Plantar fascia thickness and pain

NewsBot · Jun 8, 2007

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Plantar Fasciitis: Are Pain and Fascial Thickness Associated With Arch Shape and Loading?
Wearing SC, Smeathers JE, Sullivan PM, Yates B, Urry SR, Dubois P.
Phys Ther. 2007 Jun 6; [Epub ahead of print]

BACKGROUND AND PURPOSE: Although plantar fascial thickening is a sonographic criterion for the diagnosis of plantar fasciitis, the effect of local loading and structural factors on fascial morphology are unknown. The purposes of this study were to compare sonographic measures of fascial thickness and radiographic measures of arch shape and regional loading of the foot during gait in individuals with and without unilateral plantar fasciitis and to investigate potential relationships between these loading and structural factors and the morphology of the plantar fascia in individuals with and without heel pain.

SUBJECTS: The participants were 10 subjects with unilateral plantar fasciitis and 10 matched asymptomatic controls.

METHODS: Heel pain on weight bearing was measured by a visual analog scale. Fascial thickness and static arch angle were determined from bilateral sagittal sonograms and weight-bearing lateral foot roentgenograms. Regional plantar loading was estimated from a pressure plate.

RESULTS: On average, the plantar fascia of the symptomatic limb was thicker than the plantar fascia of the asymptomatic limb (6.1+/-1.4 mm versus 4.2+/-0.5 mm), which, in turn, was thicker than the fascia of the matched control limbs (3.4+/-0.5 mm and 3.5+/-0.6 mm). Pain was correlated with fascial thickness, arch angle, and midfoot loading in the symptomatic foot. Fascial thickness, in turn, was positively correlated with arch angle in symptomatic and asymptomatic feet and with peak regional loading of the midfoot in the symptomatic limb.

DISCUSSION AND CONCLUSION: The findings indicate that fascial thickness and pain in plantar fasciitis are associated with the regional loading and static shape of the arch.
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Admin2 · Jun 8, 2007

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NewsBot · Sep 14, 2007

Effect of gender, age and anthropometric variables on plantar fascia thickness at different locations in asymptomatic subjects.
Pascual Huerta J, Alarcón García JM.
Department of Podiatry, Universidad Europea de Madrid, Spain.

PURPOSE: The study was aimed to investigate plantar fascia thickness at different locations in healthy asymptomatic subjects and its relationship to the following variables: weight, height, sex and age.

MATERIAL AND METHODS: The study evaluates 96 feet of healthy asymptomatic volunteers. The plantar fascia thickness was measured at four different locations: 1cm proximal to the insertion of the plantar fascia, at the insertion of the plantar fascia on the calcaneus and separate out 1 cm + 2 cm distal to the insertion. A 10 MHz linear-array transducer was used.

RESULTS: There were statistically significant differences in plantar fascia thickness at the four different locations (p<0.001) although no differences in PF thickness were found between the two distal from insertion locations (1 and 2 cm). Multiple regression analysis showed sex as independent predictor of plantar fascia thickness at 1cm proximal to the insertion. At origin and 1cm distal to insertion weight was an independent predictor of plantar fascia thickness.

CONCLUSIONS: There are differences of thickness at different locations of plantar fascia measured by ultrasonography. Thickness at 1cm proximal to the insertion is influenced by sex and thickness at origin and at 1cm distal to the insertion has a direct relationship with body weight. This could be attributed to the overloading effect that weight has on plantar fascia in healthy symptomatic subjects at these two locations. Height and age did not seem to influence as independent variables in plantar fascia thickness among non-painful subjects.
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Simon Spooner · Sep 14, 2007

Huerta- he bad boy:D

NewsBot · Nov 6, 2007

Ultrasonographic evaluation in plantar fasciitis.
Karabay N, Toros T, Hurel C.
J Foot Ankle Surg. 2007 Nov-Dec;46(6):442-6.

The heels of 23 patients who were diagnosed with unilateral/bilateral plantar fasciitis were evaluated via ultrasonography and compared with their asymptomatic feet and a control group of 23 people. Plantar fascial thickness, echogenity, and heel pad thickness were evaluated, and the results were statistically analyzed. For symptomatic feet, increased thickness of the fascia and reduced echogenity were constant ultrasonographic findings (mean, 4.79 mm for symptomatic feet; 2.17 mm for control group, P < .05). No significant difference was found between heel pads of the diseased and healthy feet (mean, 12.96 mm for symptomatic feet; 13.10 mm for control group; P > .05). Ultrasonography seems to be a valuable, noninvasive diagnostic tool for the evaluation of plantar fasciitis.
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NewsBot · Sep 26, 2008

Relationship of Body Mass Index, Ankle Dorsiflexion, and Foot Pronation on Plantar Fascia Thickness in Healthy, Asymptomatic Subjects
Javier Pascual Huerta, Juan Maria Alarcón García, Eva Cosin Matamoros, Julia Cosin Matamoros and Teresa Díaz Martínez
Journal of the American Podiatric Medical Association; Volume 98 Number 5 379-385 2008

Background: We sought to investigate the thickness of plantar fascia, measured by means of ultrasonographic evaluation in healthy, asymptomatic subjects, and its relationship to body mass index, ankle joint dorsiflexion range of motion, and foot pronation in static stance.

Methods: One hundred two feet of 51 healthy volunteers were examined. Sonographic evaluation with a 10-MHz linear array transducer was performed 1 and 2 cm distal to its insertion. Physical examination was also performed to assess body mass index, ankle joint dorsiflexion, and degree of foot pronation in static stance. Both examinations were performed in a blinded manner.

Results: Body mass index showed moderate correlation with plantar fascia thickness at the 1- and 2-cm locations. Ankle dorsiflexion range of motion showed no correlation at either location. Foot pronation showed an inverse correlation with plantar fascia thickness at the 2-cm location and no correlation at the 1-cm location.

Conclusion: Body mass index and foot supination at the subtalar joint are related to increased thickness at the plantar fascia in healthy, asymptomatic subjects. Although the changes in thickness were small compared with those in patients with symptomatic plantar fasciitis, they could play a role in the mechanical properties of plantar fascia and in the development of plantar fasciitis
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NewsBot · Apr 2, 2011

Plantar enthesopathy: thickening of the enthesis is correlated with energy dissipation of the plantar fat pad during walking.
Wearing SC, Smeathers JE, Urry SR, Sullivan PM, Yates B, Dubois P.
Am J Sports Med. 2010 Dec;38(12):2522-7.

BACKGROUND: The enthesis of the plantar fascia is thought to play an important role in stress dissipation. However, the potential link between entheseal thickening characteristic of enthesopathy and the stress-dissipating properties of the intervening plantar fat pad have not been investigated.

PURPOSE: This study was conducted to identify whether plantar fat pad mechanics explain variance in the thickness of the fascial enthesis in individuals with and without plantar enthesopathy.

STUDY DESIGN: Case-control study; Level of evidence, 3.

METHODS: The study population consisted of 9 patients with unilateral plantar enthesopathy and 9 asymptomatic, individually matched controls. The thickness of the enthesis of the symptomatic, asymptomatic, and a matched control limb was acquired using high-resolution ultrasound. The compressive strain of the plantar fat pad during walking was estimated from dynamic lateral radiographs acquired with a multifunction fluoroscopy unit. Peak compressive stress was simultaneously acquired via a pressure platform. Principal viscoelastic parameters were estimated from subsequent stress-strain curves.

RESULTS: The symptomatic fascial enthesis (6.7 ± 2.0 mm) was significantly thicker than the asymptomatic enthesis (4.2 ± 0.4 mm), which in turn was thicker than the enthesis (3.3 ± 0.4 mm) of control limbs (P < .05). There was no significant difference in the mean thickness, peak stress, peak strain, or secant modulus of the plantar fat pad between limbs. However, the energy dissipated by the fat pad during loading and unloading was significantly lower in the symptomatic limb (0.55 ± 0.17) when compared with asymptomatic (0.69 ± 0.13) and control (0.70 ± 0.09) limbs (P < .05). The sonographic thickness of the enthesis was correlated with the energy dissipation ratio of the plantar fat pad (r = .72, P < .05), but only in the symptomatic limb.

CONCLUSION: The energy-dissipating properties of the plantar fat pad are associated with the sonograpic appearance of the enthesis in symptomatic limbs, providing a previously unidentified link between the mechanical behavior of the plantar fat pad and enthesopathy.
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