Radiographic Evaluation of Suspected Heel Calcification

Standard Radiographic Protocol

• The American College of Radiology recommends standard ankle radiographs to include three views: anteroposterior, lateral, and mortise views for sufficient radiographic evaluation of the osseous anatomy in the ankle region 1, 2
• 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 3, 4

Specialized Views for Heel/Calcaneal Evaluation

• The American College of Radiology recommends the axial Harris-Beath view for suspected calcaneal pathology, as it is optimal for evaluating calcifications in the heel 1, 2
• The axial Harris-Beath view is particularly valuable for determining intra-articular extent of calcaneal abnormalities 1, 2

Additional Considerations

• For patients with suspected Charcot neuro-osteoarthropathy, bilateral plain X-rays should be performed if possible 4, 5
• Standing (weight-bearing) radiographs provide important information about stability and alignment that may be relevant to heel pathology 1, 3

Advanced Imaging

• If standard radiographs including the axial Harris-Beath view are normal but clinical suspicion remains high, advanced imaging such as MRI may be warranted 5, 6
• MRI can evaluate both osseous and soft tissue structures, making it a useful next step if radiographs are normal but symptoms persist 5, 7
• CT may be considered if MRI is unavailable or contraindicated, particularly for detailed evaluation of complex bony architecture 3, 4