Shear Wave Elastography (SWE) for the Evaluation of Patients with Plantar Fasciitis.

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. LEVEL OF EVIDENCE II.

[1]  W. Clancy,et al.  Plantar fascia release for chronic plantar fasciitis in runners , 1983, The American journal of sports medicine.

[2]  R. Witte,et al.  Shear-Wave Elastography: Basic Physics and Musculoskeletal Applications. , 2017, Radiographics : a review publication of the Radiological Society of North America, Inc.

[3]  R. Crawford,et al.  Diagnosis and treatment of plantar fasciitis. , 2011, American family physician.

[4]  Daniel L. Riddle,et al.  Volume of Ambulatory Care Visits and Patterns of Care for Patients Diagnosed with Plantar Fasciitis: A National Study of Medical Doctors , 2004, Foot & ankle international.

[5]  A. Shakourirad,et al.  Application of ultrasound in the assessment of plantar fascia in patients with plantar fasciitis: a systematic review. , 2014, Ultrasound in medicine & biology.

[6]  K. Chino,et al.  Effect of toe dorsiflexion on the regional distribution of plantar fascia shear wave velocity , 2019, Clinical biomechanics.

[7]  Jin Su Kim,et al.  Sonoelastography in the Evaluation of Plantar Fasciitis Treatment: 3-Month Follow-Up After Collagen Injection , 2016, Ultrasound quarterly.

[8]  Mostafa Fatemi,et al.  An experimental phantom study on the effect of calcifications on ultrasound shear wave elastography , 2015, 2015 37th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC).

[9]  Xiang Fei,et al.  [Assessment of plantar fasciitis using shear wave elastography]. , 2014, Nan fang yi ke da xue xue bao = Journal of Southern Medical University.

[10]  F. Impellizzeri,et al.  Cross-Cultural Adaptation and Validation of the Foot Function Index for Use in German-Speaking Patients with Foot Complaints , 2008, Foot & ankle international.

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

[12]  Jean-Luc Gennisson,et al.  Artifacts and Technical Restrictions in 2D Shear Wave Elastography , 2018, Ultraschall in der Medizin - European Journal of Ultrasound.

[13]  W. Jeong,et al.  Current status of musculoskeletal application of shear wave elastography , 2017, Ultrasonography.

[14]  Hee Jin Park,et al.  Ultrasound elastography in the early diagnosis of plantar fasciitis. , 2014, Clinical imaging.

[15]  José Ríos-Díaz,et al.  Sonoelastography of Plantar Fascia: Reproducibility and Pattern Description in Healthy Subjects and Symptomatic Subjects. , 2015, Ultrasound in medicine & biology.

[16]  Mohamad Adam Bujang,et al.  Requirements for Minimum Sample Size for Sensitivity and Specificity Analysis. , 2016, Journal of clinical and diagnostic research : JCDR.

[17]  C. Kuhl,et al.  Shear Wave Elastography (SWE) of Asymptomatic Achilles Tendons: A Comparison Between Semiprofessional Athletes and the Nonathletic General Population. , 2019, Academic radiology.

[18]  A. Massè,et al.  Real-time sonoelastography: principles and clinical applications in tendon disorders. A systematic review. , 2017, Muscles, ligaments and tendons journal.

[19]  M. Baums,et al.  Analysis of agreement between the German translation of the American Foot and Ankle Society’s Ankle and Hindfoot Scale (AOFAS-AHS) and the Foot Function Index in its validated German translation by Naal et al. (FFI-D) , 2014, Archives of Orthopaedic and Trauma Surgery.

[20]  U. Fredberg,et al.  Long-Term Prognosis of Plantar Fasciitis: A 5- to 15-Year Follow-up Study of 174 Patients With Ultrasound Examination , 2018, Orthopaedic journal of sports medicine.

[21]  Edgar Erdfelder,et al.  G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences , 2007, Behavior research methods.

[22]  Andrew McMillan,et al.  Diagnostic imaging for chronic plantar heel pain: a systematic review and meta-analysis , 2009, Journal of foot and ankle research.

[23]  Chiara Martini,et al.  Real-time sonoelastography of the plantar fascia: comparison between patients with plantar fasciitis and healthy control subjects. , 2013, Radiology.

[24]  Wen-Shiang Chen,et al.  Plantar fascia softening in plantar fasciitis with normal B-mode sonography , 2015, Skeletal Radiology.