Retrospective Analysis of Plantar Fascia by Ultrasound Imaging in Patients with Plantar Fasciitis

Abstract

Background: We compared diagnostic ultrasound images of the plantar fascia with available patient histories for symptomatic patients previously diagnosed as having plantar fasciitis. Plantar fascia thickness and depth, the prevalence of perifascial hypoechoic lesions, and injury timelines in patients were reviewed. Methods: Images and histories for 126 symptomatic patients were collected from a patient database. We documented plantar fascia depth and thickness and the visualization of hypoechoic perifascial lesions. After image analysis, the obtained plantar fascia thickness measurements were compared with various patient attributes for possible relationships, including age, weight, and body mass index. In addition, plantar fascia thickness measurements were separated based on injury timeline as well as symptomatic/asymptomatic foot for patients with unilateral conditions to check for significant differences between subgroups. These were, in turn, compared with a control group of 71 individuals with no heel pain or diagnosis of plantar fasciitis. Results: Overall, mean ± SD symptomatic thickness (n = 148) was 6.53 ± 1.56 mm. Mean ± SD symptomatic depth (n = 136) was 13.36 ± 2.14 mm. For the control group, mean ± SD thickness was 3.20 ± 0.66 mm and depth was 10.30 ± 2.00 mm. Comparison of thickness based on injury timeline showed two significant differences: acute injuries (≤3 months) are significantly thicker than chronic injuries (>3 months), and only acute symptomatic thicknesses are significantly different from their asymptomatic thickness counterparts. Age, weight, and body mass index did not show significant correlations to thickness. Analysis of ultrasound images showed that 93% of symptomatic feet had hypoechoic lesions. Conclusions: Injury timeline and the presence of hypoechoic lesions may play important roles in patient discomfort, diagnosis, and treatment of plantar fasciitis.

Intense Therapeutic Ultrasound for Pain Relief in the Treatment for Chronic Plantar Fasciopathy

“…There are 3 main findings of this collaboration: first, patients reported outcomes in pain and level of daily activity improved between treatment and first follow-up and continued to improve or maintain over the duration of the study; second, intra-and perifascial hypoechoic lesion volume reduced alongside pain scores and correlated strongly with this patient self-reported outcome. Hypoechoic lesions as viewed on diagnostic ultrasonography represent areas of noncontinuous fibers, suggesting lack of continuity of the plantar fascia and disruption or edema in the surrounding tisse 15,[17][18][19] ; third, patients were largely satisfied with the ITU treatment they received, with no adverse effects occurring from treatment. Based on these results and findings, the original hypothesis has support.…”

“…with r1, r2, and r3 representing the 3 radii detailed above (Figure 1). 9,15,[17][18][19] Hypoechoic lesions were also seen in 15% of asymptomatic, collateral feet.…”

“…Recent studies using diagnostic ultrasound have shown a high percentage of patients experiencing plantar fascia pain also have perifascial hypoechoic lesions. 15,[17][18][19] These may represent a weakness in the support structure, resulting in pain. Ten percent of the adult population will experience some form of plantar fasciopathy, usually between the ages of 40 and 60 years.…”

EURO-MUSCULUS/USPRM Dynamic Ultrasound Protocols for Ankle/Foot

“…40 Plantar fasciitis presents with sharp pain, especially prominent in the morning, whereby US shows fusiform thickening, fiber disorganization, surrounding soft tissue edema, and entheseal bone formation. 41 Plantar fibromatosis (also known as the Ledderhose disease) is characterized by fibrous proliferation of the plantar fascia, which forms nodules of varying sizes. 42,43 Fascial rupture is characterized by marked hypoechoic swelling where the fascial ends remain lax during dorsiflexion of the forefoot.…”

“…The plantar fascia is a strong fascia that runs throughout almost the full length of the plantar aspect of the foot from its origin (calcaneus) to its complex insertion (metatarsal heads) and maintains the longitudinal arch of the foot 40 . Plantar fasciitis presents with sharp pain, especially prominent in the morning, whereby US shows fusiform thickening, fiber disorganization, surrounding soft tissue edema, and entheseal bone formation 41 . Plantar fibromatosis (also known as the Ledderhose disease) is characterized by fibrous proliferation of the plantar fascia, which forms nodules of varying sizes 42,43 .…”