A calcaneus X-ray is a common imaging test that uses radiation to create pictures of the bones in the foot. The calcaneus, also known as the heel bone, is the largest bone in the foot, located at the back, just below the lower leg bones. This procedure helps visualize the structure and alignment of the heel bone.
Reasons for a Calcaneus X-Ray
A doctor might request a calcaneus X-ray to investigate pain, swelling, or limited mobility in the heel. A primary reason is acute trauma, such as a fall or motor vehicle accident, which can lead to a calcaneal fracture. The calcaneus is the most frequently fractured tarsal bone, accounting for about 60% of all tarsal fractures.
Chronic heel pain that persists despite conservative treatments can also prompt an X-ray. This imaging helps identify underlying bone issues contributing to discomfort, such as bone spurs. Athletes or individuals who have recently increased physical activity might undergo an X-ray to check for suspected stress fractures, which are small cracks in the bone caused by repetitive stress.
The X-ray can also evaluate deformities of the heel bone, such as Haglund’s deformity, a bony enlargement on the back of the heel. Additionally, X-rays are used for post-surgical or post-injury follow-up to monitor fracture healing and assess bone alignment.
The X-Ray Procedure
A calcaneus X-ray requires minimal preparation. Patients should wear loose, comfortable clothing and remove any metal objects, such as jewelry, from the foot, as these can interfere with image quality. There is no need to fast or restrict food or fluids before the test.
In the imaging room, a radiologic technologist will perform the X-ray. The patient will sit or lie on an examination table, and the technologist will position the affected foot carefully to obtain clear images. Multiple views are taken for a thorough assessment of the calcaneus and surrounding joints.
Two common views are acquired: a side view (lateral) and a top-down view (axial or plantodorsal). For the lateral view, the foot is positioned on its side to visualize the calcaneus’s height and shape. For the axial view, the foot is dorsiflexed so the plantar surface is perpendicular to the image receptor, allowing evaluation of the talocalcaneal joint and plantar aspects of the calcaneus. The entire process is quick, taking less than 15 minutes, and involves very low radiation exposure.
Interpreting the X-Ray Results
A radiologist examines the calcaneus X-ray images for various findings. Fractures are a primary focus, revealing the location, severity, and displacement of a fracture. This includes simple breaks, complex intra-articular fractures extending into a joint space like the subtalar joint, and avulsion fractures where a small bone piece is pulled away by a tendon or ligament.
The X-ray can also reveal bone spurs, which are bony projections along bone edges, often seen in conditions like plantar fasciitis. Signs of arthritis, such as narrowing joint space, changes in bone density, or cysts, may also be visible.
The X-ray allows assessment of bone alignment and structural deformities, including Haglund’s deformity. Less common findings, such as foreign objects, bone infections, or tumors, can also be detected. After interpretation, the radiologist compiles a detailed report for the ordering physician to discuss findings and determine the course of action.