Critical differences in lateral X-rays with and without a diagnosis of plantar fasciitis.

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.

[1]  G. Allison,et al.  Treatment of plantar fasciitis by LowDye taping and iontophoresis: short term results of a double blinded, randomised, placebo controlled clinical trial of dexamethasone and acetic acid , 2006, British Journal of Sports Medicine.

[2]  P. C. Chigwanda A prospective study of Plantar fasciitis in Harare. , 1997, The Central African journal of medicine.

[3]  D. Mccarthy,et al.  The anatomical basis of inferior calcaneal lesions. A cryomicrotomy study. , 1979, Journal of the American Podiatry Association.

[4]  J. Read,et al.  Atlas of Imaging in Sports Medicine , 1999 .

[5]  J. Narváez,et al.  Painful heel: MR imaging findings. , 2000, Radiographics : a review publication of the Radiological Society of North America, Inc.

[6]  R. Panush,et al.  Common painful foot syndromes. , 1999, Bulletin on the rheumatic diseases.

[7]  R K Chhem,et al.  Plantar fasciitis: sonographic evaluation. , 1996, Radiology.

[8]  G. Long,et al.  Ultrasound of the plantar aponeurosis (fascia) , 1999, Skeletal Radiology.

[9]  R. Kier Magnetic resonance imaging of plantar fasciitis and other causes of heel pain. , 1994, Magnetic resonance imaging clinics of North America.

[10]  W. Kibler,et al.  Functional biomechanical deficits in running athletes with plantar fasciitis , 1991, The American journal of sports medicine.

[11]  B. Roger,et al.  MRI of plantar fasciitis , 1997, European Radiology.

[12]  B. Lehnert,et al.  Imaging of the rearfoot. , 1999, Journal of the American Podiatric Medical Association.

[13]  S J Barrett,et al.  Plantar fasciitis and other causes of heel pain. , 1999, American family physician.

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

[15]  H. Ozdemir,et al.  The role of bone scintigraphy in determining the etiology of heel pain. , 2002, Annals of nuclear medicine.

[16]  W G Hopkins,et al.  Measures of Reliability in Sports Medicine and Science , 2000, Sports medicine.

[17]  J. Berkowitz,et al.  Plantar fasciitis: MR imaging. , 1991, Radiology.

[18]  B. Bresnihan,et al.  The role of ultrasonography in the diagnosis and management of idiopathic plantar fasciitis. , 2001, Rheumatology.