Shear wave elastography to assess plantar fasciitis

NewsBot · Mar 5, 2014

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Assessment of plantar fasciitis using shear wave elastography
Zhang LI1, Wan WB, Zhang LH, Xiao HY, Luo YK, Fei X, Zheng ZX, Tang PF.
Nan Fang Yi Ke Da Xue Xue Bao. 2014 Feb 20;34(2):206-9.

OBJECTIVE:
To assess the stiffness and thickness of the plantar fascia using shear wave elastography (SWE) in healthy volunteers of different ages and in patients with plantar fasciitis.
METHODS:
The bilateral feet of 30 healthy volunteers and 23 patients with plantar fasciitis were examined with SWE. The plantar fascia thickness and elasticity modulus value were measured at the insertion of the calcaneus and at 1 cm from the insertion.
RESULTS:
The elderly volunteers had a significantly greater plantar fascia thickness measured using conventional ultrasound (P=0.005) and a significantly lower elasticity modulus value than the young volunteers (P=0.000). The patients with fasciitis had a significantly greater plantar fascia thickness (P=0.001) and a lower elasticity modulus value than the elderly volunteers (P=0.000). The elasticity modulus value was significantly lower at the calcaneus insertion than at 1 cm from the insertion in patients with fasciitis (P=0.000) but showed no significantly difference between the two points in the elderly or young volunteers (P=0.172, P=0.126).
CONCLUSION:
SWE allows quantitative assessment of the stiffness of the plantar fascia, which decreases with aging and in patients with plantar fasciitis.
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NewsBot · Jul 23, 2014

Ultrasound elastography in the early diagnosis of plantar fasciitis
So-Yeon Lee et al
Clinical Imaging; Available online 18 July 2014

Background
The purpose of this study was to investigate whether ultrasound (US) elastography is useful for the early diagnosis of plantar fasciitis.
Material and methods
We retrospectively reviewed US elastography findings of 18 feet with a clinical history and physical examination highly suggestive of plantar fasciitis but with normal findings on conventional US imaging as well as 18 asymptomatic feet.
Result
Softening of the plantar fascia was significantly greater in the patient than in the control group [Reviewers 1 and 2: 89% (16/18) vs. 50% (9/18), P= .027, respectively].
Conclusion
US elastography is useful for the early diagnosis of plantar fasciitis.
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NewsBot · Sep 9, 2017

Investigation of the acute plantar fasciitis with contrast-enhanced ultrasound and shear wave elastography - first results.
Putz FJ et al
Clin Hemorheol Microcirc. 2017 Sep 4. doi: 10.3233/CH-179222.

BACKGROUND:
The plantar fasciitis is a common disease with a high prevalence in public and a frequent cause of heel pain.
OBJECTIVE:
In our pilot study, we wanted to characterise the feasibility of shear-wave elastography and contrast-enhanced ultrasound (CEUS) in the assessment of the plantar fasciitis.
METHODS:
23 cases of painful heels were examined by B-Mode ultrasound, Power Doppler (PD), shear wave elastography and contrast-enhanced ultrasound before anti-inflammatory radiation. Time-intensity-curves were analysed by the integrated software. The results for area-under-the-curve (AUC), peak, time-to-peak (TTP) and mean-transit-time (MTT) were compared between the plantar fascia and the surrounding tissue.
RESULTS:
All cases showed thickening of the plantar fascia, in most cases with interstitial oedema (87.0%). Shear wave elastography showed inhomogeneous stiffness of the plantar fascia. 83.3% of cases showed a visible hyperperfusion in CEUS at the proximal plantar fascia in comparison to the surrounding tissue. This hyperperfusion could also be found in 75.0% of cases with no signs of vascularisation in PD. AUC (p = 0.0005) and peak (p = 0.037) were significantely higher in the plantar fascia than in the surrounding tissue.
CONCLUSION:
CEUS and shear wave elastography are new diagnostic tools in the assessment of plantar fasciitis and can provide quantitative parameters for monitoring therapy.
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NewsBot · Nov 14, 2018

Effect of toe dorsiflexion on the regional distribution of plantar fascia shear wave velocity
KentaroChinoabLilianLacourpaillecJunSasaharadYasuhiroSuzukibFrançoisHugce
Clinical Biomechanics; 8 November 2018

Highlights
•Shear wave velocity of the plantar fascia was estimated by ultrasound elastography.
•Shear wave velocity can be considered as an index of tensile stress.
•Shear wave velocity was greater in the insertional region than the distal region.
•Toe dorsiflexion did not affect shear wave velocity in the insertional region.
•Toe dorsiflexion induced an increase in shear wave velocity in the distal region.
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Background
The plantar fascia is exposed to repetitive tensile stress induced by cyclic loads associated with daily activities, such as walking and running. Due to overuse or abnormal foot alignment, insertional and distal (i.e., mid-substance) regions within the plantar fascia may exhibit microtears, which leads to plantar fasciopathy. Ultrasound shear wave elastography is an imaging technique to measure shear wave velocity propagating through biological tissues, considered herein as an index of tensile stress. This study aimed to quantify the effect of toe dorsiflexion on the regional distribution of plantar fascia shear wave velocity.

Methods
Shear wave velocity of the plantar fascia was measured in the insertional and distal regions using ultrasound shear wave elastography in sixteen healthy participants (7 males and 9 females). The measurements were performed while the toes were maintained in neutral or dorsiflexed positions.

Findings
When considering the insertional region, there was no significant difference in shear wave velocity between neutral toe position [mean (SEM): 5.4 (0.6) m/s] and dorsiflexed toe position [5.5 (0.5) m/s] (P = 0.88; effect size = 0.05). When considering the distal region, there was a significant difference in shear wave velocity between the neutral position [7.8 (0.4) m/s] and dorsiflexed position [9.9 (0.3) m/s] (P = 0.002; effect size = 0.88). The difference in shear wave velocity between the insertional and distal regions showed a large effect size for either neutral (P = 0.010; effect size = 0.75) or dorsiflexed toe position (P = 0.003; effect size = 0.86).

Interpretation
In contrast to clinical beliefs, these findings suggest that toe dorsiflexion induces non-homogeneous changes in tensile stress within the plantar fascia.
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NewsBot · Mar 1, 2019

Medical Image Analysis Based on T2 Mapping and Intravoxel-Incoherent-Motion Diffusion-Weighted Imaging in the Diagnosis of Plantar Fasciitis
Song, Xiubao; Xu, Xi; Ye, Yufeng; Liang, Jianye; Huang, Jiaxi; Peng, Qiwen
Journal of Medical Imaging and Health Informatics, Volume 9, Number 2, February 2019, pp. 303-307(5)

Objective: Plantar fasciitis is the most common cause of heel pain, which often influence the patient's daily activities. An early and quantitative evaluation helps an effective treatment in plantar fasciitis. Our aims were to explore the feasibility of T2 mapping and intravoxel-incoherent-motion diffusion-weighted imaging (IVIM-DWI) in the quantitative evaluation of plantar fasciitis. Methods: A 3.0T MR scanner was performed on 23 feet of 18 patients with plantar fasciitis and 24 feet of 19 healthy subjects. The imaging protocol consisted of conventional sequences including coronal and sagittal T1- and T2-weighted imaging (T2WI) with and without fat saturation, as well as T2 mapping and IVIM-DWI. The fascial thickness, effusion, tissue edema and other related manifestations were noted. The quantitative parameters including D, D*, f, and T2 values were measured in the fascia, muscle, and subcutaneous fat pad, respectively. Two independent t-test was mainly used for statistical analysis.Results: Qualitatively, bone spur, subcutaneous effusion, and soft tissue edema around the plantar fascia were observed; the fascias were thickened; and the signal intensity of T2WI of soft tissues increased in the patients compared to the healthy subjects. Quantitatively, both D and T2 values were found significant differences in the fascia, muscle, and fat pad between the patients and healthy subjects, except D *; and f values. Conclusions: Both T2 mapping and IVIM-DWI had high clinical values in the quantitative evaluation of plantar fasciitis. D and T2 values may be useful surrogate markers in predicting the severity of plantar fasciitis clinically.
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NewsBot · May 5, 2019

Noninvasive in Vivo Study of the Morphology and Mechanical Properties of Plantar Fascia Based on Ultrasound
Kunyang Wang ; Jing Liu ; Jianan Wu ; Zhihui Qian ; Luquan Ren ; Lei Ren
IEEE

The overall distributions of the plantar fascia thickness and Young’s modulus in the ten subjects were systematically investigated in this paper using two-dimensional ultrasound and shear wave elastography (SWE). The statistical analyses showed that ICC 1,1 of the plantar fascia thickness and Young’s modulus ranged from 0.950 to 0.991, with the 95% CI in the range of 0.953–0.996. This result indicated that the thickness and Young’s modulus exhibited excellent retest reliability. The conclusion that both the thickness, d , and Young’s modulus, E , of the plantar fascia showed a simple and specific spatial dependence on the characteristics of the gradient distribution can be drawn. As the plantar fascia extends from the calcaneus to the five toes, both the thickness, d , and Young’s modulus, E , of the five bundles of plantar fascia showed a downward trend of a negative exponential function, and the thickness, d , and Young’s modulus, E , were the largest at the tubercle of the calcaneus and closest to the lowest value at the tubercles of the five metatarsal bones. The coefficient of determination (R 2 ) of the fitting curve of thickness, d , and Young’s modulus, E , was higher than 0.959 in all ten subjects. The distribution characteristics of the plantar fascia thickness, d , and Young’s modulus, E , showed good consistency in the healthy subjects in this paper. The conclusions of this paper may provide more accurate references and a basis for material mechanics data for plantar fascia diseases (such as fasciitis) and foot mechanical models (such as finite element models).
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NewsBot · Jun 4, 2019

Shear Wave Elastography (SWE) for the Evaluation of Patients with Plantar Fasciitis
MatthiasGatzMDaLjudmilaBejderMDaValentinQuackMDaSimoneSchradingMDbTimmDirrichsMDbMarkusTingartMDaChristianeKuhlMDbMarcelBetschMDa
Academic Radiology; 30 May 2019

Rationale and Objectives
The current imaging standard for diagnosing plantar fasciitis is B-Mode ultrasound (B-US). The aim of this study was to determine the diagnostic potential of Shear Wave Elastography (SWE) and the correlation of clinical scores to elastographic parameters.

Materials and Methods
Diagnostic case-control study with n = 82 plantar fascia (PF). PF were divided into three subgroups: (1) symptomatic PF (n = 39); (2) control group of unilateral asymptomatic PF (n = 23); (3) bilateral asymptomatic PF (n = 20). Reference standard for positive findings in B-US was a PF thickness greater than 4 mm. For SWE tissue elasticity (Young's modulus kPa; shear wave speed m/s) was measured at Location 1: directly at the calcaneus; Location 2: +1 cm distal of the calcaneus and Location 3: central part of the calcaneus. Sensitivity, specificity, and diagnostic accuracy as well as correlation to American Orthopaedic Foot and Ankle Score (AOFAS) and Food Functional Index (FFI) were determined.

Results
Symptomatic PF are thicker (4.2 mm, n = 39) than asymptomatic (3.0 mm, n = 43) (p < 0.001). Thickness of the PF (n = 82) correlated poorly to clinical scores (p = 0.001): FFI-pain (r = 0.349); FFI-function (r = 0.381); AOFAS (r = −0.387). Cut-off point for positive SWE finding was 51.5 kPa (4.14 m/s). Symptomatic PF (31.9 kPa, 3.26 m/s, n = 39) differ significantly from asymptomatic PF (93.3 kPa, 5.58 m/s, n = 43) with significant differences at L1 between all groups (p < 0.001). Correlation between Young's modulus (n = 82) and clinical scores was strong (p < 0.001): FFI-pain (r = −0.595); FFI-function (r = −0.567); AOFAS (r = 0.623,). B-US: sensitivity (61%), specificity (95%); SWE sensitivity (85%), specificity (83%). The combination of SWE and B-US increases the sensitivity (100%) with a diagnostic accuracy of 90%.

Conclusion
Based on our results, we could show that SWE can improve the diagnostic accuracy in patients with plantar fasciitis compared to B-US.
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NewsBot · Oct 23, 2019

Ultrasonographic detection of normal plantar fascia thickness in healthy Egyptian adults
H.S.El-Banna et al
Musculoskeletal Science and Practice; 16 October 2019, 102071

Highlights
•The mean value of plantar fascia thickness in healthy Egyptians was 3.16 ± 0.65 mm.
•The mean thickness didn't differ in men and women, or in right and left feet.
•The thickness is higher in older patients and, those with elevated body mass index.
•Thickness significantly correlated with age, weight, height, and body mass index.
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Aim of the study
To measure normal plantar fascia thickness in healthy Egyptians using high resolution ultrasound and to assess its relationship with age, sex, height, weight and body mass index (BMI), to generate normal values.

Methods
Plantar fascia thickness was measured in 150 healthy volunteers (300 feet) in a prone position at 5 mm distal to its insertion into the calcaneus using (7.5–12 MHz), linear array transducer. We also assess height, weight and BMI.

Results
The mean plantar fascia thickness for the whole sample was (3.16 mm ± 0.65), for male subjects was (3.29 mm ± 0.62), female subjects was (3.06 mm ± 0.66), Right side was (3.21 mm ± 0.67) and left side (3.11 mm ± 0.63). The mean plantar fascia thickness was not significantly higher in men than in women or in right than left feet (p > 0.05). There was significant correlation between age, weight, height, body mass index; and plantar fascia thickness in the tested population (p < 0.05).

Conclusion
The mean plantar fascia thickness was estimated to be less than 4 mm in most participants (93%). The mean thickness is higher in obese and old patients but similar in both feet and both sexes. Age, weight, height and BMI are correlated with the plantar fascia thickness. The generated normal values of the plantar fascia thickness are very important for assessment of patients with plantar fasciitis.
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NewsBot · May 19, 2020

Evaluation of plantar fasciopathy shear wave elastography: a comparison between patients and healthy subjects.
Schillizzi G et al
J Ultrasound. 2020 May 16

PURPOSE:
The aim of this study is to compare elasticity features between patients with plantar fasciitis (PFis) and an asymptomatic healthy control group using shear wave elastography (SWE) and to correlate SWE values with clinical scores.

METHODS:
Consecutive patients diagnosed with PFis and asymptomatic subjects were enrolled in the present study. Both groups underwent clinical, ultrasound (US), and SWE evaluation. A plantar fascia thickness > 4 mm was considered pathognomonic of PFis. SWE stiffness elasticity (Young's modulus in kPa and shear wave velocity in m/s) was measured 1 cm distally from the calcaneal insertion. Correlations with VAS and the 17-Italian Foot Function Index (17-FFI) were determined.

RESULTS:
A total of 19 patients satisfied the inclusion criteria for the patient group and were enrolled in the study, and 21 healthy subjects were used as a control group. Statistically significant differences were found for shear wave velocity between the patient and the control group, with SWE findings of 3.8 (5.1; 1.5) m/s and 4.7 (4.07; 7.04) m/s, respectively (p = 0.006). Strong positive correlations were found between the SWE findings and both the pain and the functional scale (VAS: p = 0.001; FFI: p = 0.012).

CONCLUSION:
SWE allows quantitative assessment of the stiffness of the plantar fascia and can show PFis alterations, increasing the diagnostic performance of B-mode US. In addition, SWE shows a strong correlation with clinical scores, improving patient assessment and follow-up.
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NewsBot · Jul 4, 2020

Statistical and Texture Descriptors of Symptomatic Plantar Fasciitis using Ultrasound Shear Wave Elastography
Hongmei Zhang ; Lei Xu ; Zhihui Liu ; Shukuan Lu ; Jichao Yin ; Sibo Tian ; Xiaofeng Yang ; Mingxi Wan
IEEE

Plantar fasciitis (PFis) is a common cause of heel pain. This study aims to assess the plantar fascia (PF) quantitatively by using feature descriptors and seek valuable imaging biomarkers that can reliably diagnose PFis. A total of 63 participants underwent B-mode and longitudinal shear wave imaging (SWE) on unilateral plantar fasciae. To characterize the statistical and spatial texture features of the PF, ten statistical descriptors of the shear modulus in the standardized region of interest in PF and twenty texture descriptors in the SWE measurement window (in both horizontal and vertical directions) are proposed. Four statistical quantities (mode, avg, med, qG) and four texture descriptors (autoc, sosvh, savgh svarh) showed potential for diagnosing PFis, based on significant differences between the PFis and the healthy groups. Receiver operating characteristic (ROC) curve analysis revealed that the statistical descriptors have area under the curve (AUC) of approximately 0.9 (likelihood ratio>6.798) and the texture descriptors have AUC of approximately 0.85 (likelihood ratio>3.195). Combinations of statistical and texture descriptors can achieve higher AUCs~0.968. In addition, these descriptors were related to the clinical indices (body mass index and visual analogue scale) with Spearman’s correlation coefficient of r=-0.5~-0.4(p<0.05). The proposed statistical and texture descriptors showed valuable potential if applied to clinical shear wave elastography for the diagnosis of PFis. This work lays the foundation of using ultrasound shear wave image features for describing symptomatic PFis.
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NewsBot · Oct 2, 2020

Shear wave elastography for treatment monitoring of plantar fasciitis
Matthias GATZ et al
The Journal of Sports Medicine and Physical Fitness 2020 August;60(8):1137-47

BACKGROUND: Plantar fasciitis is a common cause of heel pain. Monitoring therapy effects is challenging with conventional B-mode ultrasound. Shear wave elastography (SWE) provides important diagnostic information beyond B-mode, with typically lower tissue stiffness in symptomatic plantar fascia. Up to now little is known about SWE features for therapy monitoring in plantar fasciitis. We evaluated the clinical effects of a 3-month physical therapy based treatment and its influence on B-mode and SWE ultrasound findings in patients suffering from plantar fasciitis, correlating ultrasound findings to score-based symptom development.
METHODS: Prospective, IRB-approved clinical study in plantar fasciitis patients undergoing a 3-month physical therapy based treatment. Measurement time points were before (T0), after 1 (T1) and 3 (T2) months of treatment, consisting of clinical orthopedic (FFI, AOFAS-Score) and multimodal radiologic sonographic examinations (B-mode/SWE) using a high-resolution linear 18-MHz probe.
RESULTS: A total of 33 patients with 43 symptomatic plantar fascia were included. We found a significant (P<0.001) clinical score improvement (AOFAS +14, FFI-Pain -21, FFI-Function -18) between T0 and T2. Mean initial thickness (T0) of symptomatic plantar fascia was 4.2 (±1.2) mm, compared to 3.2 (±0.7) mm at the asymptomatic contralateral side (P<0.001). No significant thickness changes were seen at T1 (4.2±1.1 mm) and T2 (4.5±1.3 mm), even though clinical scores improved significantly. Mean initial stiffness (T0) of symptomatic plantar fascia was 59.57 (±43.3) kPa, compared to 83.23 (±47.3) kPa at the asymptomatic contralateral side (P<0.001). In contrast to B-mode ultrasound, SWE values increased significantly between T0 (59.6±43.3 kPa), T1 (82.6±47.3 kPa) and T2 (102.5±47.2 kPa) (P<0.001-0.009), with positive correlations for AOFAS/FFI-Pain/Function scores (r=0.285-0.473, P<0.001-0.002).
CONCLUSIONS: A physical therapy based treatment relieves plantar fasciitis symptoms during a 3-month period. In line with symptom reduction, stiffness (Young’s-moduli) of plantar fascia increased significantly, while B-mode ultrasound revealed no measurable changes during the healing process. Shear wave elastography was able to quantify plantar fascia pathologies and their recovery under therapy.
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NewsBot · Oct 4, 2021

Ultrasonographic measurements of plantar fascia thickness and echogenicity in individuals with and without plantar fasciitis: Reliability and group differences
Saman Salehi et al
Foot (Edinb). 2021 Jul 8;49:101849

Objective: Imaging techniques such as ultrasonography are beneficial for diagnosis of plantar fasciitis. The purpose of this study was to investigate intra-rater reliability of plantar fascia thickness and echogenicity in subjects with and without plantar fasciitis and to compare the measurements between the two groups.

Design: Sonographic evaluation of the plantar fascia was performed in prone position in 20 subjects without plantar fasciitis and 20 subjects with plantar fasciitis. The outcome measures extracted from the ultrasound images included plantar fascia thickness at the insertion, 1 cm and 3 cm distal from the insertion and plantar fascia echogenicity. The reliability of outcome measures was estimated for both groups using absolute and relative reliability variables. The two groups were compared using analysis of variance (ANOVA).

Results: ICCs (3, 3) for intra-rater reliability of plantar fascia thickness and echogenicity were, respectively, ≥0.89 and ≥0.89 in the healthy controls and 0.87≥ and 0.90≥ in the plantar fasciitis group. The subjects with plantar fasciitis showed a thicker plantar fascia with lower echogenicity in all of measurement stations of plantar fascia compared to the healthy controls.

Conclusion: The results of the present study indicated that ultrasonography is a reliable method to measure plantar fascia thickness and echogenicity. Furthermore, the findings showed that plantar fascia is affected not only at its insertion but also in other points remote from the insertion in patients with plantar fasciitis. These findings support the diagnostic value of ultrasonography in therapy and research of the patients with plantar fasciitis.
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NewsBot · Apr 24, 2022

Biomechanical Effects of Plastic Heel Cup on Plantar Fasciitis Patients Evaluated by Ultrasound Shear Wave Elastography
Che-Yu Lin et al
J Clin Med. 2022 Apr 12;11(8):2150

The plastic heel cup has been adopted to treat plantar heel problems for years. However, its mechanisms and biomechanical effects are yet to be fully understood. The purpose of this study was to investigate the effects of the plastic heel cup on the microchamber and macrochamber layers of the heel pad by comparing the stiffness (in terms of the shear wave speed) and thickness of these two layers with and without a plastic heel cup during static standing. Fifteen patients with unilateral plantar fasciitis were recruited. The shear wave speed and thickness of the microchamber and microchamber layers of each symptomatic heel pad during standing measured by ultrasound shear wave elastography were compared between conditions with and without a plastic heel cup. It was found that a plastic heel cup reduced the shear wave speed of the microchamber layer to 55.5% and increased its thickness to 137.5% compared with the condition without a plastic heel cup. For the microchamber layer, the shear wave speed was reduced to 89.7%, and thickness was increased to 113.6% compared with the condition without a plastic heel cup. The findings demonstrate that a plastic heel cup can help to reduce the stiffness and increase the thickness for both layers of the heel pad during standing, suggesting that the mechanism of a plastic heel cup, and its resulting biomechanical effect, is to reduce the internal stress of the heel pad by increasing its thickness through confinement.
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NewsBot · Aug 30, 2022

Ultrasound elastography for the evaluation of plantar fasciitis: A systematic review and meta-analysis
Chueh-Hung Wu et al
Eur J Radiol. 2022 Aug 20;155:110495

Purpose: This meta-analysis aimed to investigate the utility of ultrasound (US) elastography in the assessment of plantar fasciitis (PF).

Methods: We searched PubMed, Embase, and Scopus and systemically reviewed clinical studies that used US elastography for imaging PF. The primary outcome was the comparison of plantar fascia stiffness between healthy controls and patients with PF, quantified using the weighted mean difference (WMD) and standardized mean difference (SMD).

Results: Eleven studies were included in the final systematic review and meta-analysis. In six studies that employed shear wave elastography, patients with PF had a lower shear wave velocity, with a WMD of -1.772 m/s (95 % confidence interval [CI], -2.663 to -0.880) and an SMD of -1.239 m/s (95 % CI, -1.876 to -0.603), compared to those with asymptomatic heels. One study using the strain ratio showed that the WMD and SMD of patients with diseased heels vs healthy controls were -0.400 (95 % CI, -0.850 to 0.050) and -0.442 (95 % CI, -0.946 to 0.062), respectively. In six articles that use the color histogram of strain elastography, less stiffness was consistently reported in the diseased plantar fascia compared with healthy controls.

Conclusion: This meta-analysis showed that the plantar fasciae were less stiff in the PF group than in asymptomatic subjects. The diagnostic performance of US elastography (over B-mode) warrants further investigation.
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NewsBot · Sep 22, 2022

Quantification of the in vivo stiffness and natural length of the human plantar aponeurosis during quiet standing using ultrasound elastography
Shuhei Nozaki et al
Sci Rep. 2022 Sep 20;12(1):15707

This study aimed to identify the stiffness and natural length of the human plantar aponeurosis (PA) during quiet standing using ultrasound shear wave elastography. The shear wave velocity (SWV) of the PA in young healthy males and females (10 participants each) was measured by placing a probe in a hole in the floor plate. The change in the SWV with the passive dorsiflexion of the metatarsophalangeal (MP) joint was measured. The Young's modulus of the PA was estimated to be 64.7 ± 9.4 kPa, which exponentially increased with MP joint dorsiflexion. The PA was estimated to have the natural length when the MP joint was plantarflexed by 13.8°, indicating that the PA is stretched by arch compression during standing. However, the present study demonstrated that the estimated stiffness for the natural length in quiet standing was significantly larger than that in the unloaded condition, revealing that the PA during standing is stiffened by elongation and through the possible activation of intrinsic muscles. Such quantitative information possibly contributes to the detailed biomechanical modeling of the human foot, facilitating an improved understanding of the mechanical functions and pathogenetic mechanisms of the PA during movements.
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NewsBot · Jan 16, 2023

Elasticity evaluation of the plantar fascia: A shear wave elastography study involving 33 early-stage plantar fasciopathy subjects
Zhen-Zhen Jiang et al
Front Physiol. 2022 Dec 16;13:1060728

Background: Plantar fasciopathy, the most common foot condition seen in elderly and athletic populations, can be diagnosed and differentially diagnosed with imaging modalities such as ultrasound shear wave elastography (SWE). However, standard guidelines for ultrasound elastography of the plantar fascia are lacking. The purpose of this study was to determine the impact of the region of interest (ROI) on the evaluation of the plantar fascia elasticity and confirm the screening accuracy of SWE in the early-stage of plantar fasciopathy. Methods: This was an observational case‒control study involving 50 feet of 33 early-stage plantar fasciopathy subjects (the plantar fasciopathy group) and 96 asymptomatic feet of 48 healthy volunteers (the non-pain group). Clinical information, including age, gender, height, weight, visual analogue scale (VAS) score, American Orthopaedic Foot and Ankle Scale score (AOFAS), and the symptom duration, were recorded. All participants underwent both conventional ultrasound and SWE evaluation. The plantar fascia elastic parameters included SWEsingle-point, calculated with a single-point ROI set at the greatest thickness of the plantar fascia, and SWEmulti-point, calculated by multipoint ROIs set continuously from the origin at the calcaneus to about 2 cm from the calcaneal origin. Results: The plantar fasciopathy group presented a higher VAS score (median [IQR), 4.00 (3.00) vs. 0.00 (0.00), p < 0.001] and lower AOFAS score [median (IQR), 79.50 (3.00) vs. 100.00 (10.00), p < 0.001] than the non-pain group. The median plantar fascia thickness of the plantar fasciopathy group was significantly greater than that of the non-pain group [median (IQR), 3.95 (1.37) mm vs 2.40 (0.60) mm, p < 0.001]. Abnormal ultrasound features, including echogenicity, border irregularities, and blood flow signals, were more prominent in the plantar fasciopathy group than in the non-pain group (29% vs. 0%, p < 0.001; 26% vs. 1%, p < 0.001; 12% vs. 0%, p < 0.001, respectively). Quantitative analysis of the plantar fascia elasticity revealed that the difference between the value of SWEsingle-point and SWEmultipoint was significant [median (IQR), 65.76 (58.58) vs. 57.42 (35.52) kPa, p = 0.02). There was a moderate and significant correlation between the value of SWEsingle-point and heel pain. However, there was no correlation between the value of SWEmultipoint and heel pain. Finally, we utilized the results of SWEsingle-point as the best elastic parameter reflecting clinical heel pain and found that SWEsingle-point could provide additional value in screening early-stage plantar fasciopathy, with an increase in sensitivity from 76% to 92% over conventional ultrasound alone. Additionally, compared with conventional ultrasound and SWE, the use of both improved the accuracy of screening for plantar fasciopathy. Although there were no significant differences in the negative predictive value of conventional ultrasound, SWE, and their combination, the positive predictive value when using both (90.20%) was significantly greater than that when using conventional ultrasound (74.50%) or SWE alone (76.50%). Conclusion: The plantar fascia elastic parameter calculated with single-point ROIs set at the greatest thickness of the plantar fascia is positively correlated with fascia feel pain. Single-point analysis is sufficient for the screening of the early-stage plantar fasciopathy using SWE. SWEsingle-point may provide additional valuable information for assessing the severity of plantar fasciopathy.
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NewsBot · Apr 3, 2023

Added Value of Shear Wave Elastography (SWE) for Evaluation of Patients with Plantar Fasciitis
Zagazig University Medical Journal March 2023 XML

Background: Plantar fasciitis, a common cause of heel pain . Ultrasound is a reliable diagnostic tool , but not all patients exhibit changes on ultrasound, making additional techniques necessary. Shear wave elastography can assess the mechanical properties of the plantar fascia and provides a quantitative measure of tissue stiffness.

Method: This is a case control study has been conducted on 30 patients clinically diagnosed with plantar fasciitis and 30 matched control healthy individual with no pain. It aimed to determine the added value of elastography to B-Mode ultrasound in the diagnosis of plantar fasciitis in comparison with healthy people.PF thickness and SWE stiffness elasticity were measured .

Results: SWE velocity and elasticity can significantly assess plantar fasciitis .there is negative correlation between plantar fascia thickness and both SWE velocity and elasticity .Mean SWV value in healthy subjects was 5.92 m/s and in patients 3.02 m/s with a mean stiffness value of 109.1 kPa and 49.35 kPa respectively (p < 0.001). For SWV a cut-off value of 4.1 m/s had a specificity of 100 % and sensitivity of 93.33%. For stiffness a cut-off value of 48.1 kPa had a specificity of 100% and sensitivity of 76.67%.

Conclusion: Our study has proven that SWE improves the diagnostic accuracy compared to B-US and that the combination of SWE and B-US is a strong diagnostic tool in the detection of plantar fasciitis and may be helpful in diagnose early cases .
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NewsBot · Apr 7, 2023

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

. 2023 Mar 4;15(3):e35764.

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, work-related 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.
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