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Fallibility of the Heel-Pad Thickness in the Diagnosis of Acromegaly

1967; Radiological Society of North America; Volume: 88; Issue: 5 Linguagem: Inglês

10.1148/88.5.892

1527-1315

S. E. Puckette, E. Quitman Seymour,

Peripheral Nerve Disorders

The most constant x-ray manifestation of acromegaly, according to a previous report, is thickening of the soft tissue of the fingers, toes, and scalp (1). A more recent article indicates that there is a diagnostic relationship between the thickness of the heel pad and acromegaly (2). It was suggested that a heel-pad thickness in excess of 21 mm indicates a diagnosis of acromegaly with reasonable accuracy if other causes of local soft-tissue swelling are excluded. The purpose of this paper is to point out that a wide variation in heel-pad measurements occurs, with values extending well above the previously reported limits proposed for normals (2). Method A comparable technic was employed to obtain heel-pad measurements for comparison with those cited in the recent article by Steinbach and Russell (2). A lateral view of the calcaneus was obtained with a focal spot distance of 40 in. Initially, a cardboard holder was used in addition to a view with an intensifying screen. The measurements obtained with and without intensifying screens were identical. We therefore employed the intensifying screen to reduce the radiation dose in the majority of subjects. The shortest distance from the calcaneus to the plantar skin surface of the heel in millimeters was the measured distance. Two hundred examinations were collected in a group selected at random from the Medical College Hospital complex. The subjects were considered nonacromegalic by physical examination and/or a normal x-ray film of the sella turcica (3). Ninety-three patients were Caucasian and 107 were Negroes. Results The sex and age of the patients did not appear to cause a significant variation in heel-pad thickness (Tables I and II). Negroes in our series exhibited a greater average heel-pad measurement (Table III). The largest heel pad in our group was in a 52-year-old white male, with a value of 30 mm. Forty per cent of the Negro patients exceeded the previously established upper limit of 21 mm for normals. Nine per cent of Caucasians had heel pads measuring greater than 21 mm (Table IV). Discussion The results in our series fail to confirm the previously reported accuracy of the heel-pad measurement in the diagnosis of acromegaly. A wide variation among apparently normal persons exists, and many nonacromegalic patients have heel-pad measurements well within the previously proposed acromegalic range.