surgeon Mr Malik to see and investigate you in one sitting.

If you are a new patient and have a bony deformity, a fracture or suspect arthritis (see list below) then please inform us ( so that we can arrange for your radiographs to be taken prior to the clinic consultation. Please arrive at least 30 minutes prior to your consultation so that you have enough time to register and have your radiographs taken.

The following is a list (not exclusive) of conditions that need radiographs as part of the initial work up –

  • Accessory navicular
  • Achilles tendon problems (insertional)
  • Ankle arthritis
  • Ankle pain persisting after “sprain”
  • Anterior ankle impingement
  • Big toe arthritis – Hallux Rigidus
  • Big toe sesamoid conditions
  • Bunion – Hallux Valgus
  • Flat feet – Pes Planus
  • Forefoot pain (metatarsalgia)
  • Fractures around the foot & ankle
  • Freiberg’s Disease
  • Lesser toe deformities – Claw, Hammer and Mallet
  • Metatarsal instability
  • Midfoot arthritis
  • Morton’s neuroma
  • Non-union of fracture
  • Posterior ankle impingement (including Os Trigonum)
  • Posterior tibial tendon dysfunction
  • Rheumatoid Arthritis Foot & Ankle
  • Subtalar joint osteoarthritis
  • Tailor’s Bunion – Bunionette
  • Tarsal coalitions

The limitations of plain radiographs are the inability to assess the soft tissues such as nerves, cartilage and tendons.

No preparation is necessary for plain radiographs. You can eat and drink normally beforehand. If you know or think you may be pregnant please notify the radiographer and your surgeon Mr Malik as radiographs utilise x-ray beams, which can be harmful to a developing fetus.


Investigations - MRI pic 2

MRI image of the hindfoot

Magnetic resonance imaging (MRI) uses a powerful magnet and radio waves to produce superbly detailed views of the foot and ankle, particularly soft tissues such as muscles, tendons, ligaments and cartilage. It can take anywhere from 45 minutes to an hour to carry out and does involve going into a circular machine. It is very important to stay still during the duration of the scan otherwise the image will be blurred. The images are reviewed and reported on by one of our specialist musculoskeletal radiologists.

You may still require plain radiographs as each investigation adds something different to the overall picture.

No preparation is necessary for an MRI scan. You can eat and drink normally before the scan.

As a strong magnet is used, all metallic devices MUST be removed before entering the MRI room.

Patients with somecardiac pacemakers and cochlear implants cannot undergo MRI scans. Other metallic implants may prohibit patients from having an MRI scan. This includes people with certain types of cerebral aneurysm clips, vascular stents, infusion pumps and neuro-stimulators. Please discuss with the radiology staff and your surgeon Mr Malik.

The MRI scan occurs in an enclosed space, so if you are claustrophobic or feel anxious, please inform us in advance.


Investigations - CT pic 1

CT image of the hindfoot

A CT scan, is a sophisticated test that uses an X-ray machine that spins around the patient to obtain detailed images known as cross sectional imaging. This means that many images of the body are produced as if the body had been sliced and turned onto its side for viewing. Modern CT scanners can produce multiple slices of the body in one single rotation and as such are now referred to as Multi-Slice CT scanners. The sophisticated computer within the CT scanner is then able to stack these slices together to create a 3-Dimensional image of the body part that has been studied

Investigations - CT pic 2

3D CT reconstruction of the ankle

CT scanning allows for your surgeon to assess bone deformity, diagnose subtle fractures, assess fracture healing as well as plan for surgery. The images are reviewed and reported on by one of our specialist musculoskeletal radiologists.

If you are pregnant, or it is possible that you may be pregnant, then a CT scan is usually not performed unless it is an absolute medical necessity to do so. It is possible that an ultrasound or MRI scan may provide similar information and therefore be used as a substitute. Please inform our radiographers and your surgeon Mr Malik if this applies to you.


Ultrasound scan uses inaudible high frequency sound waves to create detailed pictures of the body. It is a safe, painless and radiation free examination that has been used in medicine for well over 50 years.

Ultrasound is useful in evaluating superficial structures around the foot and ankle such as tendons, ligaments and muscle. It can also be used to evaluate swellings or to guide needles for tissue biopsy, aspiration of fluid or local injection.

Please interact with your radiologist and inform them of where you have pain or a swelling if it is not obvious.

No preparation is necessary for an ultrasound scan. You can eat and drink normally before the scan.

In addition to the ultrasound you may have an injection, typically into a tendon sheath or a bursa (if these are abnormal). For more details please see Diagnostic & Therapeutic Injections below.

Bone Scan

Investigations - Bone Scan pic 1

Bone scan of both feet and ankles

A radionuclide bone scan is a way of imaging bones, organs and other parts of the body by using a small dose of a radioactive chemical. A radionuclide is used which collects in areas where there is a lot of bone activity (where bone cells are breaking down or repairing parts of the bone). A bone scan is used to detect areas of bone where there is cancer, infection, or damage. These areas of activity are seen as ‘hot spots’ on the scan picture.

A bone scan is not very specific (poor at telling you what is wrong) but is very sensitive (good at picking up the fact that there is an abnormality). Other investigations may be organised as part of your treatment plan.

What happens during a radionuclide scan?

Depending on the type of scan you have, you either swallow a small quantity of radionuclide, or it is injected into a vein in your arm. It then takes some time – sometimes several hours (depending on what is being scanned) – for the radionuclide to travel to the target organ or tissue, and to be ‘taken’ into the active cells. So, after receiving the radionuclide you may have a wait of a few hours before the scan itself. You may be able to go out and come back to the scanning room later in the day.

When it is time to do the scanning, you lie on a couch while the gamma camera detects the gamma rays coming from your body. The computer turns the information into a picture. You need to lie as still as possible whilst each picture is taken (so it is not blurred). Some pictures can take 20 minutes or more to expose.

The number of pictures taken, and the time interval between each picture, varies depending on the body part being scanned. Sometimes only one picture is needed. However, for some scans (such as bone scans or heart scans), two or more pictures are needed. Each picture may be taken several hours apart. So, the whole process can take several hours.

What preparation do I need?

Little preparation is necessary for a bone scan. The radiology department should give you specific information to help you prepare for the scan. As these tests involve a small amount of radiation, pregnant women should not have them. If you are pregnant, or it is possible that you may be pregnant, then a Bone scan will not be performed. Please inform our radiographers and your surgeon Mr Malik if this may apply to you. You should also let your doctor know if you are breast-feeding. For some types of scan, you may be asked to have lots to drink to help to flush the radionuclide from your body.

What can I expect after a radionuclide scan?

Radionuclide scans do not generally cause any side effects. Through the natural process of radioactive decay, the small amount of radioactive chemical in your body will lose its radioactivity over time. It may also pass out of your body through your urine or stool (faeces) during the first few hours or days following the test. You may be instructed to take special precautions after urinating, to flush the toilet twice and to wash your hands thoroughly.

If you have contact with children or pregnant women you should inform our radiographers and your surgeon Mr Malik. Although the levels of radiation used in the scan are small, they may advise special precautions.