Correlation between computerised findings and Newman's scaling on vascularity using power Doppler ultrasonography imaging and its predictive value in patients with plantar fasciitis

Abstract

Objectives: The purpose of this study was to correlate findings on small vessel vascularity between computerised findings and Newman's scaling using power Doppler ultrasonography (PDU) imaging and its predictive value in patients with plantar fasciitis. Methods: PDU was performed on 44 patients (age range 30-66 years; mean age 48 years) with plantar fasciitis and 46 healthy subjects (age range 18-61 years; mean age 36 years). The vascularity was quantified using ultrasound images by a customised software program and graded by Newman's grading scale. Vascular index (VI) was calculated from the software program as the ratio of the number of colour pixels to the total number of pixels within a standardised selected area of proximal plantar fascia. The 46 healthy subjects were examined on 2 occasions 7-10 days apart, and 18 of them were assessed by 2 examiners. Statistical analyses were performed using intraclass correlation coefficient and linear regression analysis. Results: Good correlation was found between the averaged VI ratios and Newman's qualitative scale (r50.70; p,0.001). Intratester and intertester reliability were 0.89 and 0.61, respectively. Furthermore, higher VI was correlated with less reduction in pain after physiotherapeutic intervention. Conclusions: The computerised VI not only has a high level of concordance with the Newman grading scale but is also reliable in reflecting the vascularity of proximal plantar fascia, and can predict pain reduction after intervention. This index can be used to characterise the changes in vascularity of patients with plantar fasciitis, and it may also be helpful for evaluating treatment and monitoring the progress after intervention in future studies.

Association Between Plantar Fascia Vascularity and Morphology and Foot Dysfunction in Individuals With Chronic Plantar Fasciitis

“…7 The power Doppler ultrasonography settings were standardized for high sensitivity, with low wall filtering to allow the detection of vessels with low blood flow. The pulse repetition frequency was 370 Hz, and medium persistence was used.…”

“…Details of the procedure have previously been reported by our group. 7 In brief, the total number of pixels, as well as the color pixels within the region of interest, were counted by the customized software. The VI was defined as the ratio of the number of color pixels to the total number of pixels within the region of interest.…”

“…7,31 This increase is typical in those who have had plantar fasciitis for less than 12 months, and has been associated with greater intensity of pain.…”

“…11,31 A moderate to marked increase in vascularity in the proximal plantar fascia has been observed in patients with plantar fasciitis. 7,31 This increase is typical in those who have had plantar fasciitis for less than 12 months, and has been associated with greater intensity of pain. 31 Similar vascularization has been observed in patients with Achilles, 23,36 patellar, 9 and rotator cuff tendinopathy.…”

Hyperemia in Plantar Fasciitis Determined by Power Doppler Ultrasound

“…This grading scale was recently shown to have good correlation with a computerized method that quantified tissue vascularity by calculating the total number of color pixels in the region of interest (Spearman rho = 0.70, P<.01). 6 To reach consensus on the grading of hyperemia, the 2 assessors examined PDU images together.…”