Objective. Analysis of sonographic examination of plantar aponeurosis in norm and in plantar fasciitis, determination of the staging of plantar fasciitis depending on the duration of the pain syndrome and sonographic changes in plantar aponeurosis.
Materials and Methods. 193 patients (272 cases) with plantar fasciitis (131 females and 62 males). The average age of patients was 47.69±0.97 years (18-81 years). Unilateral pathology was noted in 114 patients (114 cases) and bilateral – in 79 patients (158 cases). The average body mass index was 26.68±0.24. The average duration of pain syndrome was 101.12±5.83 days (7-390 days). The pain syndrome lasted up to 1 month in 26 patients (37 cases), from 1 to 6 months – in 126 patients (181 cases), and more than 6 months – in 41 patients (54 cases). The control group included 20 healthy volunteers (40 feet). Clinical radiological, sonographic, and statistical methods were used.
Results. The average thickness of plantar aponeurosis in the study group was 6.14±1.49 mm (2.3-7.7 mm) and in control group – 3.5±0.1 mm (2.5-4.4 mm). There were three stages of the plantar fasciitis. Stage I was characterized by the absence of thickening of the plantar aponeurosis and structural changes, and by signs of local perifocal edema in the subcutaneous fat of the area adjacent to the aponeurosis, which are manifested by a zone of heterogeneous echogenicity. Stage II was characterized by a spindle-shaped form of aponeurosis, a thickening of enthesis more than 4 mm, significant reduction in echogenicity, erased or missing fibrous pattern, fuzzy contour of the aponeurosis, and modified contour of the calcaneus. At stage III, inequality of the cortical calcaneal contour and small focal hyperechogenicity points in enthesis were detected. Distal free part of the aponeurosis also changed. Loci of vascularization were detected using power Doppler sonography.
Conclusions. A quantitative sonographic sign of plantar fasciitis is the thickening of the enthesis of the plantar aponeurosis of more than 4 mm. Qualitative signs were changes in echogenicity and structure, changes in the contours of the cortical layer of enthesis and plantar aponeurosis, and distribution of echographic changes distally to the free part of the aponeurosis. The described signs, when compared with the duration of the pain syndrome, determine the stage of plantar fasciitis.
Stecco C, Corradin M, Macchi V, Morra A, Porzionato A, Biz C, et al. Plantar fascia anatomy and its relationship with Achilles tendon and paratenon. J. Anat. 2013;223:665-76. DOI: 10.1111/joa.12111.
Natali AN, Pavan PG, Stecco C. A constitutive model for the mechanical characterization of the plantar fascia. Connect Tissue Res. 2010;51(5):337-46. DOI: 10.3109/03008200903389127.
Franceschi F, Papalia R, Paciotti M, Franceschetti E, di Martino A, Maffulli N, et al. Obesity as a Risk Factor for Tendinopathy: A Systematic Review. Int J of End. 2014;2014:1-10. DOI:10.1155/2014/670262.
Waclawski ER, Beach J, Milne A, Yacyshyn E, Dryden DM. Systematic review: plantar fasciitis and prolonged weight bearing. Occup Med (Lond). 2015;65(2):97-106. DOI: 10.1093/occmed/kqu177.
Inrving DB, Cook JL, Young MA, Menz HB. Impact of chronic plantar heel pain on health-related quality of life. J Am Podiatr Med Assoc. 2008;98(4), 283-9. PMID: 18685048.
McMillan AM, Landorf KB, Barrett JT, Menz HB, Bird AR. Diagnostic imaging for chronic plantar heel pain: a systematic review and metaanalysis. J Foot Ankle Res. 2009;2(32):1-11. DOI: 10.1186/1757-1146-2-32.
McMillan AM, Landorf KB, Gregg JM, de Luca J, Cotchett MP, Menz HB. Hyperemia in plantar fasciitis determined by power Doppler ultrasound. J Orthop Sports Phys Ther. 2013;43(12),875-80. DOI: 10.2519/jospt.2013.4810.
Rathleff MS, Moelgaard C, Lykkegaard Olesen J. Intra- and interobserver reliability of quantitative ultrasound measurement of the plantar fascia. J Clin Ultrasound. 2011;39(3):128-34. DOI: 10.1002/jcu.20787.
Goff JD, Crawford R. Diagnosis and treatment of plantar fasciitis. Am Fam Physician. 2011;84(6):676-682. PMID: 21916393.
Hansen L, Krogh TP, Ellingsen T, Bolvig L, Fredberg U. Long-Term Prognosis of Plantar Fasciitis: A 5- to 15-Year Follow-up Study of 174 Patients With Ultrasound Examination. Orthop J Sports Med. 2018;6(3):1-9. DOI: 10.1177/2325967118757983.
Lee SY, Park HJ, Kwag HJ, Hong HP, Park HW, Lee YR, et al. Ultrasound elastography in the early diagnosis of plantar fasciitis. J Clin Imaging Sci. 2014;38(5):715-18. DOI: 10.1016/j.clinimag.2012.12.004.
Martinoli C. Musculoskeletal ultrasound: technical guidelines. Insights Imaging. 2010;1(3):99-141. DOI: 10.1007/s13244-010-0032-9.
Abul K, Ozer D, Sakizlioglu SS, Buyuk AF, Kaygusuz MA. Detection of normal plantar fascia thickness in adults via the ultrasonographic method. J Am Podiatr Med Assoc. 2015;105:8-13. DOI: 10.7547/8750-7315-105.1.8.
Granado MJ, Lohman EB, Gordon KE, Daher NS. Metatarsophalangeal joint extension changes ultrasound measurements for plantar fascia thickness. Journal of Foot and Ankle Research. 2018;11(20). DOI: 10.1186/S13047-018-0267-0.
Chen CK, Lew HL, Chu NC. Ultrasound-guided diagnosis and treatment of plantar fasciitis. Am J Phys Med Rehabil. 2012;91(2):182-4. DOI: 10.1097/PHM.0b013e3182412187.
Akfirat M, Sen C, Günes T. Ultrasonographic appearance of the plantar fasciitis. Clin Imaging. 2003;27(5):353-7. PMID: 12932690.
Chen H, Ho HM, Ying M, Fu SN. Correlation between computerised findings and Newman’s scaling on vascularity using power Doppler ultrasonography imaging and its predictive value in patients with plantar fasciitis. The British Journal of Radiology. 2012;85:925-9. DOI: 10.1259/bjr/99342011.
This work is licensed under a Creative Commons Attribution 4.0 International License.