Physical therapist vs Doctors

Physicians tend to order imaging instead of relying on the results of a good physical exam (often resulting in unnecessary costs). This is not a knock on them. There is so much pressure on them by their patients, such as yourself, to quickly find a "cause" of their ailment.

If the x-ray is clean and the PTs you saw believe it to be due to soft tissue instead of bone then it's a good chance (but not 100%) that it's probably not a stress fracture. On the other hand, MRI's are more accurate and you would be able to know if you have a stress fracture (if piece of mind is your end game).

Further food for thought: If the MRI comes back positive you will have to take a few weeks off to let the fracture heal, but since you are in that much pain wouldn't a few weeks off benefit your foot either way??? I know of way too many college and high school athletes, particularly runners, who get all sorts of imaging (MRI and xray) just for piece of mind when the obvious course of action is to back off the training load or take a few weeks off. The coaches are also to blame. What a waste of money.

Accurate and thoughtful analysis of the current model for health services.

OP, what sparked you to see three different professionals? I'm all for PTs and, in my experience, they tend to be knowledgeable and know their limits. Generally, just a helpful group of people.

But its the Dr.'s job to diagnose, not the PT's. I probably wouldn't get the MRI anyway, though.

Just trying to find out the cause. The funny thing is the doc who wants the mri said I can still run. Which sounds odd.

I mean what are symptoms of heel stress fracture. Can other things mimic it or vice versa?

Thanks!

Also, PTs CAN diagnose musculoskeletal disorders, it's within their scope of practice. They will/should refer a patient to an MD if something is not within their scope of practice (such as if they believe imaging is indicated). Albiet, laws very state by state.

My best advice (not being able to look at your foot and running/walking gait pattern) would be to take a few days off (3-7), rest and relax.

sillyquestion wrote:

Went to see 2 physical therapist about possible heel stress fracture. They told me its is not a stress frac. I still went to a sport doc, he took xray and wants an mri to rule out a stress frac. The PTS did a pretty good hands on exam and said its prob tightness and inflammation or some type of Achilles paraneol tendinitis at the insertion.

Do you think ts worth getting an MRI? sports doc said xray was clean and good, but did no hands on exam.

any input would be great?

Since you went to two physical therapists (assuming different practices) who didn't think it was a stress fracture, PLUS had an X-ray done by a sports doc, what do you think? Hard to believe a sports doc didn't do a " hands on exam". With that said, skip the MRI and go see the PTs who will give you therapy for several weeks (hopefully your insurance covers) or like the poster above stated, give it a rest for few days and monitor it. If swelling, bruising and pain occurs, go back to your sports doc for that MRI.

X-rays will only detect a stress fracture 30% of the time. It's garbage. You need an MRI or a bone scan for a definitive diagnosis. OF course the PT told you you don't need an MRI...because they aren't allowed to order them!

You are an idiot. He didn't say PTs thought the MRI was unnecessary. They just had a different opinion. I would trust any doctor who did a hands in exam over someone who didn't any day, regardless of expertise.

asdfasdfddd wrote:

X-rays will only detect a stress fracture 30% of the time. It's garbage. You need an MRI or a bone scan for a definitive diagnosis. OF course the PT told you you don't need an MRI...because they aren't allowed to order them!

A PT would refer the patient to an MD if they suspected an MRI was needed using their clinical judgement. A PT would not tell a patient that they don't need an MRI because they can't "order" one.