Imaging of plantar fascia disorders: findings on plain radiography, ultrasound and magnetic resonance imaging

Abstract

Plantar fascia (PF) disorders commonly cause heel pain and disability in the general population. Imaging is often required to confirm diagnosis. This review article aims to provide simple and systematic guidelines for imaging assessment of PF disease, focussing on key findings detectable on plain radiography, ultrasound and magnetic resonance imaging (MRI). Sonographic characteristics of plantar fasciitis include PF thickening, loss of fibrillar structure, perifascial collections, calcifications and hyperaemia on Doppler imaging. Thickening and signal changes in the PF as well as oedema of adjacent soft tissues and bone marrow can be assessed on MRI. Radiographic findings of plantar fasciitis include PF thickening, cortical irregularities and abnormalities in the fat pad located deep below the PF. Plantar fibromatosis appears as well-demarcated, nodular thickenings that are iso-hypoechoic on ultrasound and show low-signal intensity on MRI. PF tears present with partial or complete fibre interruption on both ultrasound and MRI. Imaging description of further PF disorders, including xanthoma, diabetic fascial disease, foreign-body reactions and plantar infections, is detailed in the main text. Ultrasound and MRI should be considered as first- and second-line modalities for assessment of PF disorders, respectively. Indirect findings of PF disease can be ruled out on plain radiography. Teaching Points • PF disorders commonly cause heel pain and disability in the general population.• Imaging is often required to confirm diagnosis or reveal concomitant injuries.• Ultrasound and MRI respectively represent the first- and second-line modalities for diagnosis.• Indirect findings of PF disease can be ruled out on plain radiography.

Spontaneous distal rupture of the plantar fascia

“…Tears of the plantar fascia are rare injuries. They can be partial or complete . Spontaneous tears typically occur at the calcaneal insertion of the plantar fascia and represent a complication of plantar fasciitis and local treatment with steroid injections .…”

“…The history of sudden pain in the sole during activity in conjunction with clinical findings of a tender lump and subcutaneous bleeding should suggest this diagnosis. Imaging is valuable in confirming and determining the severity of the injury . According to Jeswani et al, ultrasound imaging is superior to MRI in differentiating true fiber interruption and tearing from edema.…”

“…Spontaneous tears of the plantar fascia are typically proximal and represent a complication of plantar fasciitis and local treatment with steroid injections. 1 In contrast, distal ruptures of the plantar fascia commonly result from traumatic injuries. Here, we describe an unusual case of spontaneous distal rupture of the plantar fascia.…”

New Approach for B-Mode Ultrasound (US) Evaluation of the Plantar Aponeurosis (PA) Thickness in Healthy Subjects

“…It arises from the lateral portion of the medial calcaneal tubercle and covers the abductor digiti minimi muscle in its course, where it extends distally to insert into the capsule of the fifth metatarsal joint. The medial portion is thinner than the two other portions and arises from the mid-portion of the central tendon and inserts into the first metatarsal joint capsule covering the plantar surface of the abductor hallicus muscle in its way [2,3].…”

Plantar Fibromatosis: An Unusual Cause of Plantar Pain

“…The sonographic presentation of plantar fibroma is typically a fusiform hypoechoic lesion located superficially in the plantar aponeurosis [3]. The common MRI appearance is a nodule of low signal intensity on both T1-and T2-weighted sequences due to its fibrous nature and may show high signal on fluid-sensitive sequences.…”