Real-time sonoelastography of the plantar fascia: comparison between patients with plantar fasciitis and healthy control subjects.

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.

[1]  C. Pasapula,et al.  Plantar fasciitis , 2012, Annals of the Royal College of Surgeons of England.

[2]  M. Reijnierse,et al.  Clinical indications for musculoskeletal ultrasound: A Delphi-based consensus paper of the European society of musculoskeletal radiology , 2012, European Radiology.

[3]  Marco Amedeo Cimmino,et al.  A few considerations on "sonoelastography of the plantar fascia". , 2011, Radiology.

[4]  O. Gilja,et al.  Real-Time Elastography: Strain Ratio Measurements Are Influenced by the Position of the Reference Area , 2011, Ultraschall in der Medizin - European Journal of Ultrasound.

[5]  Ke-Vin Chang,et al.  Sonoelastography of the plantar fascia. , 2011, Radiology.

[6]  Annamaria Iagnocco,et al.  Ultrasound Elastography Assessment of Skin Involvement in Systemic Sclerosis: Lights and Shadows , 2010, The Journal of Rheumatology.

[7]  C. Martinoli.  Musculoskeletal ultrasound: technical guidelines , 2010 .

[8]  E. Mcnally,et al.  Plantar Fascia: Imaging Diagnosis and Guided Treatment , 2010, Seminars in musculoskeletal radiology.

[9]  L. Sconfienza,et al.  Sonoelastography in the evaluation of painful Achilles tendon in amateur athletes. , 2010, Clinical and experimental rheumatology.

[10]  G. Feuchtner,et al.  Real-Time Sonoelastography: Findings in Patients with Symptomatic Achilles Tendons and Comparison to Healthy Volunteers , 2009, Ultraschall in der Medizin.

[11]  G. Garlaschi,et al.  Sonoelastography may help in the differential diagnosis between rheumatoid nodules and tophi. , 2010, Clinical and experimental rheumatology.

[12]  D. Wilson,et al.  Real-time ultrasound elastography of the normal Achilles tendon: reproducibility and pattern description. , 2009, Clinical radiology.

[13]  G. Feuchtner,et al.  Real-time sonoelastography findings in healthy Achilles tendons. , 2009, AJR. American journal of roentgenology.

[14]  Werner Jaschke,et al.  Real-time sonoelastography of lateral epicondylitis: comparison of findings between patients and healthy volunteers. , 2009, AJR. American journal of roentgenology.

[15]  Odd Helge Gilja,et al.  Freehand real-time elastography: impact of scanning parameters on image quality and in vitro intra- and interobserver validations. , 2008, Ultrasound in medicine & biology.

[16]  G. Garlaschi,et al.  Sonoelastography can help in the localization of soft tissue damage in polymyalgia rheumatica (PMR). , 2007, Clinical and experimental rheumatology.

[17]  Dafna Gladman,et al.  Classification criteria for psoriatic arthritis: development of new criteria from a large international study. , 2006, Arthritis and rheumatism.

[18]  S. Bartold.  The plantar fascia as a source of pain—biomechanics, presentation and treatment , 2004 .

[19]  C. Şen,et al.  Ultrasonographic appearance of the plantar fasciitis. , 2003, Clinical imaging.

[20]  G. Gold,et al.  Plantar fasciitis and fascial rupture: MR imaging findings in 26 patients supplemented with anatomic data in cadavers. , 2000, Radiographics : a review publication of the Radiological Society of North America, Inc.

[21]  Hicks Jh.  The mechanics of the foot: II. The plantar aponeurosis and the arch , 1954 .

[22]  J. H. Hicks,et al.  The mechanics of the foot. II. The plantar aponeurosis and the arch. , 1954, Journal of anatomy.