Applicability of contrast‐enhanced ultrasound in the diagnosis of plantar fasciitis

Abstract

Contrast-enhanced ultrasound (CEUS) is used to visualize the microvascularization in various tissues. The purpose of this study was to investigate whether CEUS could be used to visualize the microvascular volume (MV) in the plantar fascia, and to compare the method to clinical symptoms and B-mode ultrasound (US) in patients with plantar fasciitis (PF). Twenty patients with unilateral PF were included and were divided by US in insertional thickening (10), midsubstance thickening (5), and no US changes (5). The MV was measured simultaneously in both heels. Four areas in the plantar fascia and plantar fat pad were measured independently by two observers. Inter- and intra-observer correlation analyses were performed. The asymptomatic heels showed a constantly low MV, and for the whole group of patients, a significantly higher MV was found in the symptomatic plantar fascia and plantar fat pad. Inter-observer correlation as well as intra-observer agreement was excellent. The MV in the plantar fascia and plantar fat pad can be measured reliably using CEUS, suggesting that it is a reproducible method to examine patients with plantar fasciitis.

Sonographic measurements of the achilles tendon, plantar fascia, and heel fat pad are reliable: A test‐retest intra‐ and intertester study

“…However, studies have described an involvement of the heel pad in patients with plantar fasciitis. Using contrast‐enhanced US, increased blood flow in the fat pad has been noticed in feet with plantar fasciitis compared with healthy feet, which might affect the thickness of the fat pad . The shock‐absorbing capacity of the heel fat pad has also been found to change in feet with plantar fasciitis .…”

“…Using contrast-enhanced US, increased blood flow in the fat pad has been noticed in feet with plantar fasciitis compared with healthy feet, which might affect the thickness of the fat pad. 24 The shock-absorbing capacity of the heel fat pad has also been found to change in feet with plantar fasciitis. 25 In addition, Sabir et al 3 found a significant correlation between the thickness of the plantar fascia and the heel fat pad, but did not describe how these measurements were made.…”

The thickness of heel fat-pad in patients with plantar fasciitis

“…A single USG device (Philips EPIQ 5 L12-5 50 mm 12-5 MHz linear-array transducer, Philips Medical System, Andover, MA, USA) was used throughout the study by a single operator to measure the unloaded THPs and TFMFPs of all the patients. A method has been developed to take ultrasound measurements by reviewing previous studies 18, 19, 20. The patients were placed on the examination table in a prone position so that their feet were free outside the table.…”

The relationship between ultrasonography with or without contrast and the clinical outcome in plantar fasciitis

“…The protocol has been described in detail 13 . The subjects were instructed not to do any kind of rigorous exercise 24 h before the examination, and we required that the patients rested 30 min prior to the investigation.…”

“…The image analysis process is described in detail elsewhere 13 . The relative microvascular blood volume in the thickened part of the plantar fascia and in the heel fat pad separately was determined as the mean signal intensity in decibels (dB) during the first plateau phase after subtraction of the baseline levels (the mean signal intensity registered before the contrast bolus injection) 13 …”