Medical imaging for plantar heel pain: a systematic review and meta‐analysis

Abstract

Background Medical imaging can be used to assist with the diagnosis of plantar heel pain. The aim of this study was to synthesise medical imaging features associated with plantar heel pain. Methods This systematic review and meta-analysis conducted searches in MEDLINE, CINAHL, SPORTDiscus, Embase and the Cochrane Library from inception to 12th February 2021. Peer-reviewed articles of cross-sectional observational studies written in English that compared medical imaging findings in adult participants with plantar heel pain to control participants without plantar heel pain were included. Study quality and risk of bias was assessed using the National Institutes of Health quality assessment tool for observational cohort and cross-sectional studies. Sensitivity analyses were conducted where appropriate to account for studies that used unblinded assessors. Results Forty-two studies (2928 participants) were identified and included in analyses. Only 21% of studies were rated ‘good’ on quality assessment. Imaging features associated with plantar heel pain included a thickened plantar fascia (on ultrasound and MRI), abnormalities of the plantar fascia (on ultrasound and MRI), abnormalities of adjacent tissue such as a thickened loaded plantar heel fat pad (on ultrasound), and a plantar calcaneal spur (on x-ray). In addition, there is some evidence from more than one study that there is increased hyperaemia within the fascia (on power Doppler ultrasound) and abnormalities of bone in the calcaneus (increased uptake on technetium-99 m bone scan and bone marrow oedema on MRI). Conclusions People with plantar heel pain are more likely to have a thickened plantar fascia, abnormal plantar fascia tissue, a thicker loaded plantar heel fat pad, and a plantar calcaneal spur. In addition, there is some evidence of hyperaemia within the plantar fascia and abnormalities of the calcaneus. Whilst these medical imaging features may aid with diagnosis, additional high-quality studies investigating medical imaging findings for some of these imaging features would be worthwhile to improve the precision of these findings and determine their clinical relevance.

Common Painful Foot and Ankle Conditions

“…However, only 2% of imaged heels (4 of 215 heels) in patients with atraumatic plantar heel pain have radiographic findings that affect initial treatments . A meta-analysis of 21 observational studies on medical imaging (1199 participants) demonstrated an association between ultrasonography-measured thickness of the plantar fascia in plantar fasciitis compared with controls (mean difference [MD], 2.00 mm [95% CI, 1.62-2.39]; P < .001) . MRI shows a T2-weighted hyperintensity in the origin of the plantar fascia at the calcaneal tuberosity as well as thickening of the plantar fascia, but should only be used when the clinical diagnosis is unclear.…”

Supination resistance variations in foot and ankle musculoskeletal disorders: implications for diagnosis and customised interventions with wedged insoles

“…Moreover, the supination resistance in PF was not significantly different from the healthy counterparts. Plantar fasciopathy is characterised by microtears in a thickened plantar fascia [48], but unlike PTTD and CAI, PF does not usually lead to ligamentous or muscles injuries [48,49]. It appears that one important factor that could influence supination resistance is foot and ankle mobility/ rigidity and that the specific structures affected in PF do not have a direct impact on supination resistance.…”

Fluoroscopic and Endoscopic Calcaneal Spur Resection Without Plantar Fascial Release for Recalcitrant Plantar Fasciitis

“… 31 The diagnosis of plantar fasciitis was based on tenderness at the medial insertion of the plantar fascia to the calcaneus and the thickness of >4.0 mm on magnetic resonance imaging (MRI). 10 , 17 After failing to respond to >6 months of conservative treatment, the patients with plantar fasciitis underwent endoscopic CSR with or without PFR. Patients with a calcaneal spur ≥2 mm underwent endoscopic CSR alone, and those with a calcaneal spur <2 mm underwent endoscopic PFR combined with CSR.…”