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Anatomical features of plantar aponeurosis: cadaveric study using ultrasonography and magnetic resonance imaging

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Abstract

Objective

Abnormalities of the plantar aponeurosis are commonly encountered in patients with subcalcaneal heel pain. Understanding normal anatomy is required to accurately diagnose some disorders of the foot. The purpose of our study was to describe the normal anatomy of the plantar aponeurosis, using ultrasonography and MRI with close anatomic correlation in cadavers.

Materials and methods

After MRI and ultrasonography of 10 cadaveric foot specimens, the thickness of the central and lateral portions of the plantar aponeurosis displayed by imaging studies was measured by three radiologists. One specimen was sectioned in the transverse plane, one in the coronal plane, one in the sagittal plane, and two in a sagittal oblique plane. Normal anatomy was identified and similar measurements of the plantar aponeurosis were also made. An average value was determined and a statistical analysis was accomplished.

Results

The calcaneal insertions of the plantar aponeurosis were better visualized than its distal portions with both MRI and ultrasonography. The measurements of the plantar aponeurosis made by three different radiologists were different, but without statistical significance. The average measurements for the central and lateral portions of the plantar aponeurosis with both imaging methods were different from each other because of differences in the morphology of these structures. The values obtained with ultrasonography and MRI, were also different from each other for both the central and lateral portions of the plantar aponeurosis, but with no statistical significance.

Conclusions

We have described the detailed anatomy of the plantar aponeurosis with emphasis on the more distal structures that can be visualized with MRI. There was no statistically significant difference between the accuracy of ultrasonography and MRI regarding the measurements of the thickness of the central and lateral portions of the plantar aponeurosis. Knowledge of the normal anatomy of these structures enables the radiologist to identify early alterations, providing timely diagnosis and treatment.

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References

  1. Sarrafian S. Plantar aponeurosis. In: Sarrafian S, editor. Anatomy of the foot and ankle: descriptive, topographic, and functional. 2nd ed. Philadelphia: Lippincott; 1993. p. 137–149.

    Google Scholar 

  2. Warwick R, Williams P, editors. Gray’s anatomy of the human body. 35th British ed. Philadelphia: Saunders; 1973. p. 579–580.

    Google Scholar 

  3. Bojsen-Møller F, Flagstad K. Plantar aponeurosis and internal architecture of the ball of the foot. J Anat 1976; 121: 599–611.

    PubMed  Google Scholar 

  4. Resnick D. Abnormalities of the plantar soft tissues. In: Resnick D, editor. Diagnosis of bone and joint disorders. 3rd ed. Philadelphia: Saunders; 1995. p. 3204–3208.

    Google Scholar 

  5. Resnick D, Kang H, Pretterklieber M. Internal derangements of joints, vol 1. Amsterdam: Elsevier; 2007. p. 129–152.

    Google Scholar 

  6. Resnick D, Kang H, Pretterklieber M. Internal derangements of joints, vol 2. Amsterdam: Elsevier; 2007. p. 1218–1419.

    Google Scholar 

  7. Hicks J. The mechanics of the foot: the plantar aponeurosis and the arch. J Anat 1954; 88: 25–31.

    PubMed  CAS  Google Scholar 

  8. Berkowitz JF, Kier R, Rudicel S. Plantar fasciitis: MR imaging. Radiology 1991; 179: 665–667.

    PubMed  CAS  Google Scholar 

  9. Cardinal E, Chem R, Beauregard G, et al. Plantar fasciitis: sonographic evaluation. Radiology 1996; 201: 257–259.

    PubMed  CAS  Google Scholar 

  10. Theodorou DJ, Theodorou SJ, et al. Disorders of the plantar aponeurosis: a spectrum of MR imaging findings. AJR Am J Roentgenol 2001; 176: 97–104.

    PubMed  CAS  Google Scholar 

  11. Theodorou DJ, Theodorou SJ, Kakitsubata Y, et al. Plantar fasciitis and fascial rupture: MR imaging findings in 26 patients supplemented with anatomic data in cadavers. Radiographics 2000; 20: S181–S197.

    PubMed  Google Scholar 

  12. Gibbon W, Long G. Ultrasound of the plantar aponeurosis (fascia). Skeletal Radiol 1999; 28: 21–26.

    Article  PubMed  CAS  Google Scholar 

  13. Balint PV, Kane D, Wilson H, McInnes IB, Sturrock RD. Ultrasonography of entheseal insertions in the lower limb in spondyloarthropathy. Ann Rheum Dis 2002; 61: 905–910.

    Article  PubMed  CAS  Google Scholar 

  14. Griffith JF, Wong TY, et al. Sonography of plantar fibromatosis. AJR Am J Roentgenol 2002; 179: 1167–1172.

    PubMed  Google Scholar 

  15. Brushoj C, Henriksen BM, Albrecht-Beste E, Hölmich P, Larsen K, Nielsen MB. Reproducibility of ultrasound and magnetic resonance imaging measurements of tendon size. Acta Radiol 2006; 47 9: 954–959.

    Article  PubMed  CAS  Google Scholar 

  16. Muhle C, Frank LR, Rand T, et al. Collateral ligaments of the ankle: high-resolution MR imaging with a local gradient coil and anatomic correlation in cadavers. Radiographics 1999; 19: 673–683.

    PubMed  CAS  Google Scholar 

Download references

Acknowledgements

The authors would like to express their gratitude to Paul Clopton for the statistical support.

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Correspondence to Clarissa Canella Moraes do Carmo.

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Moraes do Carmo, C.C., Fonseca de Almeida Melão, L.I., Valle de Lemos Weber, M.F. et al. Anatomical features of plantar aponeurosis: cadaveric study using ultrasonography and magnetic resonance imaging. Skeletal Radiol 37, 929–935 (2008). https://doi.org/10.1007/s00256-008-0497-5

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  • DOI: https://doi.org/10.1007/s00256-008-0497-5

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