Sonographic Evaluation of the Plantar Heel in Asymptomatic Endurance Runners

Abstract

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

The thickness of heel fat-pad in patients with plantar fasciitis

“…The first is that there is no control group. Fad pad thickness differences between dominant and non-dominant feet in a healthy population is quite possible 19 . However, there was no statistically significant difference in the dominant and non-dominant distribution of the painful feet of the patients in this study (p = 0.203).…”

“…A single USG device (Philips EPIQ 5 L12-5 50 mm 12-5 MHz linear-array transducer, Philips Medical System, Andover, MA, USA) was used throughout the study by a single operator to measure the unloaded THPs and TFMFPs of all the patients. A method has been developed to take ultrasound measurements by reviewing previous studies 18, 19, 20. The patients were placed on the examination table in a prone position so that their feet were free outside the table.…”

Ultrasonography Features of the Plantar Fascia Complex in Patients with Chronic Non-Insertional Achilles Tendinopathy: A Case-Control Study

“…CFP protects the rear-foot from the stress produced during the initial phase of locomotion and the heel-strike actions. CFP thickness was described as a valid and reliable method to quantify and assess the heel fat pad by USI [24]. Several authors argued that CFP has been implicated in foot and plantar disturbances, such as diabetes [35], fractures [36] and plantar heel pain [37].…”

“…Thirdly, for the metatarsal region of the PF, the transducer was located on the same longitudinal line near to the second metatarsal head (Figure 1, C) [29]. For the ultrasound examination of the CFP, the subjects were placed in a prone position and the transducer was placed longitudinally at the midpoint of the heel (Figure 2) [24]. According to López et al [30], the evaluator both flexed and extended the big toe while palpating the subject´s PF to allow accurate identification of the calcaneal tuberosity.…”

“…For the Achilles tendon complex, prior studies were focused on the tendon thickness and CSA in subjects with AT [13]. However, limited evidence of the surrounding soft tissues has been observed, such as PF and calcaneal fat pad (CFP) by USI [24].…”