Dr. Lew Schon: How WBCT Changes the Understanding of Joint Collapse

When CT Is Not Enough

In a recent discussion on the clinical value of weight bearing imaging, foot and ankle surgeon Lew C. Schon, MD shared how weight bearing CT is helping clinicians better understand joint pathology that may not appear on traditional imaging. Drawing from his experience evaluating complex foot and ankle conditions, Dr. Schon explains how imaging under load can reveal functional collapse across multiple joints, providing critical insight for diagnosis and treatment planning.

Why Weight Bearing Imaging Changes the Clinical Picture

In orthopedic imaging, what you see doesn’t always tell the full story.

Traditional CT scans provide detailed anatomical information, but they capture the body in a non-weight bearing state. For many conditions, especially in the foot and ankle, that limitation can mask the true extent of pathology.

The Limitation of Conventional CT

In cases of ankle arthritis, a CT scan may appear relatively normal at first glance.

Clinicians may identify structural indicators such as osteophytes or cysts, but these findings don’t always reflect how the joint behaves under real-world conditions. As described in the video,

“If you have an arthritic ankle joint and you get a CT scan, it may actually look normal.”

What Changes Under Load

When imaging is performed under weight bearing conditions, a different picture emerges.

Joint collapse becomes visible, revealing functional changes that are not apparent in non-weight bearing scans. This collapse is not isolated to a single joint, it can extend across multiple regions of the foot.

“When you do a weight bearing CT, you’re seeing the collapse of the joint… affecting the ankle joint, the hindfoot, the midfoot, and even sometimes the toes.”

This reinforces an important clinical reality: foot and ankle conditions are often multi-joint problems, not single-joint diagnoses.

A More Complete Assessment

Clinical evaluation has always been performed with weight bearing in mind. Physical exams and functional assessments are inherently load-based.

What weight bearing imaging provides is the ability to visually confirm and quantify what clinicians are already observing.

“To have the imaging to back up what we see and to give us further information is really the exciting game changer.”

Conclusion

Weight bearing imaging bridges the gap between static anatomy and functional reality.

By capturing joints under load, clinicians gain a more complete understanding of pathology, enabling more informed decision-making across diagnosis, planning, and treatment.

The views and opinions expressed in this video are those of Lew Schon and do not necessarily reflect the official policy or position of CurveBeam AI. Any clinical insights or recommendations are based on the personal experience and judgment of the speaker.