Ultrasonographic appearance of the plantar fasciitis
Introduction
Plantar aponeurosis is the longest ligament on plantar side of the foot, which gives normal shape of plantar arch of foot. Plantar fasciitis (PF) is recognized as inflammation of plantar fascia and periplantar structures; it may be idiopathic or with seronegative spondyloarthropathies, rheumatoid arthritis or after trauma [1]. It is the most frequent reason of inferior heel pain and its incidence is high in obese people and sportsman especially in athletes [2], [3], [4].
Typically, the patient has heel pain during the first few steps after rest or on rising in the morning, which gradually decreases with ordinary walking but worsens with increased activity [5]. A pathognomonic feature is the tenderness at the insertion site of the plantar fascia on the medial tubercle of the calcaneus [6], [7]. The symptoms increase with intensity of sportive activities [5].
Plain radiographs may reveal subcalcaneal spurs in PF, but they may also be encountered in asymptomatic heels [3], [4], [8].
A pattern of abnormal calcaneal uptake along the plantar surface can be seen as nonspecific finding [9], [10].
Ultrasonography (US) and magnetic resonance imaging (MRI) have been useful in diagnosis of PF; however, MRI is expensive and not always available [3], [4], [11].
In our study, inflammation of plantar fascia was evaluated using high frequency linear array transducer accompanied by some diagnostic criteria.
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Materials and methods
We presented the patients with idiopathic PF. Patients were divided into two groups. Group I consisted of 25 patients (21 unilateral and 4 bilateral; 23 women and 2 men) who had painful heel. Group II consisted of 15 patients (11 women and 4 men) who presented with no symptoms as control group. Two-tailed student's t-test was used for statistical analysis of age, weight and body mass index (BMI). Moreover, Mann–Whitney U-test was used for subcalcaneal spur.
On clinical examination, there was
Results
Demographic features of all cases are demonstrated in Table 1. There were no significant differences in terms of age, weight and BMI between two groups (P>.05). There were 21 patients with unilateral signs (16 right side, 5 left side) and 4 patients with bilateral signs of the PF for symptomatic group. The signs of PF included thickness of plantar fascia, echogenity, biconvexity, collection of fluid around fascia, intrafascial calcification and subcalcaneal spur (Table 2). Asymptomatic heels in
Discussion
There are many causes of chronic heel pain, which results from bony abnormalities, such as calcaneal stress fractures, calcaneal avulsion fractures and calcaneal spurs, to conditions which are primarily soft tissue injuries, namely PF, Aschill tendonitis or plantar fascia rupture.
The plantar fascia is not strictly a fascial layer; in fact, it is the common tendon aponeurosis for the superficial layer of intrinsic plantar foot muscles [1]. It arises from posterior to the medial and lateral
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