Value of Radiographs in the Initial Evaluation of Nontraumatic Adult Heel Pain

Abstract

Adult patients with nontraumatic plantar heel pain often present to orthopaedic surgeons for evaluation. A thorough history and physical examination are often sufficient for diagnosis, yet radiographs usually are ordered during the initial evaluation. The purpose of this study was to evaluate the value and cost-effectiveness of these radiographs. A retrospective chart and radiographic review of 157 consecutive adults (215 heels) presenting with nontraumatic heel pain was done to evaluate the utility of routine radiographs in the initial evaluation. The most common diagnosis was plantar fasciitis (80.9%, 174 of 215). Radiographs were normal in (17.2%, 37 of 215), and incidental radiographic findings were observed in 81.4% (175 of 215). The most common incidental findings were plantar calcaneal spurs (59.5%, 128 of 215) and Achilles spurs (46.5%, 100 of 215). Only (2%, 4 of 215) of all patients had abnormal findings that prompted further evaluation. Routine radiographs are of limited value in the initial evaluation of nontraumatic plantar heel pain in adults and were not necessary in the initial evaluation. Radiographs should be reserved for patients who do not improve as expected or present with an unusual history or confounding physical findings.