Investigations
1st investigations to order
foot x-ray
Test
Initial test if there is suspicion of a stress fracture or other cause of heel pain, or if there is a history of trauma.[3]
Otherwise can be ordered subsequently if the patient does not improve with standard therapy.[26]
Examples of seronegative arthritis may include psoriatic arthritis, ankylosing spondylitis, and reactive arthritis.
Result
may show infracalcaneal heel spurring, although not diagnostic and is more likely an incidental finding; exaggerated or bizarre spurring may indicate a seronegative arthritis
Investigations to consider
technetium (Tc-MDP 3-phase) bone scan
Test
Indicated if x-rays are inconclusive for stress fractures or if the patient does not respond to conservative treatment.
Result
focal increased uptake in blood pool images corresponding to the plantar fascial insertion
MRI
Test
Indicated in cases of recalcitrant heel pain or if soft tissue or osseous mass is palpated or visualised on other imaging studies.
Result
thickening of the plantar fascia by 4 mm or more; focal oedema at the insertion of the fascia into the calcaneus
HLA-B27
Test
Ordered if any suspicion of spondyloarthropathy (e.g., ankylosing spondylitis, reactive arthritis).[6]
Result
positive if the gene is expressed (more likely in the presence of spondyloarthropathy)
rheumatoid factor
Test
Ordered if any radiographic signs or clinical suspicions suggest rheumatoid arthritis.[6]
Result
positive in 70% of patients with rheumatoid arthritis (1:60 is considered the lowest positive result)
ultrasound
Test
Ancillary study that can be used in lieu of MRI.[29]
Result
thickening of the plantar fascia by 4 mm or more; enthesopathy or hypoechogenicity
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