x-ray unhelpful other than to exclude other causes. Presence of spur is not diagnostic
plasma viscosity, C-reactive protein (CRP) and HLA-B27 may be useful if bilateral, and other enthesopathy or arthropathy present
nerve conduction tests if clinical suspicion of tarsal tunnel syndrome, but not enough confidence to inject
ultrasound, magnetic resonance imaging (MRI) and bone scan via secondary care, if not responding after 3 months' treatment. (This is a fairly arbitrary figure from the USA)
Reference:
ARC (February 2004). Hands On - practical advice on the management of rheumatic disease, 2.
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