J Rheum Dis.  2017 Apr;24(2):93-98. 10.4078/jrd.2017.24.2.93.

Does Painful Heels in Ankylosing Spondylitis Demonstrate Distinctive Features on Plain Radiographs: A Study of 104 Cases

• Kim TH
• Lee S
• Sung IH
• Kim SJ
• Sung HK
• Hur JS

• KMID: 2378087
• DOI: http://doi.org/10.4078/jrd.2017.24.2.93

Abstract

OBJECTIVE
To investigate simple radiographic findings on painful heels in ankylosing spondylitis (AS). Heel radiography in most studies was from AS patients' non-painful heel.
METHODS
Seventy AS patients (34 bilateral cases) with heel pain at the time digital radiographs were taken were studied. Standing lateral views (104 radiographs) of the heel were reviewed. Associations between radiologic abnormalities and disease duration and among various abnormal findings were analyzed.
RESULTS
Ninety-six (93.4%) had radiographic abnormalities (82.7% in soft tissues/61.5% in bone). Abnormalities of bone only were observed in 9.6%, of the soft tissues only in 30.8%, and of both were 51.9%. These included Kager's triangle's blurring (77.9%), posterior soft tissue swellings near the Achilles tendon insertion (65.4%), obliterations of the retrocalcaneal recess (65.4%), erosions of the superior pole of the posterior calcaneus (31.7%), subplantar irregular spurs (20.2%), posterior traction spurs (16.3%), subplantar erosions (14.4%) and cortical thickenings of the inferior calcaneal body (5.8%). There was a significant association between swelling in the posterior soft tissue and obliteration of the retrocalcaneal recess (p<0.001).
CONCLUSION
Digital radiography in AS is useful for observing not only bony lesions but also soft tissue abnormalities of the heel, particularly of the posterior heel. For assessing the symptomatic enthesitis of the Achilles, this simple and quick diagnostic tool is valuable when examining for soft tissues' alterations of the posterior heel.

Keyword

Ankylosing spondylitis; Heel pain; Enthesitis of heel; Radiography

MeSH Terms

Achilles Tendon
Calcaneus
Heel*
Humans
Radiographic Image Enhancement
Radiography
Spondylitis, Ankylosing*
Traction

Figure

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  Figure 1. Lateral plain foot radiographs. (A) Subplantar erosion with an irregular spur (small arrow) in the inferior calcaneal tuberosity without any involvement soft tissue and bone of the posterior heel. (B) Focal involvement of soft tissues of the posterior heel such as blurred Kager's triangle (large arrows), swelling of the posterior soft tissue shadow (small arrows) and obliteration of the retrocalcaneal recess (arrowhead), which are distinctively comparable to posterior heel of (A). (C) Concomitant involvement of bone and soft tissue of the posterior heel such as blurred Kager's triangle, erosion of the posterior calcaneal tuberosity (large arrow), swelling of the posterior soft tissue shadow (small arrow) and obliteration of the retrocalcaneal recess (arrowhead).

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