Evaluation of plantar fascia using high-resolution ultrasonography in clinically diagnosed cases of plantar fasciitis

Abstract

The aim of this study was to assess the efficacy of high-resolution ultrasonography in the assessment of plantar fascia in individuals with heel pain, before and after treatment. Material and methods: This study was conducted from 2016 to 2019, during which time 44 clinically diagnosed patients of plantar fasciitis were compared to 50 normal volunteers. There were 25 males and 25 females in the control group and 42 females and two males in the study group. Thirty-eight patients had unilateral disease, and six patients had bilateral disease. The thickness of the plantar fascia was measured just anterior to its calcaneal attachment using ultrasonography. Body mass index (BMI) was also calculated in both groups. Results: The plantar fascia was 2-4 mm thick in the control group whereas it was > 4 mm thick in 48 heels in the study group. With cutoff of > 4 mm as diagnostic of plantar fasciitis, this study had a sensitivity of 96%, specificity of 100%, and accuracy of 98%. BMI was increased in 60% of female patients. All patients were treated with local infiltration of corticosteroid. In 37/42 patients (43 heels) who had improved clinically, the thickness of plantar fascia was reduced to < 4 mm when assessed after six weeks of corticosteroid injection. Conclusions: Diagnosis of plantar fasciitis can be easily verified by ultrasonography with plantar fascia thickness > 4 mm being suggestive of plantar fasciitis. Ultrasound can also be used to evaluate treatment response. Ultrasonography helps the clinician in confirming the diagnosis of plantar fasciitis and also in assessing the response to treatment.

The Diagnostic Significance of Ultrasonographic Measurement of the Achilles Tendon Thickness for the Insertional Achilles Tendinopathy in Patients with Heel Pain

“…A previous study in the Korean population suggested that a thickness of greater than 3.8 mm was a clinically meaningful US finding of plantar fasciitis [ 8 ]. In the present study, the thickness of the plantar fascia in patients with plantar fasciitis was significantly thicker than in normal controls, but the mean thickness of the plantar fascia in patients with plantar fasciitis ( n = 109 feet) was 3.74 mm, which appears to be less thick than previously reported cases with a mean maximal thickness of 2.9 to 6.9 mm [ 6 , 7 , 33 , 34 , 35 ]. Our finding that the thickness of the plantar fascia in patients with plantar fasciitis was less than that in prior research can be attributed to the following causes.…”

“…Second, in cases of plantar fasciitis as well, US findings, such as the thickness of the plantar fascia, did not always correlate with clinical status and vice versa. Previous studies have reported high sensitivity and specificity values of US based on a cutoff value of 4 mm for the diagnosis of plantar fasciitis [ 6 , 7 ]; however, there have also been contrasting results that only 42.7% to 60% of patients with plantar fasciitis exhibited thickening of the plantar fascia to more than 4 mm on US and some research suggests the mean plantar fascia thickness is 2.9 mm in cases of plantar fasciitis [ 35 , 36 , 37 ]. Our results demonstrated that a cutoff value of 3.8 mm for the plantar fascia thickness yielded a sensitivity of 48.6% and specificity of 90.6% with less accurate diagnostic value (AUC 0.63).…”

“…For the US evaluation of the plantar fascia, patients were positioned lying prone with their ankles hanging free in a slightly plantarflexed position. Plantar fascia thickness was measured as the maximal anteroposterior diameter in the long-axis view at its thickest point within 1 cm of the calcaneal attachment [ 6 , 7 ] ( Figure 2 C) and echogenicity was assessed around the medial tubercle of the calcaneus. Abnormal echogenicity of the plantar fascia was defined as hypoechoic area evident in both the longitudinal and transverse scans and heterogeneous appearance of the fibrillar pattern ( Figure 2 D).…”

“…For tendinopathy, US reveals structural abnormalities, such as tendon thickening, textural heterogeneity with intra-tendinous focal hypoechoic areas, and altered vascularity [ 5 ]. There is a consensus on the role of US measurement of the thickness of the plantar fascia in establishing the diagnosis of plantar fasciitis [ 6 , 7 ]. A thickness of greater than 3.8 or 4.0 mm of the plantar fascia as measured by US is diagnostic of plantar fasciitis [ 8 ].…”

Medical imaging for plantar heel pain: a systematic review and meta‐analysis

“…Three unblinded ultrasound studies reported the number of participants with plantar fascia thickness > 4 mm [ 19 , 22 , 35 ]. Meta-analysis was conducted and included a total of 99 PHP participants and 160 control participants.…”