Importance of thickness of the plantar fascia in plantar fasciitis

NewsBot · Apr 27, 2018

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Relationship of Plantar Fascia Thickness and Preoperative Pain, Function, and Quality of Life in Recalcitrant Plantar Fasciitis.
Gamba C et al
Foot Ankle Int. 2018 Apr 1:1071100718772041. doi: 10.1177/1071100718772041

BACKGROUND:
The measurement of plantar fascia thickness has been advocated as a diagnostic and prognostic instrument in patients with plantar fasciitis, but there are no data relative to it in recalcitrant plantar fasciitis. The aim of the study is to evaluate the correlation between plantar fascia thickness and pain, functional score, and health perception in patients with this condition.

METHODS:
Thirty-eight feet were studied with ultrasound and magnetic resonance imaging to measure plantar fascia thickness. The visual analogue scale (VAS), American Orthopaedic Foot & Ankle Hindfoot Score (AOFAS), and SF-36 were then recorded for each patient. The relationship between the fascia and these scores was analyzed to evaluate the correlation of thickness with pain, functional level, and health perception of patients.

RESULTS:
In patients with recalcitrant plantar fasciitis, plantar fascia thickness did not correlate with pain (VAS), AOFAS, or any item of the SF-36.

CONCLUSION:
The thickness of the plantar fascia in patients with recalcitrant plantar fasciitis did not correlate with its clinical impact, and thus, we believe it should not be used in treatment planning.
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NewsBot · May 30, 2018

Metatarsophalangeal joint extension changes ultrasound measurements for plantar fascia thickness
Michael J. Granado, Everett B. LohmanIII, Keith E. Gordon and Noha S. Daher
Journal of Foot and Ankle Research201811:20

Background
Ultrasound is an inexpensive method for quantifying plantar fascia thickness, especially in those with plantar fasciitis. Ultrasound has also been used to assess the effectiveness of various treatments for plantar fasciitis by comparing plantar fascia thickness before and after an intervention period. While a plantar fascia thickness over 4 mm via ultrasound has been proposed to be consistent with plantar fasciitis, some researchers believe the 4 mm plantar fascia thickness level to be a dubious guideline for diagnosing plantar fasciitis due to the lack of standardization of the measurement process for plantar fascia thickness. In particular, no universal guidelines exist on the positioning of the metatarsophalangeal (MTP) joints during the procedure and the literature also has inconsistent protocols. The purpose of this study is to investigate and compare the influence of MTP joint extension on plantar fascia thickness in healthy participants and those with unilateral plantar fasciitis.

Methods
The plantar fascia thickness of forty participants (20 with unilateral plantar fasciitis and 20 control) was measured via ultrasound three times at three different MTP joint positions: 1) at rest, 2) 30° of extension from the plantar surface, and 3) maximal extension possible.

Results
The plantar fascia became significantly thinner as MTP joint extension increased in both the plantar fasciitis group (p < 0.001) and the control group (p < 0.001). In the plantar fasciitis group, the involved plantar fascia was 1.2 to 1.3 mm thicker (p < 0.001) than the uninvolved side depending on the MTP joint position. In the control group, the difference in plantar fascia thickness between the two sides was less than 0.1 mm (p < 0.92) at any MTP joint position.

Conclusions
MTP joint position can influence the ultrasound measurement of plantar fascia thickness. It is recommended that plantar fascia thickness measurements be performed with the toes at rest. If MTP joints must be extended, then the toes should be extended maximally and then noted to ensure subsequent ultrasound procedures are repeated. Standardizing the position of the MTP joints is not only important for attaining the most accurate thickness measurement of the plantar fascia, but is also important to researchers who use plantar fascia thickness to determine the effectiveness of various plantar fasciitis interventions.
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NewsBot · Jul 1, 2018

Intra and Inter-Rater Reliability of Ultrasound in Plantar Fascia
Thickness Measurement
Masoomeh Nakhaee et al
Iran J Radiol. In Press(In Press):e59022.

ackground: Plantar fascia is a thick connective tissue on the plantar side of the foot, which provides the normal shape of the
longitudinal arch. Plantar fasciitis is an inflammation on the medial tuberosity of calcaneus on the inferior side that may cause heel
pain. Imaging plays an important role in the diagnosis of heel pain. Ultrasonography has been recognized as an effective imaging
tool for assessing plantar fascia thickness, monitoring the effect of different interventions and guiding therapeutic interventions
in patients with plantar fasciitis. Operator dependency is a major limitation for the common use of ultrasound.
Objectives: The purpose of the present study was to evaluate intra and inter-rater reliability of ultrasound in measurements of the
thickness of plantar fascia in different points of plantar fascia.
Patients and Methods: Twelve healthy (without any lower extremity disorder) young (above 18) volunteers were recruited. Both
heels were scanned in the sagittal plane by two raters. Subjects lied prone. Thickness of the plantar fascia was measured at the insertion
point of the calcaneus, 5 and 10 mm from insertion of the calcaneus. For statistical analysis, intraclass correlation coefficients
(ICC), 95% confidence intervals (CI), and linear mixed model ANOVA effects were run.
Results: Our results showed that both intra and inter-rater reliability of plantar fascia thickness, measured by ultrasound, have high
reproducibility (ICC > 0.821, ICC > 0.849). The linear mixed model suggested that neither rater nor time had a significant effect on
the rater’s measurements.
Conclusion: The results of the present study indicate that both intra and inter-rater of measuring plantar fascia thickness at three points using ultrasound seemed to be high.
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NewsBot · Oct 14, 2018

Thickness of plantar fascia is not predictive of functional outcome in plantar fasciitis treatment
CenkErmutluaMuratAksakalbAyşemGümüştaşcGüvenÖzkayadEmrahKovalakaYükselÖzkanb
Acta Orthopaedica et Traumatologica Turcica; 9 October 2018

Objective
The aim of this study was to define a quantitative parameter to indicate which cases of plantar fasciitis will benefit from local corticosteroid injection or ESWT and to compare the efficacy of two different treatment modalities.

Methods
Seventy patients (mean age: 49.10; range: 41–58) with chronic plantar fasciitis unresponsive to conservative treatment for 3 months were treated with either betamethasone injection or extracorporeal shock wave therapy (ESWT). Correlation between AOFAS scores, fascia thickness, duration of symptoms, age and calcaneal spur length were assessed.

Results
Degree of fascial thickening (mean 4.6 mm for all patients) did not influence baseline AOFAS scores (r = −0.054). Plantar fascia thickness significantly decreased in both groups after treatment (1.2 mm for steroid, 1.2 mm for ESWT) (p < 0.01 for both groups). Percentage of change in AOFAS scores (68% for steroid and 79% for ESWT, p = 0.069) and fascial thickness (24% for steroid and 26% for ESWT, p = 0.344) were similar between two groups. Functional recovery was not correlated with baseline fascial thickness (r = 0.047) or degree of fascial thinning after treatment (r = −0.099). Percentage of change in AOFAS scores was correlated only with baseline AOFAS scores (r = −0.943).

Conclusions
Plantar fascia thickness increases significantly in plantar fasciitis and responds to treatment. Both ESWT and betamethasone injection are effective in alleviating symptoms and reducing plantar fascia thickness in chronic plantar fasciitis. However, the only predictive factor for functional recovery in terms of AOFAS scores is patients' functional status prior to treatment. Measuring of plantar fascia is not helpful as a diagnostic or prognostic tool and MRI imaging should be reserved for differential diagnosis
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NewsBot · Nov 11, 2018

Effect of Gender, Toe Extension Position, and Plantar Fasciitis on Plantar Fascia Thickness.
Granado MJ et al
Foot Ankle Int. 2018 Nov 9:1071100718811631

BACKGROUND::
Ultrasound is a widely used diagnostic tool for patients with plantar fasciitis. However, the lack of standardization during the measurement for plantar fascia thickness has made it challenging to understand the etiology of plantar fasciitis, as well as identify risk factors, such as gender. The purpose of this study was to investigate gender differences regarding plantar fascia thickness while controlling for metatarsophalangeal (MTP) joint position in the healthy and those with unilateral plantar fasciitis.

METHODS::
Forty participants (20 with unilateral plantar fasciitis and 20 controls) with plantar fascia thickness (mean age, 44.8 ± 12.2 years) participated in this study. The majority were females (n = 26, 65%). Plantar fascia thickness was measured via ultrasound 3 times at 3 different MTP joint positions: (1) at rest, (2) at 30 degrees of extension, and (3) at maximal extension.

RESULTS::
When comparing gender differences, the males in the plantar fasciitis group had a significantly thicker plantar fascia than the females ( P = .048, η2 = 2.35). However, no significant differences were observed between healthy males and females. The males with unilateral plantar fasciitis also had significantly thicker asymptomatic plantar fasciae collectively compared with controls ( P < .05), whereas females with unilateral plantar fasciitis had a similar but not significant change.

CONCLUSION::
It appears that healthy males and females have similar plantar fascia thickness. However, as plantar fasciitis develops, males tend to develop thicker plantar fasciae than their female counterparts, which could have future treatment implications.
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NewsBot · Mar 5, 2019

Thickness of the plantar fascia in asymptomatic subjects.
Narindra LH, Herinirina NF, Rakotonirina H, Andrianah GE, Ranoharison HD, Randriamboavonjy R, Ahmad A.
J Med Ultrasound

Objectives: The objectives of this study are to determine the average and extreme values of the thickness of plantar fascia (PF) and to evaluate its correlations with anthropometric parameters and walking activity. Materials and Methods: Analytic study of 226 feet. On these feet, the thickness of the PF was measured on ultrasound; and its correlation with the age, height, weight, body mass index (BMI), gender, and daily walking of the participants were studied. Results: Thickness of the PF was symmetrical; the extreme values were 1.8 mm and 4.3 mm with an average of 3 mm ± 0.5. There was positive correlation of PF thickness with age, height, weight, BMI, and daily walking (P < 0.05). The variation of the PF thickness with gender was not significant (P > 0.05). Conclusion: Thickness of PF has a close correlates with age, height, weight, BMI, and walking activity.
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NewsBot · Apr 14, 2019

Thickness estimation, automated classification and novelty detection in ultrasound images of the plantar fascia tissues
Boussouar, A
2019 PhD thesis, University of Salford.

The plantar fascia (PF) tissue plays an important role in the movement and the stability of the foot during walking and running. Thus it is possible for the overuse and the associated medical problems to cause injuries and some severe common diseases. Ultrasound (US) imaging offers significant potential in diagnosis of PF injuries and monitoring treatments. Despite the advantages of US, the generated PF images are difficult to interpret during medical assessment. This is partly due to the size and position of the PF in relation to the adjacent tissues. This limits the use of US in clinical practice and therefore impacts on patient services for what is a common problem and a major cause of foot pain and discomfort. It is therefore a requirement to devise an automated system that allows better and easier interpretation of PF US images during diagnosis. This study is concerned with developing a computer-based system using a combination of medical image processing techniques whereby different PF US images can be visually improved, segmented, analysed and classified as normal or abnormal, so as to provide more information to the doctors and the clinical treatment department for early diagnosis and the detection of the PF associated medical problems. More specifically, this study is required to investigate the possibility of a proposed model for localizing and estimating the PF thickness a cross three different sections (rearfoot, midfoot and forefoot) using a supervised ANN segmentation technique. The segmentation method uses RBF artificial neural network module in order to classify small overlapping patches into PF and non-PF tissue. Feature selection technique was performed as a post-processing step for feature extraction to reduce the number of the extracted features. Then the trained RBF-ANN is used to segment the desired PF region. The PF thickness was calculated using two different methods: distance transformation and a proposed area-length calculation algorithm. Additionally, different machine learning approaches were investigated and applied to the segmented PF region in order to distinguish between symptomatic and asymptomatic PF subjects using the best normalized and selected feature set. This aims to facilitate the characterization and the classification of the PF area for the identification of patients with inferior heel pain at risk of plantar fasciitis. Finally, a novelty detection framework for detecting the symptomatic PF samples (with plantar fasciitis disorder) using only asymptomatic samples is proposed. This model implies the following: feature analysis, building a normality model by training the one-class SVDD classifier using only asymptomatic PF training datasets, and computing novelty scores using the trained SVDD classifier, training and testing asymptomatic datasets, and testing symptomatic datasets of the PF dataset. The performance evaluation results showed that the proposed approaches used in this study obtained favourable results compared to other methods reported in the literature.
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eddavisdpm · Jul 15, 2019

Sonographic evaluation of plantar fascial pathology should not rely on an isolated criterion such as plantar fascial thickness. Sonographic criteria may include items such as: 1) Fibrillar pattern of the fascia or alterations thereof, 2) Presence or absence of calcification within the fascia, 3) Regions of hypoechogenicity within the substance of the fascia, deep to the fascia or superficial to the fascia which may be consistent with fluid (edema), 4) Potential fascial rupture, 5) Potential hypertrophy of the inferior calcaneal nerve.

NewsBot · Apr 5, 2022

Variations in the Thickness of the Plantar Fascia After Training Based in Training Race. A Pilot Study
Raquel Alabau-Dasi et al
J Foot Ankle Surg. 2022 Feb 20

Plantar fascia (PF) is a connective tissue made up of mostly type 1 collagen that is subjected to constant loads. This study evaluated the effect of continuous running on tissue stress in the PF by measuring changes in the thickness of the PF using ultrasound scans. It was a cross-sectional study involving 24 runners from the University of Valencia, recruited as volunteers between December 2018 and February 2019. A variety of data was recorded: (age, body mass index, type of footwear, number of workouts per week, KM run per week, sports injuries in the last year, pre and postrace ultrasound PF measurements). There were significant differences in the 3 postrace measurements of the left foot (<0.001). PF thicknesses were measured before and after running, with a minimal average difference of 0.4 mm in the medial and central fascicles, and 0.3 mm in the lateral fascicle. We observed PF thicknesses above 4mm in asymptomatic patients with no signs of vascularisation, proving that increased PF thickness is not the only criterion for diagnosis of plantar fasciitis.
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