Role of high-resolution ultrasound in guiding treatment of idiopathic plantar fasciitis with minimally invasive techniques

Abstract

The presence of peri-fascial oedema may represent an effective criterion for guiding treatment decisions towards HRUS-guided corticosteroid injection.

Plantar fasciitis

“…33 One comparison study suggested that if ultrasonography revealed perifascial oedema then cortisone injections gave superior results, but if not then shock wave therapy gave superior results. 34 Cortisone iontophoresis has also been used, for those who wish to avoid the pain of an injection. 35 Injections are notoriously painful, particularly when ultrasound guided (as the procedure takes longer), although it is argued that ultrasound guided injections are more accurate.…”

Plantar fascia evaluation with a dedicated magnetic resonance scanner in weight-bearing position: our experience in patients with plantar fasciitis and in healthy volunteers

“…However, it does not have the same sensitivity as MR imaging, it is highly operator-dependent and is unable to identify associated changes such as calcaneal marrow oedema [5][6][7]. In the diagnostic phase, MR imaging has the undeniable advantage of providing an overall structural and morphological evaluation, with the possibility of evaluating the course, thickness, margins and signal intensity of the plantar fascia, as well as distinguishing between the different types of abnormalities [1][2][3][8][9][10][11].…”

“…A significant reduction (p<0.0001) was observed in fascial thickness between scans acquired in the supine position and those in the weight-bearing position in the proximal and middle portions but not in the distal portion (p=0.0078) both in groups. A possible explanation is the different architectural and arrangement of the fascial fibres, which are more malleable in the proximal and middle portions and theredi riscontrare alterazioni associate come l'edema dell'osso subcondrale calcaneare [5][6][7]. In fase diagnostica, la RM presenta l'indubbio vantaggio di permettere la valutazione morfologica e strutturale globale, con possibilità di valutare il decorso, lo spessore, i margini, e l'intensità di segnale della fascia plantare, nonché di distinguere i differenti tipi di alterazioni [1][2][3][8][9][10][11].…”

“…A thorough clinical examination based on precise manoeuvres usually provides correct diagnostic orientation [4]. In the setting of diagnostic imaging, both ultrasonography (US) and magnetic resonance (MR) imaging have high levels of accuracy in identifying alterations to the plantar fascia [5][6][7][8][9][10][11]. The intrinsic technical and methodological characteristics of MR imaging (multiplanar acquisitions, highcontrast resolution, absence of bone artefacts) generally allow optimisation of the scans in relation to the topography and morphology of the plantar fascia, such that the technique provides invaluable information.…”

“…Un accurato esame clinico, basato su precise manovre semeiologiche, fornisce, di norma, il corretto orientamento diagnostico [4]. Nell'ambito delle tecniche di diagnostica per immagini, sia l'ecografia (US) che la risonanza magnetica (RM) sono accreditate di elevata accuratezza diagnostica nell'identificazione delle alterazioni della fascia plantare [5][6][7][8][9][10][11]. Le caratteristiche tecnico-metodologiche intrinseche della RM (acquisizione multiplanare, elevata risoluzione di contrasto, assenza di artefatti ossei), permettono, in genere, di ottimizzare le scansioni in rapporto alla topografia ed alla morfologia della fascia plantare, rendendo insostituibile l'apporto informativo offerto da tale tecnica.…”