Calcaneal Bursitis Workup

Updated: Oct 21, 2020
  • Author: Patrick M Foye, MD; Chief Editor: Consuelo T Lorenzo, MD  more...
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Workup

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.

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Imaging Studies

Plain radiographs may reveal inflammation of the calcaneal bursa, which can appear as focal swelling and convexity of the soft tissue immediately posterior to the Achilles tendon. [13]  

Haglund deformity, which may be demonstrated on plain radiographs of the calcaneus, is seen best on the lateral view. In this view, the triad consistent with Haglund disease is thickening of the Achilles tendon at insertion, retrocalcaneal bursitis, and retro-Achilles bursitis. [14]

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, which manifests as a fluid signal superficial to the Achilles tendon where it inserts at the calcaneus. However, these images probably provide little more information than would be derived from careful physical examination. Consequently, MRI may be best reserved for equivocal cases and for evaluation of the potential extent of inflammation. 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. [15, 16, 17]

Hybrid imaging modalities, most specifically single-photon emission CT (SPECT)/CT, may assist with early detection of bursitis by offering a precise, accurate, and highly localizing diagnostic image. However, little research exists on the cost benefit of this modality, and therefore, this imaging modality is not frequently used for this type of soft-tissue injury. [18]

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. [19, 20]

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Procedures

Generally, no diagnostic procedures are required.

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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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