Plantar Fasciosis

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Plantar Fasciosis

Authors, Editors, Case Information Author: Marlee Franden, OMS-III Affiliation: Rowan-Virtua School of Osteopathic Medicine Co Author(s): Zachary Noll, OMS-III Altamash Raja, D.O. Editor: Nicholas Moore, MD Clinical Vignette: A 49-year-old female with known history of right foot plantar fasciitis presented with sharp, left heel pain after walking for an hour in boots one year prior. The pain was localized to the posterior ankle and proximal plantar aspect and is worsened with ambulation. Two previous corticosteroid injections at the plantar aspect provided no relief. Type of Probe Used: 15-4 MHz Linear Transducer Unlabeled Long Axis View of the Left Proximal Plantar Fascia Unlabeled Long Axis View of the Left Proximal Plantar Fascia Labeled Long Axis View of the Left Proximal Plantar Fascia Labeled Long Axis View of the Left Proximal Plantar Fascia demonstrating a thickened and hypoechoic central cord of the plantar fascia, measuring 6.9 mm at its largest portion. PF = plantar fascia FDB = flexor digitorum brevis Unlabeled Long Axis View of the Left Proximal Plantar Fascia with Doppler Unlabeled Long Axis View of the Left Proximal Plantar Fascia with Doppler Labeled Long Axis View of the Left Proximal Plantar Fascia with Doppler Labeled Long Axis View of the Left Proximal Plantar Fascia with Doppler demonstrating a thickened and hypoechoic plantar fascia without any hyperemia. PF = plantar fascia Unlabeled Short Axis View of the Left Proximal Plantar Fascia Unlabeled Short Axis View of the Left Proximal Plantar Fascia Labeled Short Axis View of the Left Proximal Plantar Fascia Labeled Short Axis View of the Left Proximal Plantar Fascia PF= plantar fascia Unlabeled Long Axis View of the Right (unaffected) Proximal Plantar Fascia Unlabeled Long Axis View of the Right (unaffected) Proximal Plantar Fascia Labeled Long Axis View of the Right (unaffected) Proximal Plantar Fascia Labeled Long Axis View of the Right (unaffected) Proximal Plantar Fascia demonstrating plantar fascia measured at 3.4 mm in thickness. PF = plantar fascia FDB = flexor digitorum brevis Interpretation Image Interpretation: The central cord of the plantar fascia was thickened and hypoechoic without any hyperemia. The largest portion of the thickened fascia measured 6.9 mm. Sonopalpation did reproduce pain at this location. The contralateral plantar fascia measured 3.4 mm suggesting plantar fasciosis in the symptomatic foot. Teaching Pearl: Plantar fasciosis on ultrasound is suggested by focal plantar fascia thickening, typically greater than approximately 4 mm, with hypoechogenicity and pain reproduced by sonopalpation. Hyperemia may be absent, particularly in chronic degenerative disease. Consider comparing to the contralateral side when deciding whether thickening is clinically meaningful. Also scan for partial rupture, perifascial edema, calcaneal stress injury, heel fat pad pathology, and nerve entrapment clues when symptoms are atypical. References: 1. Khammas ASA, Mahmud R, Hassan HA, Ibrahim I, Mohammed SS. An assessment of plantar fascia with ultrasound findings in patients with plantar fasciitis: a systematic review. J Ultrasound. 2023;26(1):13-38. doi:10.1007/s40477-022-00712-0 2. Draghi F, Gitto S, Bortolotto C, Draghi AG, Ori Belometti G. Imaging of plantar fascia disorders: findings on plain radiography, ultrasound and magnetic resonance imaging. Insights Imaging. 2017;8(1):69-78. doi:10.1007/s13244-016-0533-2 3. Drake C, Whittaker GA, Kaminski MR, et al. Medical imaging for plantar heel pain: a systematic review and meta-analysis. J Foot Ankle Res. 2022;15(1):4. doi:10.1186/s13047-021-00507-2
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Authors, Editors, Case Information

Unlabeled Long Axis View of the Left Proximal Plantar Fascia

Labeled Long Axis View of the Left Proximal Plantar Fascia

Unlabeled Long Axis View of the Left Proximal Plantar Fascia with Doppler

Labeled Long Axis View of the Left Proximal Plantar Fascia with Doppler

Unlabeled Short Axis View of the Left Proximal Plantar Fascia

Labeled Short Axis View of the Left Proximal Plantar Fascia

Unlabeled Long Axis View of the Right (unaffected) Proximal Plantar Fascia

Labeled Long Axis View of the Right (unaffected) Proximal Plantar Fascia

Interpretation

UPCOMING EVENTS

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