Magnetic resonance imaging (MRI) is one of the most detailed imaging investigations available for assessing chronic heel pain. Although many patients believe an MRI should be the first test performed, this is rarely necessary. Most cases of plantar heel pain can initially be assessed through a careful history, physical examination and, where appropriate, diagnostic ultrasound. MRI is generally reserved for situations where additional information is required or when the diagnosis remains uncertain.
MRI is particularly useful because it provides excellent visualisation of both bone and soft tissue. Unlike ultrasound, it can identify abnormalities deep within the heel bone that cannot be assessed directly with ultrasound. This includes calcaneal bone marrow oedema, stress fractures, inflammatory bone changes and other conditions affecting the internal structure of the calcaneus.
MRI also provides valuable information about the plantar fascia. It can demonstrate thickening, degeneration, tearing and surrounding soft tissue inflammation. In addition, it allows assessment of muscles, tendons, ligaments, joints and nerves throughout the hindfoot. This broader view is especially helpful when several conditions may be contributing to persistent symptoms.
It is important to remember that MRI findings should never be interpreted in isolation. Like all imaging, MRI may identify structural abnormalities that are unrelated to the patient's pain. Conversely, some patients experience significant symptoms despite relatively modest imaging changes. For this reason, MRI findings must always be interpreted alongside the patient's history, examination findings and other investigations.
I frequently use diagnostic ultrasound and MRI as complementary investigations rather than competing tests. Ultrasound provides dynamic, real-time assessment of superficial structures and is extremely valuable during the initial consultation. MRI adds further information when deeper structures require evaluation or when ultrasound alone cannot fully explain the patient's symptoms. Together they provide a comprehensive understanding of the underlying pathology.
The aim of MRI is not simply to produce better pictures. Its value lies in helping answer specific clinical questions that influence diagnosis and treatment. Used appropriately, it allows treatment recommendations to be based on a more complete understanding of the patient's condition.