Despite author's opinion, radiology guideline was correct

doi:10.1136/bmj.324.7336.547/a

BMJ 2002;324:547 ( 2 March )

Letters

Despite author's opinion, radiology guideline was correct

The first 150 words of the full text of this article appear below.

EDITOR $---$ Godfrey writes of a patient who presented with what he thought was plantar fasciitis, possibly with a calcaneal spur;he did not send her for radiological examination because a guidelinesaid that it was not recommended in such cases.¹ He later foundout that she had metastatic cancer, and he decries the guidelinesaying that routine radiography wasunnecessary.

But the guideline in question was correct: radiography to detect calcaneal spurs is a waste of everyone's time. If the putativediagnosis is plantar fasciitis then ultrasound examination ofthe soft tissue is more useful $---$ if imaging is required atall.

Of course, if things had happened differently, and the patient had been known to have metastatic disease and had presentedwith disabling pain in the calcaneus, then no radiologist wouldhave refused an x ray examination to determine whether there wasa bone lesion to account forit.

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