Laboratory Studies
If the appearance of the bursitis cannot be explained by local factors (eg, ill-fitting shoes, excessive running, high heels) or if there are systemic symptoms or signs of rheumatologic involvement, the clinician should consider laboratory studies to evaluate for the possibility of gout (hyperuricemia), rheumatoid arthritis (rheumatoid factor), and seronegative spondyloarthropathies (HLA B-27, erythrocyte sedimentation rate, and/or C-reactive protein).
Also see related Medscape Resource Centers on Gout and Rheumatoid Arthritis.
Imaging Studies
Plain radiographs of the calcaneus may reveal Haglund deformity, which can be seen best on the lateral view. In this view, the triad consistent with Haglund's disease is thickening of Achilles tendon at insertion, retrocalcaneal bursitis, and retro-Achilles bursitis.[15]
Plain radiographs can also be used to evaluate for stress fracture of the calcaneus. If the plain radiographs are negative for stress fracture but this injury possibility remains a significant diagnostic consideration, a 3-phase bone scan or a computed tomography (CT) scan of the calcaneus should be obtained.
Magnetic resonance imaging (MRI) scans may demonstrate bursal inflammation but probably do not offer much more information than is apparent from careful physical examination. Theoretically, MRI scans may help to determine whether the inflammation is in the subcutaneous calcaneal bursa, the subtendinous calcaneal bursa, or the tendon itself, but such testing is generally unnecessary.[8, 9]
Some clinicians have suggested that ultrasonography can be used in place of MRI in cases in which imaging is desired to investigate pathology at the posterior heel. A recent study concluded that extended field-of-view sonography (EFOVS) when combined with traditional gray-scale sonography has similar sensitivity and specificity to MRI for diagnosing calcaneal bursitis in addition to more rapid results, lower cost, and lack of contraindications.[10, 11, 16]
Procedures
Generally, no diagnostic procedures are required.
Histologic Findings
Bursal inflammation is present in patients with calcaneal bursitis, but obtaining a histologic specimen from an actual patient would be extremely rare.
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