What lab tests are used to diagnose the cause of heel pain?

From the Guidelines

Laboratory tests for heel pain are not routinely needed, but may include blood tests to check for inflammatory markers like ESR and CRP, a complete blood count (CBC), uric acid levels, and HLA-B27 testing, as suggested by 1 and 1. When diagnosing the cause of heel pain, it is essential to consider the patient's history, physical examination findings, and the presence of any red flags suggesting systemic disease.

• The most common causes of heel pain are plantar fasciitis, Achilles tendinitis, or stress fractures, which can often be diagnosed through imaging studies like X-rays, ultrasound, or MRI, as recommended by 1 and 1.
• Imaging studies are often more useful than blood tests for diagnosing the structural causes of heel pain, with radiography being the initial imaging study of choice for chronic foot pain of unknown etiology, as stated in 1.
• The decision to order lab tests should be based on the patient's clinical presentation, with laboratory testing being most valuable when the clinical presentation suggests systemic disease, shows signs of infection, or when the pain doesn't respond to initial treatment, as indicated by 1 and 1.
• In cases of chronic plantar heel pain, MRI or high-frequency US may be used as the next imaging study after negative or equivocal radiographs, as suggested by 1.
• It is crucial to prioritize the patient's history, physical examination findings, and the presence of any red flags suggesting systemic disease when deciding which lab tests to order, as emphasized by 1 and 1.

From the Research

Lab Tests for Diagnosing Heel Pain

To diagnose the cause of heel pain, several lab tests can be used in conjunction with a patient's history and physical examination.

• Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are markers of inflammatory conditions that can be used to monitor chronic inflammatory conditions and diagnose acute inflammatory conditions, such as acute infections 2.
• Imaging studies, such as X-rays, may be indicated to rule out osseous disorders, such as calcaneal stress fractures or bony abnormalities 3, 4.
• Blood tests may be ordered to rule out systemic illnesses, such as inflammatory arthritis conditions, that may be contributing to heel pain 4.

Diagnostic Approach

A thorough diagnostic approach to heel pain includes:

• A patient history to pinpoint the anatomic origin of the heel pain 3, 4
• A physical examination to identify tenderness, swelling, or other abnormalities 3, 4
• Imaging studies, such as X-rays or MRI, to rule out osseous or soft tissue disorders 3, 4
• Lab tests, such as ESR and CRP, to monitor inflammatory conditions 2

Specific Conditions

Certain conditions, such as plantar fasciitis, Achilles tendinopathy, and tarsal tunnel syndrome, may require specific diagnostic tests, such as:

• Passive dorsiflexion of the toes to increase tenderness at the calcaneal tuberosity in plantar fasciitis 4
• Imaging studies to rule out calcaneal stress fractures or bony abnormalities in patients with heel pain accompanied by tingling, burning, or numbness 3, 4