Context |
Although demonstration of a heel spur on x-ray confirms the diagnosis, a negative x-ray cannot rule out early onset of a heel spur. Infrequently, calcaneal spurs may appear ill-defined on x-ray, exhibiting fluffy new bone formation, suggesting seronegative or HLA-B27 arthropathy (eg, ankylosing spondylitis, Reiter´s syndrome). RA and gout are other causes. These arthropathies, usually distinguishable from local causes of heel pain by the presence of moderate to severe heat and swelling, are discussed elsewhere in The Manual.
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