Evaluation of the diagnostic value of heel-pad thickness in acromegaly.

Thickening of the soft tissues of fingers, toes, and scalp is considered one of the most constant radiologic findings in acromegaly (1). Recent studies have shown that changes in the radiologically measured soft-tissue thickness are of diagnostic value in acromegaly (2, 3). Steinbach and Russell found that heel-pad thickness, as determined on a plain lateral film of the foot, was significantly increased in acromegaly and that this increase represented an accurate criterion for the roentgen diagnosis of acromegaly. Moreover, Sheppard and Meema (3) noted that skin thickness as measured radiologically in the forearm was increased above the upper normal limits in 19 of 21 acromegalics. Because of its simplicity, its availability to every clinician, and its reportedly high diagnostic value, measurement of the heel-pad thickness seemed a promising method in the diagnosis of acromegaly. This view was, however, severely criticized by Puckette and Seymour (4) who concluded that a wide variation in heel-pad thickne...