Heel pad thickness and athletic activity in healthy young adults: A sonographic study

Abstract

The heel pad thickness and HPCI of individuals engaging in athletic activity up to an average of 11 hours/week were similar to those of sedentary individuals.

Sonographic Evaluation of the Plantar Heel in Asymptomatic Endurance Runners

“…2 The role of musculoskeletal sonography in the evaluation of plantar heel pain has been well established with respect to the plantar fascia. [3][4][5][6][7][8][9][10][11][12][13][14][15] More specifically, plantar fascia thickening (>4 mm), hypoecho genicity, heterogeneity, and neovascularization are considered reliable markers of symptomatic plantar fasciitis, whereas a normalappearing plantar fascia warrants consideration of alternative causes of heel pain. 1,3,4,9,[12][13][14] On the contrary, the role of sonography Mederic M. Hall, MD, Jonathan T. Finnoff, DO, Yusef A. Sayeed, MD, MPH, MEng, Jay Smith, MD Received December 31, 2014, …”

“…7,[15][16][17][18][19] Structurally, the heel pad is arranged into a superficial microchamber and a deep macrochamber, which are separated by a fibrous layer referred to as the internal cup of the heel. 20 Consequently, the sonographic appearance of the normal heel pad is best described as a pattern of uniform heterogeneity in which circular or ovoid hypoechoic fat pockets are separated by hyperechoic fibrous septa.…”

“…Regardless of etiology, the architectural changes within the heel pad may result in pain secondary to reduced or unequal shock absorption. 6,7,15,16 Although prior studies have attempted to characterize the sonographic properties of the plantar heel pad and their relationship with dysfunction and pain, there are no universally recognized sonographic criteria for defining a normal heel pad. Previous investigators have associated an "inflammatory-edematous" sonographic pattern with primary heel pad pain in rheumatologic populations, consisting of increased heterogeneity and marked hypoechogenicity within the subcalcaneal hypodermal tissue, loss of the characteristic lobular structure with interruption of the hyperechoic septa and occasional anechoic fluid-filled cavities, increased plantar heel pad thickness (defined as >21 mm), increased plantar heel pad compressibility (>40% reduction in heel pad thickness with manual compression), and flow on power Doppler sonography.…”

“…7 Multiple investigations have also reported sonographically derived values for uncompressed heel pad thickness (12-28 mm; average value, 18 mm) and heel pad compressibility (heel pad compressibility index = compressed heel pad thickness divided by the uncompressed heel pad thickness; normal range, 0.45-0.75). 15 During routine ankle-foot sonographic examinations of runners without a history of heel pain syndromes, we have encountered structural "abnormalities" in both the plantar fascia and plantar heel pad. We hypothesized that the cumulative impact of running may induce asymptomatic structural changes in the heel region.…”

“…[21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] Consequently, the primary purpose of this investigation was to determine the prevalence and spectrum of asymptomatic sonographically determined structural changes in the plantar fascia and plantar heel pad among experienced runners without a history of heel pain. On the basis of our preliminary observations, we hypothesized that more than 50% of asymptomatic runners would have at least 1 structural abnormality in 1 heel, as defined by the following: (1) presence of vascularization on power Doppler sonography, (2) nonuniform heterogeneous echo texture of the plantar heel pad, (3) abnormal plantar heel pad thickness (uncompressed heel pad thickness <12 or > 28 mm), 15,36 (4) abnormal plantar heel pad compressibility (heel pad compressibility index <0.45 or >0.75), 15 (5) abnormal plantar fascia thickness (>4 mm), 1 and (6) abnormal plantar fascia echo texture.…”