Painful heel syndrome: rationale of diagnosis and treatment.

Recent developments in isotope imagery have allowed orthopaedic surgeons some insight into stress areas of the skeleton that are not readily seen on routine X-rays. This X-ray imagery has been used in evaluating patients with painful heel syndrome. In 97.7% of the cases, the bone scan was positive on the side of the heel that had the pain. An X-ray technique exposing the painful heel at a 45 degree angle on the medial side with the cassette underneath the foot showed a bony condensation in many of the cases which was thought to represent a fatigue fracture. Based on these bone scans and X-ray findings, a classification system has been devised. A flow chart is described using logical progression in the diagnosis and treatment phase of this problem.