Objective. Analysis of sonographic examination of plantar aponeurosis in norm and in plantar fasciitis, determination of the staging of plantar fasciitis depending on the duration of the pain syndrome and sonographic changes in plantar aponeurosis. Materials and Methods. 193 patients (272 cases) with plantar fasciitis (131 females and 62 males). The average age of patients was 47.69±0.97 years (18-81 years). Unilateral pathology was noted in 114 patients (114 cases) and bilateral – in 79 patients (158 cases). The average body mass index was 26.68±0.24. The average duration of pain syndrome was 101.12±5.83 days (7-390 days). The pain syndrome lasted up to 1 month in 26 patients (37 cases), from 1 to 6 months – in 126 patients (181 cases), and more than 6 months – in 41 patients (54 cases). The control group included 20 healthy volunteers (40 feet). Clinical radiological, sonographic, and statistical methods were used. Results. The average thickness of plantar aponeurosis in the study group was 6.14±1.49 mm (2.3-7.7 mm) and in control group – 3.5±0.1 mm (2.5-4.4 mm). There were three stages of the plantar fasciitis. Stage I was characterized by the absence of thickening of the plantar aponeurosis and structural changes, and by signs of local perifocal edema in the subcutaneous fat of the area adjacent to the aponeurosis, which are manifested by a zone of heterogeneous echogenicity. Stage II was characterized by a spindle-shaped form of aponeurosis, a thickening of enthesis more than 4 mm, significant reduction in echogenicity, erased or missing fibrous pattern, fuzzy contour of the aponeurosis, and modified contour of the calcaneus. At stage III, inequality of the cortical calcaneal contour and small focal hyperechogenicity points in enthesis were detected. Distal free part of the aponeurosis also changed. Loci of vascularization were detected using power Doppler sonography. Conclusions. A quantitative sonographic sign of plantar fasciitis is the thickening of the enthesis of the plantar aponeurosis of more than 4 mm. Qualitative signs were changes in echogenicity and structure, changes in the contours of the cortical layer of enthesis and plantar aponeurosis, and distribution of echographic changes distally to the free part of the aponeurosis. The described signs, when compared with the duration of the pain syndrome, determine the stage of plantar fasciitis.

Summary. Injury of the anterolateral ligament (ALL) accompanies more than half of the anterior cruciate ligament ruptures. However, the uncertainty in the anatomy of ALL raises many questions regarding its visualization on ultrasound. There are also very few ultrasonographic studies of the ALL in the scientific literature in the era of MRI and CT. Objective: to determine the optimal methods and techniques for identifying and improving the visualization of the ALL with ultrasonography. Materials and Methods. ALL ultrasonography was performed in 30 healthy volunteers without pathology of the knee joint on both knee joints using a linear high-frequency sensor (ACUSON NX2 Elite, 10 MHz) at different angles of bending and rotation. Results. Ultrasonography was able to visualize the ALL in all 30 patients as a fibrillar anisotropic structure. The distinctiveness of the ALL was significantly different between patients. It was easiest to find and visualize it well with an extended knee joint, and to assess the integrity and tension when bending the knee joint at an angle of 60° and in the maximum internal rotation of the lower leg. A clearly visible tubercle was revealed by ultrasonography at the site of attachment of the ALL to the tibia in 100% of patients, which has not been described previously and greatly facilitates its finding. There was a history of a violation of the integrity of the cortical layer at the site of attachment of the ALL to the tibia in 26.67% of patients without pathology of the knee joint and injuries. Ultrasonographic identification of the two-layer structure of the ALL failed. The femoral part of the ALL is usually woven into the initial part of the fibular collateral ligament and cannot be separated ultrasonographically from it. In all 30 patients with relatively healthy knee joints without traumatic pathology, the ALL in the contralateral joints looked similar, without statistically significant deviations in their morphometric parameters. Conclusions. Ultrasonography visualizes the tibial and femoral parts of the ALL particularly but not exclusively during movements; however, it almost does not show meniscus bundles separately. For a better visualization of the ALL and assessment of its integrity, we recommend starting its research with an extended knee joint, and then performing functional tests by alternating internal and external rotation of the lower leg at different angles of flexion of the knee joint. The starting point of the ALL is the origin of the fibular collateral ligament from the lateral condyle of the femur, and the reference point of attachment is the tubercle on the anterolateral surface of the tibia posterior to Gerdy tubercle uncovered by us with ultrasonography in all the patients, which is an important reference point that allows faster, easier, and more confident localization of the ALL tibial portion insertion site. On a healthy contralateral joint, the ALL can serve as a reference for comparison if its rupture is suspected.

BackgroundPlantar fasciitis is a chronic degenerative process of the plantar fascia enthesis. It manifests by pain, predisposition to prolonged course and treatment resistance. In many cases, plantar fasciitis develops in patients with acquired flat feet. Taken into consideration above mentioned, the study of the plantar fascia changes in patients with acquired flat feet by sonography is relevant.ObjectivesTo investigate the quantitative and qualitative sonographic changes of the plantar fascia in the case of plantar fasciitis in patients with acquired flat foot.Methods190 patients with plantar fasciitis on the basis of acquired flat feet (133 females and 57 males). The average age of patients was 48 ± 0.97 years (18-81years). Unilateral pathology was noted in 117 patients and bilateral – in 73 patients. The average body mass index was 27.68±0.3. The average duration of pain syndrome was 101 ± 6.0 days (7-390 days). The pain syndrome lasted up from 1 to 6 months – in 152 patients, and more than 6 months – in 38 patients. The control group included 15 healthy volunteers (30 feet). Clinical radiological, sonographic, and statistical methods were used.ResultsThe main sonographic features were significant reduction in echogenicity, erased or missing fibrous pattern, fuzzy contour of the aponeurosis; and modified contour of the calcaneus; small focal hyperechogenicity points in enthesis were detected. Loci of vascularization were detected using power Doppler sonography. The average thickness of plantar fascia in the study group was 6,14±1,5 mm (2,3-7,7 mm) and in control group – 3,5±0,1 mm (2,5-4,4 mm).ConclusionSonographic signs of plantar fasciitis on the basis of acquired flat feet were changes in echogenicity and structure, changes in the contours of the cortical layer of enthesis and plantar fascia, the thickening of the enthesis of the plantar fascia of more than 4 mm.Disclosure of InterestsNone declared