Real-time Sonoelastography of the Plantar Fascia and Plantar Fasciitis

NewsBot · Jan 9, 2013

Members do not see these Ads. Sign Up.
Real-time Sonoelastography of the Plantar Fascia: Comparison between Patients with Plantar Fasciitis and Healthy Control Subjects.
Sconfienza LM, Silvestri E, Orlandi D, Fabbro E, Ferrero G, Martini C, Sardanelli F, Cimmino MA.
Radiology. 2013 Jan 7.

Purpose:To evaluate the use of axial-strain real-time sonoelastography in patients with plantar fasciitis compared with that in healthy control subjects.Materials and

Methods:Institutional review board approval and patients' consent were obtained. Eighty feet of 80 patients (43 men, 37 women; mean age ± standard deviation, 46.3 years ± 8.7) with plantar fasciitis and 50 feet of 50 asymptomatic volunteers (27 men, 23 women; mean age, 44.3 years ± 8.0) were prospectively evaluated. Individuals graded heel pain with a visual analogue scale and underwent B-mode ultrasonography (US) and real-time sonoelastography. Maximum fascial thickness was measured, and two longitudinal images were recorded with both modalities. Two radiologists who were blinded to clinical symptoms independently reviewed images for hypoechoic echotexture and fascial-border blurring at B-mode US and semiquantitative elasticity score at real-time sonoelastography (blue, 1; green, 2; red, 3), with the fascia divided into proximal, intermediate, and distal sections.

Results:No differences were found for sex (P = .999) or age distribution (P = .144) between groups. Fascial thickening, hypoechoic echotexture, and fascial-border blurring at B-mode US were increased in patients versus control subjects (P < .001), and fascial thickening and hypoechoic echotexture correlated with heel pain score (r > .475, P < .001). Plantar fasciae of patients (median score, 11; interquartile interval, 10-12) were less elastic than those of control subjects (median score, 7; interquartile interval, 6-7.25) (P < .001). Image interpretation yielded high interobserver reproducibility (κ ≥ .80). Pain and real-time sonoelastographic scores correlated significantly (r = 0.851, P < .001). Pain was associated with older age (t = 3.7, P < .001), fascial thickening (t = 7.3 [multiple stepwise regression model], P < .001), and total real-time sonoelastographic score (t = 10.2, P < .001) but not with sex, fascial-border blurring, or hypoechoic echotexture. Accuracy increased from 90.0% with B-mode US to 95.4% with real-time sonoelastography (P = .016).

Conclusion:Real-time sonoelastography can show plantar fasciitis, increase diagnostic performance of B-mode US, and assist in cases of inconclusive B-mode US findings
Click to expand...

NewsBot · Feb 19, 2013

Correlation between computerised findings and Newman's scaling on vascularity using power Doppler ultrasonography imaging and its predictive value in patients with plantar fasciitis.
Chen H, Ho HM, Ying M, Fu SN.
Br J Radiol. 2012 Jul;85(1015):925-9

OBJECTIVES:
The purpose of this study was to correlate findings on small vessel vascularity between computerised findings and Newman's scaling using power Doppler ultrasonography (PDU) imaging and its predictive value in patients with plantar fasciitis.

METHODS:
PDU was performed on 44 patients (age range 30-66 years; mean age 48 years) with plantar fasciitis and 46 healthy subjects (age range 18-61 years; mean age 36 years). The vascularity was quantified using ultrasound images by a customised software program and graded by Newman's grading scale. Vascular index (VI) was calculated from the software program as the ratio of the number of colour pixels to the total number of pixels within a standardised selected area of proximal plantar fascia. The 46 healthy subjects were examined on 2 occasions 7-10 days apart, and 18 of them were assessed by 2 examiners. Statistical analyses were performed using intraclass correlation coefficient and linear regression analysis.

RESULTS:
Good correlation was found between the averaged VI ratios and Newman's qualitative scale (ρ=0.70; p<0.001). Intratester and intertester reliability were 0.89 and 0.61, respectively. Furthermore, higher VI was correlated with less reduction in pain after physiotherapeutic intervention.

CONCLUSIONS:
The computerised VI not only has a high level of concordance with the Newman grading scale but is also reliable in reflecting the vascularity of proximal plantar fascia, and can predict pain reduction after intervention. This index can be used to characterise the changes in vascularity of patients with plantar fasciitis, and it may also be helpful for evaluating treatment and monitoring the progress after intervention in future studies.
Click to expand...

NewsBot · Mar 5, 2013

Achilles Tendon Assessed with Sonoelastography: Histologic Agreement
Andrea S. Klauser et al
Radiology Published online before print February 28, 2013

Purpose: To compare and determine the level of agreement of findings at conventional B-mode ultrasonography (US) and sonoelastography of the Achilles tendon with findings at histologic assessment.

Materials and Methods: This study was conducted with the approval of the institutional review boards, and all cadavers were in legal custody of the study institution. Thirteen Achilles tendons in 10 cadavers (four male, six female; age range, 70–90 years) were examined with B-mode US and sonoelastography. B-mode US grading was as follows: Grade 1 indicated a normal-appearing tendon with homogeneous fibrillar echotexture; grade 2, a focal fusiform or diffuse enlarged tendon; and grade 3, a hypoechoic area with or without tendon enlargement. Sonoelastography grading was as follows: Grade 1 indicated blue (hardest) to green (hard); grade 2, yellow (soft); and grade 3, red (softest). Twenty-five biopsy specimens from representative lesions of the middle and distal thirds of the Achilles tendons were evaluated histologically. The concordance of B-mode US grading compared with sonoelastographic grading was assessed by using κ analysis.

Results: With B-mode US and sonoelastography, all 11 tendon thirds of histologically normal tendons were verified as normal (grade 1). Sonoelastography depicted 14 of 14 (100%) tendon thirds with histologic degeneration (grade 2 or 3), whereas B-mode US could depict only 12 of 14 (86%) lesions (grade 2 or 3). Only moderate agreement between B-mode US and sonoelastography was seen (κ = 0.52, P < .001).

Conclusion: Sonoelastography might help predict signs of histopathologic degeneration of Achilles tendinosis, potentially more sensitively than B-mode US.
Click to expand...

NewsBot · Jul 28, 2013

Investigation of the Correlation Between Ultrasound Imaging on Plantar Fascia Vascularity and Morphology and Foot Dysfunction in Individuals With Chronic Plantar Fasciitis.
Chen H, Ho HM, Ying M, Fu SN.
J Orthop Sports Phys Ther. 2013 Jul 25.

STUDY DESIGN:
Single cohort laboratory-based study.
OBJECTIVES:
To identify whether plantar fascia vascularity and thickness are associated with foot pain and dysfunction in individuals with chronic plantar fasciitis.
BACKGROUND:
Altered plantar fascia vascularity and thickening of the fascia have been identified in individuals with chronic plantar fasciitis.
METHODS:
Thirty eight patients with chronic unilateral plantar fasciitis and 21 controls participated in this study. Proximal plantar fascia vascularization and thickness were assessed using ultrasound imaging while pain and foot dysfunction were quantified with a visual analogue scale (VAS) and the Chinese version of the Foot Function Index (FFI), respectively. Paired t-tests were used to assess the side-to-side differences in fascia thickness and vascularity index (VI) in the control and patient groups; and an un-paired t-test was used to make comparisons with the patient group. Multiple regression analysis was performed to identify whether VI and fascia thickness were associated with pain and foot dysfunction.
RESULTS:
There were significantly higher VI (mean ± SD, 2.4 ± 1.4%) and fascia thickness (versus 5.0±1.3 mm) in the affected feet when compared with the unaffected feet (VI = 1.4±0.5%; fascia thickness = 3.3±0.7 mm) in the patient group; and the dominant side of the controls (VI =1.6±0.4%; fascia thickness = 2.9±0.6mm). After accounting for age, gender, body mass index, and duration of symptoms, VI explained 13% and 33% of the variance in pain scores measured with a VAS and the pain subscale of the FFI respectively; VI and FT explained 42% of the variance in FFI.
CONCLUSIONS:
Individuals with unilateral chronic plantar fasciitis demonstrated significantly greater vascularity and thickened fascia on the affected side compared to the unaffected side and also to healthy controls. Fascia vascularity was associated independently with self-perceived pain, and both fascia vascularity and thickness were associated with foot dysfunction in patients with chronic plantar fasciitis.
Click to expand...

NewsBot · Nov 12, 2014

Use of High-Resolution Ultrasound to Measure Changes in Plantar Fascia Thickness Resulting From Tissue Creep in Runners and Walkers
Aaron B. Welk, DC, Daniel W. Haun, DC, Thomas B. Clark, DC, Norman W. Kettner, DC
Journal of Manipulative & Physiological Therapeutics; Articles in Press

Objective
This study sought to use high-resolution ultrasound to measure changes in plantar fascia thickness as a result of tissue creep generated by walking and running.

Methods
Independent samples of participants were obtained. Thirty-six walkers and 25 runners walked on a treadmill for 10 minutes or ran for 30 minutes, respectively. Standardized measures of the thickness of the plantar fascia were obtained in both groups using high-resolution ultrasound.

Results
The mean thickness of the plantar fascia was measured immediately before and after participation. The mean plantar fascia thickness was decreased by 0.06 ± 0.33 mm SD after running and 0.03 ± 0.22 mm SD after walking. The difference between groups was not significant.

Conclusion
Although the parameters of this study did not produce significant changes in the plantar fascia thickness, a slightly higher change in the mean thickness of the plantar fascia in the running group deserves further investigation.
Click to expand...

NewsBot · Jan 25, 2015

Sonographic evaluation of the plantar fascia in asymptomatic subjects.
Gadalla N, Kichouh M, Boulet C, Machiels F, De Mey J, De Maeseneer M.
JBR-BTR. 2014 Sep-Oct;97(5):271-3

PURPOSE:
To evaluate the appearance of the plantar fascia in asymptomatic subjects.
MATERIALS AND METHODS:
Thirty-one asymptomatic subjects were examined by 2 musculoskeletal radiologists. The plantar fascia was evaluated for thickness, echogenicity, vascularity on power Doppler, rupture, fluid adjacent to the fascia, andcalcifications.
RESULTS:
The study included 14 men and 17 women (age, 17-79 years; mean, 45 years). The mean thickness of the plantar fascia in men was 3.7 mm (range 2.5-7 mm), and in women 3.5 mm (range, 1.7-5.1 mm). The thickness was greater than 4 mm in 4 men (bilateral in 2). The mean thickness of fascias thicker than 4 mm in men was 5.4 mm (range, 4.3-7 mm). The thickness was greater than 4 mm in 5 women ( bilateral in 4). The mean thickness of fascias thicker than 4 mm in women was 4.7 mm (range, 4.2-5.1 mm). There was no statistically significant difference between men and women and between both heels. Hypoechogenicity was observed in 3 men (bilateral in 2), and in 5 women (bilateral in 6). Hypervascularity, rupture, fluid adjacent to the fascia, and calcifications were not observed.
CONCLUSION:
A thickness greater than 4 mm and hypoechogenicity, are common in the plantar fascia of asymptomatic subjects. Findings that were not seen in asymptomatic subjects include a thickness greater than 7 mm, hypervascularity on power Doppler, rupture, fluid adjacent to the fascia, and calcifications.
Click to expand...

NewsBot · Feb 21, 2015

Application of ultrasound in the assessment of plantar fascia in patients with plantar fasciitis: a systematic review.
Mohseni-Bandpei MA et al
Ultrasound Med Biol. 2014 Aug;40(8):1737-54

Plantar fasciitis (PFS) is one of the most common causes of heel pain, estimated to affect 10% of the general population during their lifetime. Ultrasound (US) imaging technique is increasingly being used to assess plantar fascia (PF) thickness, monitor the effect of different interventions and guide therapeutic interventions in patients with PFS. The purpose of the present study was to systematically review previously published studies concerning the application of US in the assessment of PF in patients with PFS. A literature search was performed for the period 2000-2012 using the Science Direct, Scopus, PubMed, CINAHL, Medline, Embase and Springer databases. The key words used were: ultrasound, sonography, imaging techniques, ultrasonography, interventional ultrasonography, plantar fascia and plantar fasciitis. The literature search yielded 34 relevant studies. Sixteen studies evaluated the effect of different interventions on PF thickness in patients with PFS using US; 12 studies compared PF thickness between patients with and without PFS using US; 6 studies investigated the application of US as a guide for therapeutic intervention in patients with PFS. There were variations among studies in terms of methodology used. The results indicated that US can be considered a reliable imaging technique for assessing PF thickness, monitoring the effect of different interventions and guiding therapeutic interventions in patients with PFS.
Click to expand...

NewsBot · Mar 28, 2015

Ultrasound Diagnosis and Evaluation of Plantar Heel Pain.
Nicholas G. Argerakis, Rock G. Positano, Rock C. J. Positano, Ashley K. Boccio, Ronald S. Adler, Gregory R. Saboeiro, and Joshua S. Dines
Journal of the American Podiatric Medical Association: March 2015, Vol. 105, No. 2, pp. 135-140.

Background: One of the most common causes of heel pain is plantar fasciitis; however, there are other pathologic disorders that can mimic the symptoms and clinical presentation of this disorder. The purpose of this study was to retrospectively review the prevalence of various pathologic disorders on ultrasound in patients with proximal plantar heel pain.

Methods: The medical records and diagnostic ultrasound reports of patients presenting with plantar heel pain between March 1, 2006, and March 31, 2007, were reviewed retrospectively, and the prevalence of various etiologies was collected. The inclusion criteria were based on their clinical presentation of plantar fasciitis or previous diagnosis of plantar fasciitis from an unknown source. Ultrasound evaluation was then performed to confirm the clinical diagnosis.

Results: We examined 175 feet of 143 patients (62 males and 81 females; age range, 16–79 years). Plantar fibromas were present in 90 feet (51%). Plantar fasciitis was diagnosed in 128 feet (73%). Coexistent plantar fibroma and plantar fascial thickening was found in 63 feet (36%). Of the 47 feet that were negative for plantar fasciitis on ultrasound, 27 (57%) revealed the presence of plantar fibroma.

Conclusions: Diagnostic ultrasound can effectively and safely identify the prevalence of various etiologies of heel pain. The high prevalence of plantar fibromas and plantar fascial tears cannot be determined by clinical examination alone, and, therefore, ultrasound evaluation should be performed for confirmation of diagnosis.
Click to expand...

NewsBot · Jul 14, 2015

Sonoelastography of Plantar Fascia: Reproducibility and Pattern Description in Healthy Subjects and Symptomatic Subjects
José Ríos-Díaz, Jacinto J. Martínez-Payá, María Elena del Baño-Aledo, , Ana de Groot-Ferrando, Paloma Botía-Castillo, David Fernández-Rodríguez
Ultrasound in Medicine & Biology; Available online 9 July 2015

The purpose of the work reported here was to describe the sonoelastographic appearance of the plantar fascia of healthy volunteers and patients with fasciitis. Twenty-three healthy subjects and 21 patients with plantar fasciitis were examined using B-mode and real-time sonoelastography (RTSR) scanning. B-Mode examination included fascia thickness and echotexture. Echogenicity and echovariation of the color histogram were analyzed. Fasciae were classified into type 1, blue (more elastic); type 2, blue/green (intermediate); or type 3, green (less elastic). RTSE revealed 72.7% of fasciae as type 2, with no significant association with fasciitis (χ2 = 3.6, df = 2, p = 0.17). Quantitative analysis of the color histogram revealed a significantly greater intensity of green (mean = 77.8, 95% confidence interval [CI] = 71.9–83.6) and blue (mean = 74.2, 95% CI = 69.7–78.8) in healthy subjects. Echovariation of the color red was 33.4% higher in the fasciitis group than in the healthy group (95% CI = 16.7–50.1). Sonoelastography with quantitative analysis of echovariation can be a useful tool for evaluation of plantar fascia pathology.
Click to expand...

NewsBot · Jul 16, 2015

Plantar fascia softening in plantar fasciitis with normal B-mode sonography.
Wu CH, Chen WS, Wang TG.
Skeletal Radiol. 2015 Jul 16

OBJECTIVE:
To investigate plantar fascia elasticity in patients with typical clinical manifestations of plantar fasciitis but normal plantar fascia morphology on B-mode sonography.
MATERIALS AND METHODS:
Twenty patients with plantar fasciitis (10 unilateral and 10 bilateral) and 30 healthy volunteers, all with normal plantar fascia morphology on B-mode sonography, were included in the study. Plantar fascia elasticity was evaluated by sonoelastographic examination. All sonoelastograms were quantitatively analyzed, and less red pixel intensity was representative of softer tissue. Pixel intensity was compared among unilateral plantar fasciitis patients, bilateral plantar fasciitis patients, and healthy volunteers by one-way ANOVA. A post hoc Scheffé's test was used to identify where the differences occurred.
RESULTS:
Compared to healthy participants (red pixel intensity: 146.9 ± 9.1), there was significantly less red pixel intensity in the asymptomatic sides of unilateral plantar fasciitis (140.4 ± 7.3, p = 0.01), symptomatic sides of unilateral plantar fasciitis (127.1 ± 7.4, p < 0.001), and both sides of bilateral plantar fasciitis (129.4 ± 7.5, p < 0.001). There were no significant differences in plantar fascia thickness or green or blue pixel intensity among these groups.
CONCLUSION:
Sonoelastography revealed that the plantar fascia is softer in patients with typical clinical manifestations of plantar fasciitis, even if they exhibit no abnormalities on B-mode sonography.
Click to expand...

NewsBot · Apr 2, 2016

Sonoelastography in the Evaluation of Plantar Fasciitis Treatment: 3-Month Follow-Up After Collagen Injection.
Kim M et al
Ultrasound Q. 2016 Mar 31

OBJECTIVE:
The aim of this study was to investigate whether ultrasound elastography can demonstrate the outcome of the treatment in comparison with gray-scale imaging.
METHODS:
Sixteen patients (mean age, 46.9 years) with plantar fasciitis were prospectively enrolled after unsuccessful conservative treatment. Individuals graded their heel pain on a 100-mm visual analogue scale (VAS) and underwent gray-scale ultrasonography and sonoelastography. Collagen was injected in the heels. Fascial thickness and hypoechogenicity, perifascial edema, and plantar fascial elasticity were evaluated. Follow-up sonoelastography and VAS grading were done 3 months after the injection. Statistical analyses were performed by the paired t test and the Fisher exact test. A P < 0.05 was considered statistically significant.
RESULTS:
Mean plantar fascial thickness showed insignificant decrease on follow-up (from 4.30 [1.37] to 4.23 [1.15] mm, P = 0.662). Fascial hypoechogenicity and perifascial edema did not change significantly after treatment. The mean strain ratio of the plantar fascia was significantly increased (from 0.71 [0.24] to 1.66 [0.72], P = 0.001). Softening of the plantar fascia decreased significantly after injection (from 12 to 3 ft, P = 0.004). Twelve (75%) of 16 patients showed significant VAS improvement at the follow-up.
CONCLUSIONS:
Sonoelastography revealed a hardening of the plantar fascia after collagen injection treatment and could aid in monitoring the improvement of the symptoms of plantar fasciitis, in cases where gray-scale imaging is inconclusive.
Click to expand...

NewsBot · Apr 16, 2016

Reliability of Various Measurement Stations for Determining Plantar Fascia Thickness and Echogenicity
Adebisi Bisi-Balogun, Michael Cassel and Frank Mayer
Diagnostics 2016, 6(2), 15

This study aimed to determine the relative and absolute reliability of ultrasound (US) measurements of the thickness and echogenicity of the plantar fascia (PF) at different measurement stations along its length using a standardized protocol. Twelve healthy subjects (24 feet) were enrolled. The PF was imaged in the longitudinal plane. Subjects were assessed twice to evaluate the intra-rater reliability. A quantitative evaluation of the thickness and echogenicity of the plantar fascia was performed using Image J, a digital image analysis and viewer software. A sonography evaluation of the thickness and echogenicity of the PF showed a high relative reliability with an Intra class correlation coefficient of ≥0.88 at all measurement stations. However, the measurement stations for both the PF thickness and echogenicity which showed the highest intraclass correlation coefficient (ICCs) did not have the highest absolute reliability. Compared to other measurement stations, measuring the PF thickness at 3 cm distal and the echogenicity at a region of interest 1 cm to 2 cm distal from its insertion at the medial calcaneal tubercle showed the highest absolute reliability with the least systematic bias and random error. Also, the reliability was higher using a mean of three measurements compared to one measurement. To reduce discrepancies in the interpretation of the thickness and echogenicity measurements of the PF, the absolute reliability of the different measurement stations should be considered in clinical practice and research rather than the relative reliability with the ICC.
Click to expand...

NewsBot · May 8, 2016

Sonographic measurements of the achilles tendon, plantar fascia, and heel fat pad are reliable: A test-retest intra- and intertester study.
Johannsen F et al
J Clin Ultrasound. 2016 May 7

PURPOSE:
To determine intra- and interobserver reliability and precision of sonographic (US) scanning in measuring thickness of the Achilles tendon, plantar fascia, and heel fat pad in patients with heel pain.
METHODS:
Seventeen consecutive patients referred with heel pain were included. Two evaluators blinded to the diagnosis performed independently US scanning of both feet without any dialogue with the patient. The examiner left the room, and the next examiner entered. All patients had two US scans performed by each examiner. Two months later, the US images were randomly presented to the evaluators for measurements. Reliability and agreement were assessed by calculation of intraclass correlation coefficient (ICC), 95% limits of agreement (LOA), and typical error (TE). LOA was calculated as a percentage of the mean thickness of each structure to obtain a unitless parameter.
RESULTS:
We found excellent intratester reliability (ICC 0.78-0.98) and good intertester reliability using one measurement (ICC 0.72-0.91) and excellent (ICC 0.85-0.95) when using average of two measurements. The intratester agreements were good with LOA: 9.5-23.4% and TE: 3.4-8.4%. The intertester agreements were acceptable using one measurement with LOA: 16.1-36.4%, and better using two measurements with LOA: 14.4-33.2%.
CONCLUSIONS:
US is a reliable technique of measurement in the daily clinic, and one single measurement is sufficient. In research, we recommend that the same observer performs the US measurements, if one single scanning is preferred; if more researchers are involved, the average measurement of two US scans is recommended
Click to expand...

NewsBot · Feb 16, 2020

Sonoelastographic evaluation of plantar fascia after shock wave therapy for recalcitrant plantar fasciitis: A 12-month longitudinal follow-up study.
Wu CH et al
Sci Rep. 2020 Feb 13;10(1)

Extracorporeal shockwave therapy (ESWT) is proposed to be effective in reducing pain and improving functional outcome in chronic plantar fasciitis. However, no long-term reports exist on the changes in plantar fascia (PF) elasticity after ESWT. We aimed to evaluate the changes in PF stiffness in patients with plantar fasciitis undergoing ESWT. The visual analogue scale (VAS, 0-100) was used for evaluating heel pain severity. B-mode sonography and strain sonoelastography were used for evaluating the PF thickness and stiffness. The sonoelastogram was analyzed using hue histogram analysis (value: 0-255, from stiffer to softer). All evaluations were recorded before ESWT, and 1 week, 1 month, 3 months, 6 months, and 12 months after ESWT. Repeated measures ANOVA was used to compare pain VAS, PF thickness, and PF hue value at different follow-up time-points. Twenty-two participants (8 men, 14 women) completed all measurements for 12 months. The VAS of heel pain, PF thickness, and PF hue values at pre-ESWT, and 1-week, 1-month, 3-month, 6-month, and 12-month evaluations after ESWT were 62.4 ± 4.2, 49.3 ± 5.8, 38.3 ± 5.7, 27.9 ± 5.3, 18.9 ± 4.7, and 13.2 ± 3.0 (p < 0.01 in all measurements post ESWT versus pre-ESWT); 5.57 ± 0.22 mm, 5.64 ± 0.18 mm, 5.45 ± 0.24 mm, 5.37 ± 0.20 mm, 5.08 ± 0.20 mm, and 4.62 ± 0.15 mm (p < 0.01 at 6-month; otherwise p > 0.05); and 24.5 ± 2.4, 35.2 ± 3.1, 31.0 ± 4.1, 30.5 ± 3.9, 21.4 ± 2.1, and 15.9 ± 1.6 (p < 0.01 at 1-week and 6-month; otherwise p > 0.05), respectively. In conclusion, the heel pain intensity and PF thickness reduced gradually over 12 months after ESWT. The PF stiffness decreased during the first week and increased thereafter; at the 12-month follow-up, stiffness was more than at pre-ESWT.
Click to expand...

NewsBot · Nov 16, 2020

Sonoelastographic evaluation of plantar fascia after shock wave therapy for recalcitrant plantar fasciitis: A 12-month longitudinal follow-up study
Chueh-Hung Wu et al
Sci Rep. 2020 Feb 13;10(1):2571

Extracorporeal shockwave therapy (ESWT) is proposed to be effective in reducing pain and improving functional outcome in chronic plantar fasciitis. However, no long-term reports exist on the changes in plantar fascia (PF) elasticity after ESWT. We aimed to evaluate the changes in PF stiffness in patients with plantar fasciitis undergoing ESWT. The visual analogue scale (VAS, 0-100) was used for evaluating heel pain severity. B-mode sonography and strain sonoelastography were used for evaluating the PF thickness and stiffness. The sonoelastogram was analyzed using hue histogram analysis (value: 0-255, from stiffer to softer). All evaluations were recorded before ESWT, and 1 week, 1 month, 3 months, 6 months, and 12 months after ESWT. Repeated measures ANOVA was used to compare pain VAS, PF thickness, and PF hue value at different follow-up time-points. Twenty-two participants (8 men, 14 women) completed all measurements for 12 months. The VAS of heel pain, PF thickness, and PF hue values at pre-ESWT, and 1-week, 1-month, 3-month, 6-month, and 12-month evaluations after ESWT were 62.4 ± 4.2, 49.3 ± 5.8, 38.3 ± 5.7, 27.9 ± 5.3, 18.9 ± 4.7, and 13.2 ± 3.0 (p < 0.01 in all measurements post ESWT versus pre-ESWT); 5.57 ± 0.22 mm, 5.64 ± 0.18 mm, 5.45 ± 0.24 mm, 5.37 ± 0.20 mm, 5.08 ± 0.20 mm, and 4.62 ± 0.15 mm (p < 0.01 at 6-month; otherwise p > 0.05); and 24.5 ± 2.4, 35.2 ± 3.1, 31.0 ± 4.1, 30.5 ± 3.9, 21.4 ± 2.1, and 15.9 ± 1.6 (p < 0.01 at 1-week and 6-month; otherwise p > 0.05), respectively. In conclusion, the heel pain intensity and PF thickness reduced gradually over 12 months after ESWT. The PF stiffness decreased during the first week and increased thereafter; at the 12-month follow-up, stiffness was more than at pre-ESWT.
Click to expand...

NewsBot · Nov 16, 2020

Role of Ultrasonography and Magnetic Resonance Imaging in Assessment of
Plantar Fasciitis
Elham Samir Samy Mohamed et al
November. 2020 Volume 26 Issue 6

Background: plantar fasciitis is the most common cause of inferior heel pain.
Sonography should be the initial imaging modality for straight forward
confirmation of clinically suspected plantar fasciitis. MRI may be reserved for
cases where a more diagnosis of plantar fasciitis is not satisfactory to explain
the clinical presentation and when complex pathology is suspected. the aim of
the study is to assess the role of MRI in assessment of plantar fasciitis.
Methods: This study was carried out at Radio diagnosis Department, Zagazig
University Hospitals; the study was carried on 18 patients and 18 asymptomatic
volunteers were used as a control group. Ultrasonography and MRI were done
to all patients. Results: The plantar fascia was thickened in symptomatic feet.
The thickness of the plantar fascia in symptomatic feet was (2.9 – 8.4 mm;
6.01± 1.4) measured by ultrasound which was significantly thicker than in the
control group (1.90 – 3.70 mm; 3.09±0.8), P < 0.05. Other sonographic signs
used for the diagnosis of plantar fasciitis in the study were compared to MRI
findings. The diagnostic accuracy was 83.3 for plantar fascia thickening, 83.3%
for intra-fascial abnormal signal, 77.8% for soft tissue edema, and the lowest
diagnostic accuracy of ultrasound was in detection of associated calcaneal spur
(38.9%). The findings were tabulated and discussed in relation to other
literature. Conclusion: sonographic diagnosis of plantar fasciitis is a useful tool
with an acceptable diagnostic accuracy comparable to MRI. Sonography should
be the initial imaging modality. MRI may be reserved when complex pathology
is suspected.
Click to expand...

NewsBot · May 24, 2022

Effect of age and BMI on sonographic findings of plantar fascia
Daman Kumar Jha, M.S et al
May 23, 2022

Biomechanical dysfunction of the foot is most common cause of plantar fascia disorder and obesity and increasing age are well known risk factors. Due to being inexpensive and quick, ultrasound imaging techniques are considered the modality of choice to assess plantar fascia. The aim of this study was to investigate the effect of age and body mass index (BMI) on sonographic findings of plantar fascia in normal population. Ultrasonography was used to measure the plantar fascia thickness of 148 healthy adults (54 males, 36.5% and 94 females, 63.5%) during a period of one year. The age, BMI, and walking distance of each participant were recorded and statistically analysed. The mean plantar fascia thicknesses at 0.5, 1.0, and 2.0 cm distal to the insertion of the plantar fascia were 1.76 ± 0.32 mm, 2.50 ± 0.50 mm and 2.11 ± 0.41 mm respectively. The mean plantar fascia thickness for individuals ≥45 years and BMI ≥25 were significantly higher (p<0.001) compared to individuals < 45 years and BMI < 25. In a normal population, the thickness of the plantar fascia determined by ultrasound measurement was less than 3 mm. We recommend using the position 1.0 cm distal to the calcaneal insertion of the plantar fascia as the reference point for diagnosing plantar fasciitis.The thickness of plantar fascia was significantly increased with age and BMI whereas gender, walking activity, exercise and running did not seem to affect the plantar fascia thickness.
Click to expand...

NewsBot · Jun 17, 2022

Ultrasonography with or without Contrast as a Prognostic and Objective Parameter in Plantar Fasciitis
F. Johannsen et al
Semin Musculoskelet Radiol 2022; 26(03): 361-384

Purpose or Learning Objective: Plantar fasciitis (PF) is a common disorder without objective parameters to describe disease severity. This study investigated whether structural changes in the plantar fascia and heel fat pad, determined by ultrasonography (US) scanning with or without contrast, can be used as prognostic markers for outcome in patients with symptomatic PF. It also explored whether there is an association between changes in US findings and improvement in pain and function.

Methods or Background: All 90 patients in a randomized controlled trial treated with training and/or a glucocorticosteroid (GCS) injection were assessed for morning pain, function pain, Foot Function Index (FFI), and US-measured thickness of the fascia and heel fat pad at entry and after 3 and 6 months. Thirty patients were included in a longitudinal study with assessment of pain, function, and measurement of microvascular volume (MV) by contrast-enhanced US before treatment and after 5 months.

Results or Findings: None of the US parameters at the initial examination were a prognostic marker for clinical outcome at 5 to 6 months. Changes in US-measured thickness of the fascia but not the fat pad correlated with improvement in all outcome measures at 3 months (FFI: r = 0.34, p = 0.001; morning pain: r = 0.30, p = 0.004; pain during function: r = 0.28, p = 0.007) and at 6 months (FFI: r = 0.30, p = 0.005; morning pain: r = 0.21, p = 0.046; function pain: r = 0.28, p = 0.007). Patients with < 4 mm thickness have almost no symptoms. Changes in MV did not correlate with improvement in symptoms, except for patients treated with GCS.

Conclusion: Changes in US-measured fascia thickness can be used as a measure for improvement in PF patients. Fascia thickness > 4 mm is a valid threshold for painful PF.
Click to expand...

NewsBot · Jun 29, 2022

Effect of Age and BMI on Sonographic Findings of Plantar Fascia
Daman Kumar Jha et al
J Foot Ankle Surg. 2022 May 23

Biomechanical dysfunction of the foot is most common cause of plantar fascia disorder and obesity and increasing age are well-known risk factors. Due to being inexpensive and quick, ultrasound imaging techniques are considered the modality of choice to assess plantar fascia. The aim of this study was to investigate the effect of age and body mass index (BMI) on sonographic findings of plantar fascia in normal population. Ultrasonography was used to measure the plantar fascia thickness of 148 healthy adults (54 males, 36.5% and 94 females, 63.5%) during a period of one year. The age, BMI, and walking distance of each participant were recorded and statistically analyzed. The mean plantar fascia thicknesses at 0.5, 1.0, and 2.0 cm distal to the insertion of the plantar fascia were 1.76 ± 0.32 mm, 2.50 ± 0.50 mm and 2.11 ± 0.41 mm respectively. The mean plantar fascia thickness for individuals ≥45 years and BMI ≥25 were significantly higher (p < .001) compared to individuals <45 years and BMI <25. In a normal population, the thickness of the plantar fascia determined by ultrasound measurement was less than 3 mm. We recommend using the position 1.0 cm distal to the calcaneal insertion of the plantar fascia as the reference point for diagnosing plantar fasciitis. The thickness of plantar fascia was significantly increased with age and BMI whereas gender, walking activity, exercise and running did not seem to affect the plantar fascia thickness.
Click to expand...

NewsBot · Aug 9, 2022

Sonoelastographic evaluation of plantar fascia in patients with plantar fasciitis: A case–control study
Revanth RB et al
Vol. 13 No. 8 (2022) / Original Articles

Background: Plantar fascitis causes heel pain and the thickened fascia has specific morphological features that can be utilized for early diagnosis through sonoelastographic evaluation.

Aims and Objectives: This case–control study was conducted to find out the role of sonoelastography in the diagnosis of plantar fasciitis (PF).

Materials and Methods: A case–control study was conducted in the department of radiodiagnosis in a teaching medical college. Thirty
clinically diagnosed PF patients and thirty controls were recruited based on selection criteria. Shear wave elastography (SWE) was done for all participants and the thickness of plantar fascia and strain ratio was compared between the groups. Plantar fascia thickness (mm) and elasticity (stain ratio) were considered as the primary outcome variable. coGuide software was used for data analysis.

Results: The mean age of the cases was 46.73±16.92 years and controls was 47.5±16.1 years. There was no statistical difference observed between cases and controls in age, sex, and body mass index. There was a statistically significant difference in thickness of the plantar fascia (P<0.001) between cases (4.18±0.77 mm) and controls (3.33±0.71 mm). The difference in strain ratio between study groups was statistically significant (P<0.001). The strain ratio had excellent predictive validity with the area under the curve of 0.929 (P<0.001). Data were analyzed using co-Guide software, V.1.03.

Conclusion: Ultrasound elastography can detect the thickening of the plantar fascia and strain ratio has excellent predictive validity in predicting PF.
Click to expand...

NewsBot · Aug 11, 2022

Role of shear wave elastography in the diagnostic evaluation of plantar fasciitis: a prospective case-control study
Harshith Yedahally Ramu et al
J Ultrasound. 2022 Aug 10

Objectives: To assess the advantage of the addition of shear wave elastography (SWE) to gray-scale sonography in the diagnosis of plantar fasciitis.

Methods: 30 subjects between 18-60 years of age with unilateral heel pain who were clinically suspected of having plantar fasciitis were included in this study. Their affected feet were taken as cases; while their contralateral feet served as controls. On gray-scale ultrasound, the thickness of plantar fascia, its echopattern, presence of hypoechoic areas, and perifasicular collections were recorded. SWE was done by placing seven ROIs within the plantar fascia; and the mean of their Young's modulus was taken in kPa.

Results: Plantar fascial thickening more than 4 mm had 70% sensitivity and 66.7% specificity, echopattern had 90% sensitivity and 96.7% specificity, hypoechoic areas had 80% sensitivity and 96.7% specificity, and perifascial edema had 26.7% sensitivity and 100% specificity for diagnosing plantar fasciitis. Using the ROC curve, the cut-off value of Young's modulus for the diagnosis of plantar fasciitis was found to be ≤ 99.286 kPa. This predicted plantar fasciitis with 97% sensitivity and 100% specificity. The primary diagnostic feature of ultrasound of plantar fascia thickness more than 4 mm detected 21 out of 30 cases of plantar fasciitis; whereas elastography detected an additional 8 cases which would have been missed on B-mode ultrasound alone.

Conclusions: SWE is a useful supplement and improves the diagnostic accuracy of gray-scale ultrasound in plantar fasciitis.
Click to expand...

NewsBot · Jan 5, 2023

Ultrasound measurement of plantar fascia thickness: Is the current criterion for normality applicable to everyone?
Fouad Nafees, Zareen Fatima, Sajid Shaheen Malik, Qasim Yousaf, Mahrukh Latif, Syed Muhammad Yousaf Farooq
https://doi.org/10.1002/sono.12342

Background
Plantar fasciitis is a common cause of heel pain. Understandably knowledge of normal sonographic plantar fascia thickness (PFT) is crucial to diagnose this condition as thickened plantar fascia is the most important ultrasound finding for its diagnosis.

Objective
The objectives of this study are to compare the PFT among heavy weight bearing and non-weight bearing individuals sonographically and to assess the effect of age, gender and body mass index (BMI) on PFT.

Methodology
PFT of 154 patients, 77 in each category of heavy weight bearing and non-weight bearing groups, was assessed sonographically. Independent sample T test was used to compare it between two groups. Analysis of covariance was used to test the effect of heavy weight bearing and gender on PFT bilaterally, in both groups with adjustment for age, BMI and standing hours. Correlation of age with PFT was also calculated using Pearson's correlation analysis. p value ≤0.05 was considered significant.

Results
Mean PFT in all patients was 3.8 and 3.2 mm on left and right respectively. There was no significant difference in the right and left foot on paired sample t test. Those bearing heavy weight had significantly thickened PF than the other group bilaterally. ANCOVA showed that bearing heavy weight and BMI had significant effects on PFT. Age was found to be correlated with PFT in non-weight bearing group.

Conclusions
Factors causing increased stress on the plantar fascia such as increased BMI and heavy weight lifting can cause thickening as part of physiological adaptation.
Click to expand...

NewsBot · Mar 16, 2023

Ultrasonographic Assessment of Indian Patients
With Plantar Fasciitis and Its Clinical
Correlation: A Prospective Observational Study
Suhas Aradhya B et al
Source

Introduction: Plantar fasciitis is a debilitating clinical condition and is one of the most common causes of
heel pain. The risk factors include frequent and prolonged running, obesity, a sedentary lifestyle, workrelated weight bearing, and inappropriate footwear. Ultrasonography being a non-invasive, cost-effective,
and easily available modality is a useful adjunct in the diagnosis.
Methods: A prospective observational study was conducted among 30 patients with unilateral plantar
fasciitis. The diagnosis was based on history and examination. Heel pad thickness and plantar fascia
thickness were recorded using ultrasonography.
Results: The ultrasonography results showed increased plantar fascia and heel pad thickness in the affected
limb with plantar fasciitis than the normal one (p<0.001). The BMI was positively correlated with the heel
pad thickness (p<0.05). The receiver operating characteristic (ROC) curve showed 90% sensitivity and 60%
specificity for heel pad thickness (p<0.001).
Conclusions: Ultrasonography is a sensitive and specific tool to identify patients with plantar fasciitis.
Click to expand...

NewsBot · Jul 20, 2023

Diagnostic Accuracy of Ultrasonography in Patients with Plantar Fasciitis: A Cross-sectional Study.
CHITHIRAVELU, SIVAKANMANI; GUHAN, SIVATHANGAVEL THANGAVELU; AIYAPPAN, SENTHIL KUMAR; SAI, DACHEPALLI RAMYA; MITTAL, HARSHIKA
Journal of Clinical & Diagnostic Research . May2023, Vol. 17 Issue 5, p16-20. 5p.

Introduction: Plantar Fasciitis (PFS) is the most well-known cause for plantar heel pain seen predominantly in middle aged women. Imaging findings of Magnetic Resonance Imaging (MRI) is considered to be the gold standard in the diagnosis of PFS, but MRI is expensive. Hence; there is a need to study the accuracy of Ultrasonography (USG), as USG is inexpensive, free of radiation and readily available. Aim: To evaluate the diagnostic accuracy, sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) of ultrasound in comparison with MRI for the diagnosis of PFS, in patients with heel pain. Materials and Methods: The present cross-sectional study was conducted in the Department of Radiodiagnosis, SRM Medical College and Research Centre, Kattankulathur, Tamil Nadu, India, from December 2019 to July 2021. USG and MRI of foot were performed in 40 patients with heel pain. MRI protocol included three plane Proton Density Fat Saturated (PDFS), T1 sagittal, T2 axial and Short inversion Time Inversion Recovery (STIR) sagittal sequences. USG scans were done in prone position with the patient's feet dorsiflexed. The Plantar Fascia (PF) thickness was measured in both USG and MRI and association of the ultrasound and MRI measurements of PF thickness was done using Chi-square test. Results: Mean age of the cohort was 36.83±10.08 years. Out of this subject population, majority were females 29 (72.5%). Nineteen (47.5%) females were overweight i.e., BMI from 25-29.9 kg/m². The accuracy, sensitivity, specificity, PPV and NPV of plantar fascia thickness of USG as compared to MRI was found to be 80%, 60%, 82.9%, 33.3% and 93.5%, respectively. Conclusion: Despite MRI being the imaging modality of choice in diagnosing PFS, accuracy of ultrasound was comparable to that of MRI and it can be used as the initial investigation and follow-up.
Click to expand...

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

Use of extracorporeal shock wave therapy for children’s foot, ankle and leg concerns

Extracorporeal circulation compression perfusion in the treatment of diabetic foot

Is pregnancy brain real?

Peeled images and sectioned images from real-color volume models of foot

Mechanism of Action of Extracorporeal Shockwave Treatment in Musculoskeletal Disorders

Were is it really heading

Ask the Foot Doctor: Real-Life Answers to Enjoy Happy, Healthy, Pain-Free Feet

Share This Page