The role of bone scintigraphy in determining the etiology of heel pain

Abstract

In this study we aimed to determine the role of bone scintigraphy as an objective diagnostic method in patients with heel pain. 67 heels of 50 of 182 patients with defined features who attended the orthopedics outpatient clinic with heel pain over a 3-year period, were treated with combined methods such as nonsteroidal anti-inflammatory drugs (NSAID) and contrast baths, stretching exercises and changing of footwear habits. A one year follow-up was established. The criteria identified by Wolgin et al. were used in assessing the results of the treatment. Subcalcaneal spur was demonstrated by radiography in 44 of the 67 heels. There were two different imaging patterns observed on three phase bone scintigraphy. Type I imaging pattern: Focal increased activity in the heel region or normal activity on dynamic and the blood pool phases and focal increased activity at the inferior calcaneal surface in the late static phase. Type II imaging pattern: Diffuse increased activity along the plantar fascia in the dynamic and the blood pool phase, and focal increased activity at the inferior calcaneal surface in the late static phase. There were 34 (50.7%) type I and 18 (26.8%) type II imaging patterns on the scans. Type I and type II imaging patterns were described as osseous and fascial respectively. At the final examination, the results for pattern type I were good in 16 patients (66.7%), fair in 6 patients (25%) and poor in 2 patients (8.3%), whereas in pattern type II results were good in 12 patients (80%) and fair in 3 patients (20%). The recurrence frequency was 4.1% and 6.6%, respectively. Subcalcaneal spur was determined in 70.5% of the patients with osseous pathology and 55.5% of the patients with fascial pathology. Based on this result, it can be ascertained that calcaneal spurs develop during the pathological process causing heel pain. Other findings supporting this claim were the differences in symptom periods of the patients with type I and type II imaging patterns and scintigraphies were normaly in 10 of 44 heels indicating subcalcaneal spurs on radiographies. These findings suggested that metabolic changes contributing to subcalcaneal spur were complete. Three phase bone scintigraphy is an objective method which can be used to diagnose heel pain, especially when determining the etiological factors and prognosis.

Anatomic relationship of heel spur to surrounding soft tissues: Greater variability than previously reported

“…The association between heel spur and heel pain is even more complicated as, although spurs are often found simultaneously with heel pain (Rubin and Witten, 1963), they can also be identified in asymptomatic individuals (Tanz, 1963) and are often not present in symptomatic individuals (Ozdemir et al, 2002). Although it is not the purpose of the present study to determine the etiology of heel pain, we very briefly discuss its relationship to calcaneal spur here because of its clinical implications.…”

“…In support of this, it was determined in a study of runners with symptomatic heel spur, through ultrasound at 24 months post-extracorporeal shock wave therapy, that the disappearance of inflammation was correlated with improved pain (Moretti et al, 2006). Because plantar fasciitis (Steinborn et al, 1999), rupture of the plantar aponeurosis, calcaneal fracture, and atrophy of the calcaneal fat pad have all been associated with heel pain both in the presence and absence of heel spur (Steinborn et al, 1999;Ozdemir et al, 2002;Weber et al, 2005;Alshami et al, 2007), it may be that the spur itself is not the only contributing factor to pain. In fact, a recent review of the literature determined that body mass index in a nonathletic population and the presence of calcaneal spur were the two factors having an association with chronic heel pain (Irving et al, 2006).…”

Relative Efficacy of Planar Bone Scan and SPECT/CT in Localizing the Site for Corticosteroid Injection in Plantar Fasciitis

“…Bone scintigraphy (BS) is useful in the identification and evaluation of PF [13][14][15]. Since three-phase BS also provides information about soft tissue inflammation, it can be used in the differential diagnosis of heel pain originating from the bone or fascia [14].…”

“…Bone scintigraphy (BS) is useful in the identification and evaluation of PF [13][14][15]. Since three-phase BS also provides information about soft tissue inflammation, it can be used in the differential diagnosis of heel pain originating from the bone or fascia [14]. Focally increased activity in the delayed images restricted to the site of plantar fascial insertion in the calcaneus and associated with increased blood flow and blood pool in the early images is typical of PF [16].…”

A Rare Cause of Heel Pain: A Calcaneal Spur Fracture

“…These include isolated injuries to the sustentaculum tali or the plantar calcaneal tubercles, avulsion of the posterior aspect of the tuber, or even fracture of the inferior calcaneal spur. 2 A literature search and exhaustive online search using various search engines indicated only four reported cases of a plantar calcaneal spur fracture. Our case is only the fifth reported case in the English language literature of this extremely rare condition.…”