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Bone Scan for Diagnosing Heel Pain?

Posted by Susan D on 8/06/01 at 18:12 (055689)

I cannot seem to get my heel pain diagnosed. I am a high-distance runner and have had low-grade PF for 15 years and suddenly, severe heel pain for last 3 months. The severe pain increases with mileage during a run, and after long runs I am left limping through the next day. Squeezing both sides of my foward heel brings excrutiating pain. I have had an x-ray (a 'soft finding' and a heel spur but no obvious stress fracture. I have also had a bone scan that showed a definite hot spot, but my doctor is unwilling to diagnose and the orthopaedic says that PF and stress fractures look alike on a bone scan.

Can a bone scan accurately indicate a stress fracture where PF is already known to exist?

Re: Bone Scan for Diagnosing Heel Pain?

Dr. Zuckerman on 8/06/01 at 18:19 (055690)

The clinical evaluation is very important when attempting to diagnosis a stress fracture. Severe pain with lateral compression of the heel . Increase pain with increased walking. A bone scan can help to rule out a stress fracture so can an mri.

In either case rest, casting is very important. Immediate treatment is the key to resolving a stress fracture pain

Re: Bone Scan for Diagnosing Heel Pain?

Ed Davis, DPM on 8/06/01 at hrmin (055697)

Stress fractures and plantar fasciitis look 'similar' on bone scans but not 'alike.' Consider a second opinion from an individual who may be able to tell them apart. It would really be helpful to know which one it is because the treatment can be different. You need a doctor who, within reason, is sufficiently confident of the diagnosis to commit to one or the other and treat definitively. The 'lateral squeeze test' tends to point to a stress fracture.

Once the acute symptoms are resolved, look into the biomechanics of your gait. Stress fractures of the heel tend to happen more commonly in individuals with the type of biomechanical problems that lead to plantar fasciitis.
Ed

Re: Bone Scan for Diagnosing Heel Pain?

Dr. Zuckerman on 8/06/01 at 18:19 (055690)

The clinical evaluation is very important when attempting to diagnosis a stress fracture. Severe pain with lateral compression of the heel . Increase pain with increased walking. A bone scan can help to rule out a stress fracture so can an mri.

In either case rest, casting is very important. Immediate treatment is the key to resolving a stress fracture pain

Re: Bone Scan for Diagnosing Heel Pain?

Ed Davis, DPM on 8/06/01 at hrmin (055697)

Stress fractures and plantar fasciitis look 'similar' on bone scans but not 'alike.' Consider a second opinion from an individual who may be able to tell them apart. It would really be helpful to know which one it is because the treatment can be different. You need a doctor who, within reason, is sufficiently confident of the diagnosis to commit to one or the other and treat definitively. The 'lateral squeeze test' tends to point to a stress fracture.

Once the acute symptoms are resolved, look into the biomechanics of your gait. Stress fractures of the heel tend to happen more commonly in individuals with the type of biomechanical problems that lead to plantar fasciitis.
Ed