Elsevier

Clinical Imaging

Volume 38, Issue 5, September–October 2014, Pages 715-718
Clinical Imaging

Original Article
Ultrasound elastography in the early diagnosis of plantar fasciitis

https://doi.org/10.1016/j.clinimag.2012.12.004Get rights and content

Abstract

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.

Introduction

Plantar fasciitis is a frequent cause of nontraumatic heel pain, which can be reduced by treatments such as steroid injections [1], [2]. The diagnostic criteria for plantar fasciitis include heel pain worsening at awakening in the morning or after a period of rest and tenderness at a medial tubercle of the calcaneus [3], [4]. Although ultrasound (US) is not necessary for the diagnosis of plantar fasciitis, it may confirm a diagnosis or be utilized as imaging guidance for injection procedures. Typical US findings of plantar fasciitis include thickening of the plantar fascia, loss of normal striation, a hypoechoic area within the fascia, and perifascial fluid [4]. These morphologic changes, however, are not always observed on US in patients with plantar fasciitis [4], [5]. US elastography was recently shown to be feasible in evaluating plantar fasciitis, showing softening of the plantar fascia in these patients [3]. In the cited study, most of patients showed abnormal findings consistent with plantar fasciitis on both B-mode imaging and elastography. To our knowledge, elastography has not been evaluated in patients with symptoms highly suggestive of plantar fasciitis but with normal findings on B-mode imaging. We therefore investigated whether US elastography can detect plantar fasciitis earlier than B-mode imaging.

Section snippets

Study population

The study was approved by our institutional review board and complied with Health Insurance Portability and Accountability Act guidelines. The board waived the requirement for informed consent for this retrospective study. Between May and December 2011, US examinations were performed on 64 symptomatic or asymptomatic feet. Longitudinal and short-axis B-mode imaging and longitudinal elastography imaging of both feet are included in the routine US protocol of our institute for patients with

Results

There were 7 right and 11 left feet in the patient group and 9 right and 9 left feet in the control group. The mean age of patients (45±11 years) and controls (46±14 years) did not differ significantly. Mean duration of pain in the patient group was 3.9±2.1 months. On B-mode US examination, the thickness of the plantar fascia did not differ significantly in patient (Reviewers 1 and 2, 2.9±0.7 mm each) and control (Reviewer 1, 2.6±0.6 mm; Reviewer 2, 2.5±0.6 mm) feet (Table 1). However, on US

Discussion

Plantar heel pain is a symptom commonly encountered by clinicians and may be due to conditions such as plantar fasciitis, calcaneal fracture, atrophy of heel fat pad, and nerve entrapment. US can help differentiate among the causes of heel pain, for example, by detecting extrinsic compression of the nerve tarsal tunnel by a ganglion cyst or neurogenic tumor. In patients with plantar fasciitis, US can show thickening of the plantar fascia and perifascial fluid collection [4]. If US findings are

Conclusion

In conclusion, US elastography may provide valuable information about the mechanical properties of the plantar fascia before morphologic changes during the early stages of plantar fasciitis. US elastography may improve diagnostic confidence during the early stages of plantar fasciitis.

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