Magnetic resonance imaging in plantar heel pain

Magnetic Resonance Imaging (MRI) is generally only indicated in patients with plantar heel pain who have atypical symptoms or who do not improve with appropriate management.

This study retrospectively reviewed the MRI findings of 112 patients with heel pain divided into two groups consisting of 50 patients with persistent pain despite appropriate treatment and 62 patients with atypical heel pain.

Of the 50 patients with persistent heel pain, 38 (76%) of MRIs confirmed the diagnosis of plantar fasciitis. Of the 62 patients who had presented with atypical symptoms or signs, 21 patients had presented with night pain and the remaining 41 had presented with acute pain, tenderness of the lateral or medial aspect of the heel, significant swelling, neurological features or pain posterior to the insertion of the plantar fascia. Patients with night pain were shown to have plantar fasciitis associated with calcaneal marrow edema in 15 (71.4%) cases (p < 0.05). One patient presenting with night pain was found to have a plantar arterio-venous malformation. Acute pain was associated with plantar fascia tears in 4 out of 9 (p < 0.05).

MRI may provide reassurance in cases of persistent heel pain but rarely changes the management. In cases of atypical heel pain, MRI may demonstrate other pathology such as plantar fascia tearing, calcaneal edema or arteriovenous malformation.