Plantar fasciitis: sonographic evaluation.

Cardinal, Étienne; Chhem, Rethy; Beauregard, Caroline; Aubin, Benoît; Pelletier, Matthew H.

doi:10.1148/radiology.201.1.8816554

Cited by 195 publications

(123 citation statements)

References 13 publications

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“…It is however, more typical for ruptures to be located distal to the calcaneal insertion. On ultrasound, commonly used criteria of plantar fasciitis are increased thickness (greater than 4 mm), and hypoechogenicity (9)(10)(11). Ultrasound has been shown to have good reproducibility for measurement of plantar fascia thickness and appreciation of hypoechogenicity (12,13).…”

Section: Discussionmentioning

confidence: 99%

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Sonographic Evaluation of the Plantar Fascia in Asymptomatic Subjects

Gadalla

Kichouh²,

Boulet³

et al. 2014

Journal of the Belgian Society of Radiology

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Plantar fasciitis is a low-grade inflammation of the plantar fascia and perifascial tissues. It is a common cause of heel pain and usually affects middle-aged women, as well as younger, predominantly male, runners (1). The condition is likely related to repeated strain, leading to microtears and inflammation. Imaging is commonly used to confirm the diagnosis, and exclude other causes of posterior heel pain (2).Although MR imaging may be used to diagnose plantar fasciitis, many authors suggest ultrasound is an accurate, simple, and noninvasive technique to diagnose the condition. Previous investigators have reported that the most important diagnostic findings in plantar fasciitis are thickening and hypoechogenicity, and occasionally fluid collections adjacent to the fascia. Wall et al. (3) suggest that a plantar fascia thickness greater than 4 mm is consistent with plantar fasciitis. This value has been used as a reference value in several studies (4-6).To our knowledge, there are no data about the ultrasound appearance of the plantar fascia in asymptomatic subjects. Hence, it is not known if certain commonly used ultrasound criteria of plantar fasciitis might be seen in such a population. If so, this may entail the risk of attributing the patients' symptoms to a reference point where the plantar fascia crossed the anterior aspect of the inferior border of the calcaneus. The measurement points are indicated in the figures by calipers (Figs. 1-3). The plantar fascia was evaluated for echogenicity. It was only considered hypoechoic if its echogenicity was markedly decreased with respect to the subcutaneous heel fat. The plantar fascia was also assessed for presence of calcification defined as markedly hyperechoic foci, with or without acoustic shadowing, vascularity with Doppler, tear, and fluid adjacent to the fascia. The saved images were reviewed by 2 investigators. Statistical analysis was performed using a t-test (independent samples) (IBM SPSS Statistics 20, Armonk, NY). The significance threshold was set at p = 0.05. ResultsA total of 62 plantar fascias in 31 subjects (14 men, 17 women), aged from 17 to 79 years (mean age, 45 years) were evaluated ( Fig. 1-3). The results are shown in Tables I and II. The mean thickness of the plantar fascia in men was 3.7 mm (range, 2.5-7 mm), and in women 3.5 mm (range, 1.7-5.1 mm). There was no statistically significant difference between the thickness of the fascia in men and women (p = 0.21). There was no significant difference between the right and the left foot (p = 0.64).The thickness of the plantar fascia was greater than 4 mm in 4 men plantar fasciitis while other abnormalities may be overlooked and not further investigated. Therefore we decided to evaluate the plantar fascia in asymptomatic subjects with high resolution ultrasound. Materials and methodsInstitutional Review Board approval for our study was obtained and consent from the asymptomatic subjects. They were interviewed to confirm they had not been symptomatic at the sole of the foot. Other exclusion cr...

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Section: Discussionmentioning

confidence: 99%

“…Pain is usually worse with exertion. On clinical exam, tenderness at the calcaneal origin may be evident (1,9). Although plantar fasciitis may resolve after a few weeks, in some patients symptoms may become chronic.…”

Section: Discussionmentioning

confidence: 99%

Sonographic Evaluation of the Plantar Fascia in Asymptomatic Subjects

Gadalla

Kichouh²,

Boulet³

et al. 2014

Journal of the Belgian Society of Radiology

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“…2 The role of musculoskeletal sonography in the evaluation of plantar heel pain has been well established with respect to the plantar fascia. [3][4][5][6][7][8][9][10][11][12][13][14][15] More specifically, plantar fascia thickening (>4 mm), hypoecho genicity, heterogeneity, and neovascularization are considered reliable markers of symptomatic plantar fasciitis, whereas a normalappearing plantar fascia warrants consideration of alternative causes of heel pain. 1,3,4,9,[12][13][14] On the contrary, the role of sonography Mederic M. Hall, MD, Jonathan T. Finnoff, DO, Yusef A. Sayeed, MD, MPH, MEng, Jay Smith, MD Received December 31, 2014, …”

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Sonographic Evaluation of the Plantar Heel in Asymptomatic Endurance Runners

Hall

Finnoff

Sayeed

et al. 2015

J of Ultrasound Medicine

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lantar heel pain is a common condition affecting endurance runners and accounts for approximately 8% of all runningrelated injuries. 1 Although plantar fasciitis is the most common cause of heel pain in the athletic population, 2,3 the differential diagnosis of heel pain is broad and includes plantar heel pad syndrome (also referred to as fat pad syndrome), calcaneal fractures, regional nerve entrapments (eg, Baxter nerve), and referred pain syndromes. 2 The role of musculoskeletal sonography in the evaluation of plantar heel pain has been well established with respect to the plantar fascia. [3][4][5][6][7][8][9][10][11][12][13][14][15] More specifically, plantar fascia thickening (>4 mm), hypoecho genicity, heterogeneity, and neovascularization are considered reliable markers of symptomatic plantar fasciitis, whereas a normalappearing plantar fascia warrants consideration of alternative causes of heel pain. 1,3,4,9,[12][13][14] On the contrary, the role of sonography Mederic M. Hall, MD, Jonathan T. Finnoff, DO, Yusef A. Sayeed, MD, MPH, MEng, Jay Smith, MD Received December 31, 2014, ORIGINAL RESEARCHObjectives-The primary purpose of this investigation was to determine the prevalence and spectrum of asymptomatic sonographically determined structural changes in the plantar fascia and plantar heel pad among experienced runners without a history of heel pain.Methods-Thirty-nine asymptomatic runners without a history of plantar heel pain were recruited. The following sonographic measures were recorded: power Doppler sonography in the plantar heel pad and plantar fascia, echo texture of the plantar heel pad, uncompressed heel pad thickness, compressed heel pad thickness, heel pad compressibility index, plantar fascia thickness, and plantar fascia echo texture. Conclusions-At least 1 potentially abnormal sonographic finding was present in each heel of all asymptomatic runners in this study. Consequently, sonographic abnormalities in the plantar heel should be interpreted within the clinical context when evaluating runners. Results-Doppler

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“…Therefore, the purpose of the present study was to correlate the computerised VI and Newman's qualitative grading scale in quantifying plantar fascia vascularity using PDU, to evaluate the intra-and intertester reliability of the computerised quantitative method and its predictive ability of recovery in patients with plantar fasciitis. Proximal plantar fascia, which is the most commonly affected area in individuals with plantar fasciitis, according to clinical examination [25,26] and previous B-mode ultrasonography [26][27][28], was chosen as the target testing area.…”

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confidence: 99%

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

Chen

Ho²,

Ying³

et al. 2012

BJR

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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.

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Plantar fasciitis: sonographic evaluation.

Abstract: Increased thickness of the fascia and hypoechoic fascia are sonographic findings of plantar fasciitis. US may be a valuable noninvasive technique for the diagnosis of plantar fasciitis.

Cited by 195 publications

References 13 publications

Sonographic Evaluation of the Plantar Fascia in Asymptomatic Subjects

Sonographic Evaluation of the Plantar Fascia in Asymptomatic Subjects

Sonographic Evaluation of the Plantar Heel in Asymptomatic Endurance Runners

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

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