What type of X-ray (X-radiation) is best for examining suspected calcification of the heel, close to the ankle?

Best X-ray Views for Examining Suspected Heel Calcification Near the Ankle

For suspected calcification of the heel near the ankle, standard radiographic views should include anteroposterior (AP), lateral, and mortise views of the ankle, with the addition of an axial Harris-Beath view specifically for evaluating the calcaneus.

Standard Radiographic Protocol

• Standard ankle radiographs should include three views: anteroposterior, lateral, and mortise views 1
• These standard views provide sufficient radiographic evaluation of the osseous anatomy in the ankle region 1
• Weight-bearing radiographs are preferred when possible, as they may detect dynamic abnormalities such as joint mal-alignment that may not be apparent on non-weight-bearing radiographs 1

Specialized Views for Heel/Calcaneal Evaluation

• Axial Harris-Beath view: This specialized view is specifically recommended for suspected calcaneal pathology and is optimal for evaluating calcifications in the heel 1
• The axial Harris-Beath view is particularly valuable for determining intra-articular extent of calcaneal abnormalities 1
• For complete evaluation of the hindfoot, the standard three views should be supplemented with this specialized calcaneal projection 1

Additional Considerations

• If the patient has diabetes and Charcot neuro-osteoarthropathy is suspected, bilateral plain X-rays should be performed if possible 1
• Standing (weight-bearing) radiographs provide important information about stability and alignment that may be relevant to heel pathology 1
• If the patient cannot bear weight, non-weight-bearing radiographs are an acceptable alternative, though they may not demonstrate all malalignments 1

When Standard Radiographs Are Insufficient

• If standard radiographs including the axial Harris-Beath view are normal but clinical suspicion remains high, advanced imaging may be warranted 1
• MRI would be the next best examination if radiographs are normal but symptoms persist, as it can evaluate both osseous and soft tissue structures 1
• CT may be considered if MRI is unavailable or contraindicated, particularly for detailed evaluation of complex bony architecture 1

Common Pitfalls to Avoid

• Failing to include the axial Harris-Beath view when calcaneal pathology is suspected can lead to missed diagnoses 1
• Using only standard AP and lateral views without specialized calcaneal projections may be insufficient for complete evaluation of heel calcifications 1
• Not obtaining weight-bearing views when possible may miss dynamic abnormalities that contribute to the patient's symptoms 1