“I have a heel spur”
You have heel pain and you have seen the doctor for their opinion and advise. They refer you on to get an Xray which shows a heel spur and there you have it “you have a heel spur”. This term is overly used and incorrectly used to diagnose heel pain. A heel spur appears on an X-ray as a pointed bony growth projection at the heel bone. They develop over a long-period of time, well before you had any heel pain. Infact studies have shown 30% of the population have a heel spur without any heel pain.
What images should you consider when you have heel pain?
X-rays use a small amount of radiation to visualise the skeleton. It is not safe for pregnant women.For the purpose of heel pain, common reasons for requesting an X-ray would be suspicion of a calcaneus (heel) fracture, stress fractures (in some cases not evident in early stages) and size of heel spur. I personally do not often refer for an X-ray in the early management phasto investigate a heel pain because it is uncommon to have fractures or stress fractures, and the heel spur is rarely the cause of your pain.If your heel pain has developed very suddenly, from trauma, high impact activity then it would be wise to get an X-ray to rule out any injury to the bone.
A podiatrist can issue a referral for an X-ray and which are bulk billed in most places.
Ultrasounds are non-invasive and have no radiation. A gel compound is used to transmit sound waves to visualise soft tissue on the spot. Ultrasounds are very dependent on the sonographers skills and knowledge of the feet. Unfortunately, this is rare to find. Unlike an X-ray which a practitioner can view independently of the radiologists report, an ultrasound relies very heavily on the report. I’m very fortunate to have an excellent radiology centre (Shire Medical Imaging at 30 Gibbs St, Miranda) nearby that an do exceptional ultrasounds at bulk billing rates. Ultrasounds are often used to investigate heel pain because you can assess the plantar fascia and other soft tissue structures.
Common heel pain conditions that may require ultrasound would be; Plantar fasciitis, plantar fascia tear, neuritis, muscle atrophy, muscle tear, bursitis.
A podiatrist can issue a referral for an Ultrasound and you should enquire if the radiology centre bulk bills.
Bone scans are requested when you query the bone being the cause of the pain. It safely uses a very small amount of radioactive dye to help diagnose problems with your bones.
Specifically, this test is done to reveal problems with bone metabolism. Bone metabolism refers to the process in which bones break down and rebuild themselves. New bone formation is part of the healing process when bones are injured or broken. The bone scan is a good way to view and document abnormal metabolic activity in the bones.
In regards to heel pain, a bone scan might be requested because an X-ray did not show any abnormalities and you still query the bone being injured. The bone scan will be much more reliable to identify a calcaneus (heel) stress fracture, fracture or other heel bone abnormlaity.
A podiatrist cannot refer for a bone scan. They will advise you to see the doctor to get a referral.
CT, or CAT scans, are special X-ray tests that produce cross-sectional images of the body using X-rays and a computer. CT scans are also referred to as computerized axial tomography. CT Scans are used when the bone requires are a more accurate assessment. CT scans are not usually requested for heel pain because the heel bone is not usually the primary cause of pain. But in cases where there is a high probability of the heel bone being injured or having abnormalities, then it would be advantageous to have a CT scan.
A podiatrist cannot refer for a CT scan. They will advise you to see the doctor to get a referral.
Magnetic resonance imaging (MRI) is a scan that uses a magnetic field and radio waves to take pictures of the soft tissue. It is radiation-free. An MRI scan is often used when other types of imaging, such as X-ray, CT or ultrasound are not providing adequate answers.
It can identify very small tears or injuries which could be missed by an Ultrasound. MRI would only be requested if the area of suspicion is soft tissue. In cases where bone is suspected, then a CT scan or bone scan would be requested.
A general practitioner and a podiatrist are not able to refer you for an MRI. You must see a specialist.
Heel pain is not simple and often I find people visit a doctor, get and X-ray and have the label “heel spur”. This is rarely the case. Inflammation of the plantar fascia is usually the cause of the pain and a very good ultrasound will help identify this. More expensive images such as MRI are usually limited to cases that do not respond in a timely manner or for pre-surgery screening.
Dr Vanessa Hadchiti (Podiatrist)