Sonographic Evaluation of Plantar Fasciitis and its Relation to Body Mass Index and Heel Pad Thickness

Abstract

Introduction: To study the sonographic appearance of plantar fascia in clinically suspected cases of plantar fasciitis (PFs) using both quantitative and qualitative parameters, and to establish the correlation between plantar fasciitis, body mass index (BMI) and heel pad thickness (HPT).
 Methods: In this case controlled analytical study, we sonographically evaluated 100 patients with clinical plantar fasciitis (unilateral: 90, bilateral: 10 with mean age 46.9yrs) and control group of 60 (120 heels) healthy volunteers with mean age 45.3yrs. Plantar Fascia Thickness (PFT), HPT, hypoechogenity, biconvexity, perifascial fluid, intrafascial calcification and subcalcaneal spurs were evaluated sonographically. PFT was measured 5mm distal to the calcaneal insertion of plantar aponeurosis. The unloaded HPT was measured from the skin surface to the nearest calcaneal tuberosity.
 Results: Mean Plantar Fascia Thickness (PFT) and Heel Pad Thickness (HPT) are greater on the symptomatic side for patients with unilateral and bilateral PFs than on the asymptomatic side for patients with unilateral PFs, and also control subjects (PFT values are 4.41 ± 0.59, 4.63 ± 0.55, 2.83 ± 0.36, 2.62± 0.37 mm, and HPT values 17.64 ± 1.07, 17.28 ± 1.10, 16.91 ± 1.06, 16.73 ± 1.13 mm, respectively) (p <0.0001). Mean BMI values of the case and control groups are 26.14 ± 1.9 and 24.42 ± 0.89 Kg/m2, respectively (p <0.05). We found hypoechogenicity of plantar fascia in 80 cases (72.7%), calcaneal spur in 69 cases (62.7%), biconvexity in 11 cases (10%) and perifascial fluid in 16 cases (14.5%) within the plantar fasciitis group (110 symptomatic heels).
 Conclusion: Increased plantar fascia thickness, increased heel pad thickness and hypoechogenicity of plantar fascia are consistent sonographic findings in plantar fasciitis. Its occurrence has significant relation to high BMI.

Ultrasonographic Assessment of Indian Patients With Plantar Fasciitis and Its Clinical Correlation: A Prospective Observational Study

“…Both were found statistically significant (p<0.001). The mean plantar fascia thickness in the affected leg was 5.07 ± 0.9 mm and the finding is consistent with that of Khatiwada et al (4.63 ± 0.55mm) [ 3 ]. The study by Karabay et al also found similar results, where the mean plantar fascia thickness in the affected leg was 4.79 mm but no significant difference was found between heel pads of the diseased and healthy feet [ 4 ].…”

“…In this study too, we found females were affected more than males. The mean age of occurrence of plantar fasciitis was found around 40 years which is similar to the study by Khatiwada et al where the mean age was 40 to 50 years and females were affected more [3]. The majority (73.3%) of the study participants had a sedentary lifestyle in our study.…”

“…The USG is usually preferred because of its certain advantages over MRI such as non-invasiveness, relatively inexpensive modality with excellent spatial resolution, and being well tolerated by patients. Realtime high-resolution USG has been proven to be a valuable technique [3]. Thickened plantar fascia and tissue abnormalities, hypoechoic changes, peri fascial fluid collections, and bony spur have been reported in USG [3][4][5].…”

“…Realtime high-resolution USG has been proven to be a valuable technique [3]. Thickened plantar fascia and tissue abnormalities, hypoechoic changes, peri fascial fluid collections, and bony spur have been reported in USG [3][4][5].…”

“…The plantar fascia is a multilayered thickened fibrous sheet of connective tissue originating on the plantar surface of the posteromedial calcaneal tuberosity. It provides support to the longitudinal arch of the foot and acts as a dynamic shock absorber during foot strikes [ 3 ]. Plantar fasciitis is the non-inflammatory, degenerative process of the plantar fascia.…”