Heel (Calcaneus) X-ray (both feet)

What it is

The calcaneus is the large block of bone at the back of the foot that takes the body's weight at every step. It breaks under axial load — a fall from a ladder or a roof, or a crash in which the heel is crushed against the floorboard — when the talus above it is driven down into it like a wedge. Because the fracture lines run in several directions through a bone that is roughly cube-shaped, two pictures are rarely enough: this study adds angled projections, including a view taken along the axis of the heel, so the shape of the bone and the position of the fragments can be judged. This particular code covers both heels. Filming the uninjured side gives the radiologist and the surgeon a normal template of that patient's own anatomy to compare against, which matters for a bone whose normal contour varies from person to person.

Why it is done

• To find a break in the heel bone after a fall from a height or a high-energy crash
• To show whether the fragments have shifted and whether the heel has flattened or widened, which is what separates a fracture treated in a cast from one taken to surgery
• To compare the injured heel against the other one when the change in shape is subtle
• To look for other causes of persistent heel pain, such as a stress fracture, a bone spur, or changes at the attachment of the Achilles tendon
• To check alignment and healing after a cast or a surgical repair

What to expect

The technologist rests the foot on the imaging plate and rotates or angles the beam between exposures, then repeats the sequence on the other side. The room time is usually five to ten minutes. Nothing needs to be swallowed, injected, or prepared. Moving an acutely injured heel into position is the uncomfortable part; the exposures themselves are not felt. Plain films often do not settle the question on their own — a CT is frequently added when a calcaneus fracture is confirmed, because the fragment pattern inside the bone is what surgical planning depends on. A radiologist issues the formal report.

Questions worth asking

• Was the uninjured heel filmed as well? This code covers both sides, and a single-heel study is a different, cheaper code — worth confirming the bill matches what was actually taken.
• If a CT of the heel follows on the same day, will I be billed for both studies in full?
• Was this done in an emergency department, an urgent care clinic, or an orthopaedic office? The films are identical; the facility charge is not.
• Will the films taken at each cast change or follow-up visit be billed as new studies?