ROLE OF DIFFERENT RADIOLOGICAL IMAGING IN EVALUATION OF HEEL PAIN
Mohamed Osama Hosny;
Abstract
Heel pain is a common condition in adults that may cause significant discomfort and disability. A variety of soft tissue, osseous, and systemic disorders can cause heel pain. Narrowing the differential diagnosis begins with a history and physical examination of the lower extremity to pinpoint the anatomic origin of the heel pain. The most common cause of heel pain in adults is plantar fasciitis.
Plain radiographs should be the first part of the database for patients with heel problems. The reason for obtaining a radiograph of the heel is to look for causes other than plantar fasciitis that would account for heel pain and for comparison with future radiographs. The lateral radiographic view may reveal an osteophyte, soft-tissue calcification, or stress fracture of the calcaneus. Bone angels & alignment are of a great value to assess the shape of the calcaneus in heel pain, but it has very low sensitivity and specificity for the evaluation of soft tissues.
MR imaging is of great value in evaluation and follow up of painful heel causes (plantar fasciitis, plantar fascia rupture, plantar fibromatosis, plantar fascia xanthoma, insertional achilles tendinitis, FHL and FDL tendinitis, calcaneal fracture, osteomyelitis, calcaneal tumors, retrocalcaneal bursitis, tarsal tunnel syndrome, heel fat pad abnormalities). Careful analysis of MR imaging findings and correlation of these findings with patient history and findings at physical examination can suggest a specific diagnosis in most cases.
CT is the investigation of choice in calcaneus fractures. Coronal and axial views are generally taken. CT best defines the relationship of bone fragments. CT provides high-resolution depiction of osseous structures, as well as high-quality multiplanar imaging capabilities.
Ultrasound seems to be have a value in detecting plantar fascial thickness and documenting inflammatory findings. In patients with plantar fasciitis, ultrasound may detect relatively small differences in plantar fascial thickness even in clinically undetected cases. US assessment is relatively quick, cheap, and widely available.
Bone scanning is of high value in diagnosis of stress fracture which not diagnosed plain radiography and also in diagnosis of plantar fasciitis.
Plain radiographs should be the first part of the database for patients with heel problems. The reason for obtaining a radiograph of the heel is to look for causes other than plantar fasciitis that would account for heel pain and for comparison with future radiographs. The lateral radiographic view may reveal an osteophyte, soft-tissue calcification, or stress fracture of the calcaneus. Bone angels & alignment are of a great value to assess the shape of the calcaneus in heel pain, but it has very low sensitivity and specificity for the evaluation of soft tissues.
MR imaging is of great value in evaluation and follow up of painful heel causes (plantar fasciitis, plantar fascia rupture, plantar fibromatosis, plantar fascia xanthoma, insertional achilles tendinitis, FHL and FDL tendinitis, calcaneal fracture, osteomyelitis, calcaneal tumors, retrocalcaneal bursitis, tarsal tunnel syndrome, heel fat pad abnormalities). Careful analysis of MR imaging findings and correlation of these findings with patient history and findings at physical examination can suggest a specific diagnosis in most cases.
CT is the investigation of choice in calcaneus fractures. Coronal and axial views are generally taken. CT best defines the relationship of bone fragments. CT provides high-resolution depiction of osseous structures, as well as high-quality multiplanar imaging capabilities.
Ultrasound seems to be have a value in detecting plantar fascial thickness and documenting inflammatory findings. In patients with plantar fasciitis, ultrasound may detect relatively small differences in plantar fascial thickness even in clinically undetected cases. US assessment is relatively quick, cheap, and widely available.
Bone scanning is of high value in diagnosis of stress fracture which not diagnosed plain radiography and also in diagnosis of plantar fasciitis.
Other data
| Title | ROLE OF DIFFERENT RADIOLOGICAL IMAGING IN EVALUATION OF HEEL PAIN | Other Titles | دور مختلف طرق التصوير الاشعاعى فى تقييم ألم عقب القدم | Authors | Mohamed Osama Hosny | Issue Date | 2015 |
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