Plantar Fasciitis

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Thickening of the plantar fascia in patients who had plantar fasciitis is an established sonographic criterion for the diagnosis of plantar fasciitis, and has been reported in several studies [70-73]. The plantar fascia is best scanned in the longitudinal axis. The normal fascia has a fibrillar echotexture and measures about 3 to 4 mm in thickness (Fig. 29). In plantar fasciitis, the mean thickness is 5.2 mm [73]. A hypoechoic fascia is also a frequent finding in plantar fasciitis, and is related to underlying reparative process after microtears, fiber degeneration, and edema (Fig. 30) [70-73]. Moderate or marked hyperemia visualized with power Doppler has been shown to be associated with acute plantar fasciitis [74]. Facial rupture, perifascial fluid collections, and calcifications can also be detected by sonography.

Hypoechoic Fluid Sonography
Fig. 25. Peroneus longus tendinopathy. Transverse sonographic image showing a thickened hypoechoic peroneus longus tendon (arrow).
Plantar Fasciitis Torn Ligament

Fig. 26. Peroneal tendon dislocation. (A) Initial image of the peroneal tendons show the normal tendon location. Arrows show a thickened retinaculum torn from the fibula. (B) Open arrows show the dislocating peroneus brevis with ankle dorsiflexion and eversion. PB, peroneus brevis; PL, peroneus longus. (Courtesy of Jon A. Jacobson, MD, University of Michigan Medical Center, Ann Arbor, MI.)

Fig. 26. Peroneal tendon dislocation. (A) Initial image of the peroneal tendons show the normal tendon location. Arrows show a thickened retinaculum torn from the fibula. (B) Open arrows show the dislocating peroneus brevis with ankle dorsiflexion and eversion. PB, peroneus brevis; PL, peroneus longus. (Courtesy of Jon A. Jacobson, MD, University of Michigan Medical Center, Ann Arbor, MI.)

MRI is also useful in diagnosing plantar fasciitis [75]. Although MRI has advantages such as a large field of view and multiplanar capability, sonography is more convenient, costs less, and allows assessment of the contralateral heel at the same time; however, MRI is useful to diagnose other causes of hindfoot pain such as ganglion cysts, tarsal tunnel syndrome, osteomyelitis, and stress fracture of the calcaneus [75].

A recent study by Sabir and colleagues [76] compared sonography to MRI in the detection of plantar fasciitis, and found that MRI was more accurate than ultrasound. Sonography was sensitive (91.3%) in diagnosing enthesopathy, but had a lower sensitivity of 55% in diagnosing musculoaponeurotic changes of the plantar fascia.

Tarsal Tunnel Syndrome Mri
Fig. 27. Complete tear of the peroneus brevis and partial tear of the peroneus longus tendons. Transverse image of the peroneal tendons show a thickened peroneal longus with a partial thickness tear (arrow). A complete tear of the peroneus brevis (open arrow) was also found.
Peroneal Tendon Tear Mri
Fig. 28. Ankle joint synovitis. Longitudinal sonographic image of the ankle joint may depict synovitis (arrow) as hypoechoic or debris within the ankle joint. Color Doppler may aid in diagnosis.

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