For patients presenting with acute foot pain and suspected fractures, the recommended initial imaging modality is weight-bearing foot X-rays to assess for fractures and other bony abnormalities.
If symptoms persist or there is diagnostic uncertainty after initial X-rays, foot ultrasound may be considered to evaluate for alternative diagnoses.
In cases where symptoms continue despite initial management or if there is suspicion of more complex pathology, magnetic resonance imaging (MRI) of the foot can be arranged to provide detailed assessment of bone, ligamentous, and soft tissue structures.
This stepwise approach ensures appropriate use of imaging modalities, starting with X-rays and progressing to ultrasound or MRI based on clinical need and symptom persistence.
References: Weight-bearing foot X-rays and ultrasound are recommended to assess for alternative diagnoses in persistent symptoms NICE CKS. MRI is reserved for persistent symptoms or diagnostic uncertainty, providing detailed imaging of bone and soft tissues NICE CKS.