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Zhang L, Cai M, Gan Y, Xia Z, Xiong J, Sun X, Yang P, Tang H, Wang G. Anatomical features of plantar fasciitis in various age cohorts: Based on magnetic resonance imaging. J Orthop Surg (Hong Kong) 2023; 31:10225536231161181. [PMID: 36927205 DOI: 10.1177/10225536231161181] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Due to the lack of further studies on the influence of age factors on plantar fasciitis, this study evaluates the characteristic observation points of magnetic resonance imaging in various age cohorts of patients with plantar fasciitis to help diagnosis. METHODS A retrospective analysis of 160 cases of plantar fasciitis patients and normal subjects (who have the disease unrelated to plantar fasciitis) who have undergone an MRI examination in our institution. The two groups were separately divided into young adult subjects (36 to 44 years old), middle age adult subjects (45 to 59 years old), and older adult subjects (60 to 79 years old). Data was gathered regarding plantar fascia thickness, the coronal length of the plantar fascia at the calcaneal origin, the signal intensity of plantar fascia and surrounding structures, and the presence or absence of plantar calcaneal spurs, all of which were assessed objectively by the investigators. RESULTS There were statistical differences in the thickness of plantar fascia between two groups of three age cohorts (Older adult patients: 0.59 ± 0.09 cm; Middle age adult patients: 0.49 ± 0.09 cm; Young adult patients: 0.47 ± 0.05 cm) (all p < 0.001). In addition, there were also statistical differences in the high signal intensity changes of the plantar fascia and surrounding soft tissues between two groups of three age cohorts (all p < 0.001). In older adult plantar fasciitis patients, with regard to plantar calcaneal spur discovery, there was a statistical difference between the two groups (Chi-square = 12.799. df = 1. p < 0.001). CONCLUSION In plantar fasciitis cases where a diagnosis is difficult, abnormalities in the soft tissue surrounding the plantar fascia in patients of low age are noteworthy. In older adult patients, the discovery of plantar calcaneal spurs with abnormal thickening of plantar fascia deserves attention, and abnormal MRI findings are more manifest. But the final diagnosis should be based on the medical history. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- Lei Zhang
- Department of Orthopedics, 74647The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China.,Center for Orthopedic Diseases Research, 74647The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
| | - Mingyang Cai
- School of Traditional Chinese and Western Medicine, 74647Southwest Medical University, Luzhou, China
| | - Yiwen Gan
- School of Traditional Chinese and Western Medicine, 74647Southwest Medical University, Luzhou, China
| | - Zhangrong Xia
- School of Clinical Medicine, 74647Southwest Medical University, Luzhou, China
| | - Jixiang Xiong
- School of Clinical Medicine, 74647Southwest Medical University, Luzhou, China
| | - Xinghao Sun
- School of Clinical Medicine, 74647Southwest Medical University, Luzhou, China
| | - Peixin Yang
- School of Pediatrics, 74647Southwest Medical University, Luzhou, China
| | - Huining Tang
- School of Clinical Medicine, 74647Southwest Medical University, Luzhou, China
| | - Guoyou Wang
- Department of Orthopedics, 74647The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China.,Center for Orthopedic Diseases Research, 74647The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
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Chhabra A, Soldatos T, Chalian M, Faridian-Aragh N, Fritz J, Fayad LM, Carrino JA, Schon L. 3-Tesla magnetic resonance imaging evaluation of posterior tibial tendon dysfunction with relevance to clinical staging. J Foot Ankle Surg 2011; 50:320-8. [PMID: 21459628 DOI: 10.1053/j.jfas.2011.02.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Indexed: 02/03/2023]
Abstract
The posterior tibial tendon (PTT) is the most important dynamic stabilizer of the medial ankle and longitudinal arch of the foot. PTT dysfunction is a degenerative disorder of the tendon, which secondarily involves multiple ligaments, joint capsules, fascia, articulations, and bony structures of the ankle, hindfoot, midfoot, and forefoot. When the tendon progressively attenuates, the patient develops a painful, progressive collapsed flatfoot or pes planovalgus deformity. This comprehensive review illustrates the 3-Tesla magnetic resonance imaging (3T MRI) features of PTT dysfunction. In addition, the reader will gain knowledge of the expected pathologic findings on MRI, as they are related to clinical staging of PTT dysfunction.
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Affiliation(s)
- Avneesh Chhabra
- Department of Radiology and Radiological Science, The Johns Hopkins Hospital, Baltimore, MD 21287, USA.
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Abstract
BACKGROUND Magnetic Resonance Imaging (MRI) is generally only indicated in patients with plantar heel pain who have atypical symptoms or who do not improve with appropriate management. MATERIALS AND METHODS This study retrospectively reviewed the MRI findings of 112 patients with heel pain divided into two groups consisting of 50 patients with persistent pain despite appropriate treatment and 62 patients with atypical heel pain. RESULTS Of the 50 patients with persistent heel pain, 38 (76%) of MRIs confirmed the diagnosis of plantar fasciitis. Of the 62 patients who had presented with atypical symptoms or signs, 21 patients had presented with night pain and the remaining 41 had presented with acute pain, tenderness of the lateral or medial aspect of the heel, significant swelling, neurological features or pain posterior to the insertion of the plantar fascia. Patients with night pain were shown to have plantar fasciitis associated with calcaneal marrow edema in 15 (71.4%) cases (p < 0.05). One patient presenting with night pain was found to have a plantar arterio-venous malformation. Acute pain was associated with plantar fascia tears in 4 out of 9 (p < 0.05). CONCLUSION MRI may provide reassurance in cases of persistent heel pain but rarely changes the management. In cases of atypical heel pain, MRI may demonstrate other pathology such as plantar fascia tearing, calcaneal edema or arteriovenous malformation.
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Affiliation(s)
- Mukai Chimutengwende-Gordon
- Foot and Ankle Department, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore HA7 4LP, United Kingdom.
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Plantar fascia evaluation with a dedicated magnetic resonance scanner in weight-bearing position: our experience in patients with plantar fasciitis and in healthy volunteers. Radiol Med 2010; 115:246-60. [DOI: 10.1007/s11547-010-0534-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Accepted: 09/17/2009] [Indexed: 10/19/2022]
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Karabay N, Toros T, Hurel C. Ultrasonographic evaluation in plantar fasciitis. J Foot Ankle Surg 2007; 46:442-6. [PMID: 17980840 DOI: 10.1053/j.jfas.2007.08.006] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2006] [Indexed: 02/03/2023]
Abstract
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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Affiliation(s)
- Nuri Karabay
- Department of Radiology, Hand and Microsurgery & Orthopedics and Traumatology Hospital, Izmir, Turkey.
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Osborne HR, Breidahl WH, Allison GT. Critical differences in lateral X-rays with and without a diagnosis of plantar fasciitis. J Sci Med Sport 2006; 9:231-7. [PMID: 16697701 DOI: 10.1016/j.jsams.2006.03.028] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2006] [Indexed: 10/24/2022]
Abstract
Plantar fasciitis is a clinical diagnosis and is often combined with some form of imaging to validate the diagnosis. The clinical utility of lateral X-rays lies in the fact that they are relatively inexpensive and may contribute to ruling out other osseous causes of pain. In this study 106 (27 plantar fasciitis (PF) and 79 controls) plain non-weight bearing lateral X-rays were examined by a blind examiner to document the key features of the lateral X-ray between images of individuals with and without plantar fasciitis. As expected calcaneal spurs were observed in both groups (85% PF and 46% controls). However, plantar fascia thickness and fat pad abnormalities resulted in the best group differentiation (p<0.0001) with sensitivity of 85% and specificity of 95% for plantar fasciitis. It was concluded that the key radiological features that differentiate the groups were not spurs but rather changes in the soft tissues. If it is deemed necessary to confirm the diagnosis of typical plantar fasciitis with imaging, a lateral non-weight bearing X-ray should be the first choice investigation especially if these key features are noted.
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Affiliation(s)
- H R Osborne
- Centre for Musculoskeletal Studies, School of Surgery and Pathology, The University of Western Australia, and Royal Perth Hospital, WA, Australia
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Sabir N, Demirlenk S, Yagci B, Karabulut N, Cubukcu S. Clinical utility of sonography in diagnosing plantar fasciitis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2005; 24:1041-8. [PMID: 16040817 DOI: 10.7863/jum.2005.24.8.1041] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate the efficacy of sonography in the detection of plantar fasciitis (PF) compared with magnetic resonance imaging (MRI) findings in subjects with inferior heel pain. METHODS Seventy-seven patients with unilateral (n = 9) and bilateral (n = 68) heel pain were studied. Seventy-seven age- and sex-matched asymptomatic subjects served as a control group. Magnetic resonance imaging was used to establish a diagnosis of PF with sagittal T1-weighted, T2-weighted, and short tau inversion recovery sequences. The sonographic appearances of PF were compared with MRI findings. Plantar fascia and heel pad thickness were also measured on both imaging modalities. RESULTS Compared with MRI, sonography showed 80% sensitivity and 88.5% specificity in assessing PF. A strong correlation was found between plantar fascia and fat pad thickness measurements done by sonography (P < .001; r = 0.854) and MRI (P < .001; r = 0.798). Compared with the asymptomatic volunteers, patients with PF had significant increases in plantar fascia and heel pad thicknesses, weight, and body mass index (P = .0001). Heel pad thickness was also significantly increased with pain duration (P = .021). CONCLUSIONS Although MRI is the modality of choice in the morphologic assessment of different plantar fascia lesions, sonography can also serve as an effective tool and may substitute MRI in the diagnosis of PF.
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Affiliation(s)
- Nuran Sabir
- Department of Radiology, Faculty of Medicine, Pamukkale University, Denizli, Turkey.
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Abstract
Present evidence indicates that the main cause of plantar talalgia (PT) is a noninflammatory derangement at the proximal insertion of the plantar fascia. In athletes, predisposing ankle and rear-foot biomechanical abnormalities have been identified; in nonathletes, risk factors for the condition remain controversial. PT diagnosis is largely clinical, the key findings being pain and tenderness on the plantar aspect of the rear foot. Ultrasonography is a reliable confirmatory study in doubtful cases. Therapies in PT include nonsteroidal anti-inflammatory drugs, orthotic devices, night ankle dorsiflexion splints, physiotherapy, local glucocorticoid, and extracorporeal shockwave therapy. In recalcitrant cases, surgery may be offered. Of these therapies, only local glucocorticoid, as delivered by injection or iontophoresis, has shown short-term efficacy in controlled trials. The efficacy of ankle dorsiflexion splints and extracorporeal shockwave therapy is still controversial. Thus, important knowledge gaps remain on etiology, diagnosis, and treatment of PT.
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Affiliation(s)
- Jose Alvarez-Nemegyei
- Servicio de Reumatología, Hospital de Especialidades, Centro Médico Nacional Ignacio García Téllez, Instituto Mexicano del Seguro Social, Mérida, Yucatán, México.
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Narváez JA, Cerezal L, Narváez J. MRI of sports-related injuries of the foot and ankle: part 2. Curr Probl Diagn Radiol 2003; 32:177-93. [PMID: 12963866 DOI: 10.1016/s0363-0188(03)00044-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- José A Narváez
- Department of CT and MR imaging, I.D.I. Ciutat Sanitària i Universitària de Bellvitge, Barcelona, Spain
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Abstract
Heel pain is a common and frequently disabling clinical complaint that may be caused by a broad spectrum of osseous or soft-tissue disorders. These disorders are classified on the basis of anatomic origin and predominant location of heel pain to foster a better understanding of this complaint. The disorders include plantar fascial lesions (fasciitis, rupture, fibromatosis, xanthoma), tendinous lesions (tendinitis, tenosynovitis), osseous lesions (fractures, bone bruises, osteomyelitis, tumors), bursal lesions (retrocalcaneal bursitis, retroachilleal bursitis), tarsal tunnel syndrome, and heel plantar fat pad abnormalities. With its superior soft-tissue contrast resolution and multiplanar capability, magnetic resonance (MR) imaging can help determine the cause of heel pain and help assess the extent and severity of the disease in ambiguous or clinically equivocal cases. Careful analysis of MR imaging findings and correlation of these findings with patient history and findings at physical examination can suggest a specific diagnosis in most cases. The majority of patients with heel pain can be successfully treated conservatively, but in cases requiring surgery (eg, plantar fascia rupture in competitive athletes, deeply infiltrating plantar fibromatosis, masses causing tarsal tunnel syndrome), MR imaging is especially useful in planning surgical treatment by showing the exact location and extent of the lesion.
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Affiliation(s)
- J A Narváez
- Department of CT and MRI-Institut de Diagnòstic per la Imatge, Hospital Duran Reymals, Ciutat Sanitària y Universitària de Bellvitge, Barcelona, Spain.
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