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Appropriateness of Calcaneum Plain Films at Salford Royal NHS Foundation Trust
Poster Title: Appropriateness of Calcaneum Plain Films at Salford Royal NHS Foundation Trust
Submitted on 16 Sep 2019
Author(s): Dr Mark Woodward, Dr Alan Sorani, Leanne Jones.
Affiliations: Salford Royal NHS Foundation Trust
This poster was presented at BIR
Poster Views: 109
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Poster Information
Abstract: Plantar fasciitis accounts for approximately 80% of patients who present with heel pain. Diagnosis of plantar fasciitis is clinical, therefore investigations are not useful. It is controversial whether calcaneal spurs do, or do not contribute to heel pain. Surgical removal of a plantar spur does not provide any benefit for most patients. Having a calcaneal spur does not mean there is plantar fasciitis.

"NICE guidelines: Investigations are not useful in the diagnosis of plantar fasciitis. If the diagnosis is uncertain, referral to a podiatrist or orthopaedic surgeon for further investigation."

Radiologists at Salford Royal NHS Foundation Trust, (SRFT), have identified cases when calcaneum plain films have been performed, despite request cards not including an appropriate indication.

The aim is to reduce the number of inappropriate calcaneum plain films performed.

Data was collected retrospectively at SRFT using electronic patient records, (EPR and CRIS). GP request forms (n=100), and hospital request forms (n=109), for calcaneum plain films were looked at between 2016 and 2018. Musculoskeletal Radiologists reviewed the indications on request forms and deemed which were appropriate. A protocol for calcaneum plain films was implemented for radiographers at SRFT on 25/02/2019 and circulated with GPs in the Salford CCG.

The primary audit showed GP request forms were appropriate for 17.0% of cases, (n=17). Over half of inappropriate GP request forms included plantar fasciitis or calcaneal spur. Hospital request forms for calcaneum plain films were appropriate indication for 99.1% of cases, (n=108). The re-audit, 6 months after protocol implementation, showed GP request forms were appropriate for 76% of cases.
Summary: A closed loop audit on the appropriateness of calcaneum plain films at Salford Royal NHS Foundation Trust. An improvement in the percentage of GP request forms being appropriate is shown, by the implementation of a protocol.
Thomas JL, Christensen JC, Kravitz SR, et al; The diagnosis and treatment of heel pain: a clinical practice guideline-revision 2010. J Foot Ankle Surg. 2010 May-Jun49(3 Suppl):S1-19.
Heel Pain; Wheeless' Textbook of Orthopaedics.
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