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American Journal of Physical Medicine & Rehabilitation:
doi: 10.1097/PHM.0b013e31822de9ab
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Can Sonoelastography Detect Plantar Fasciitis Earlier than Traditional B-Mode Ultrasonography?

Wu, Chueh-Hung MD; Chen, Wen-Shiang MD, PhD; Wang, Tyng-Guey MD; Lew, Henry L. MD, PhD

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From the Department of Physical Medicine & Rehabilitation, National Taiwan University Hospital Yun-Lin Branch, Yunlin, Taiwan, ROC (C-HW); Department of Physical Medicine & Rehabilitation, National Taiwan University Hospital Taipei, Taiwan, ROC (C-HW, W-SC, T-GW); College of Medicine, National Taiwan University, Taipei, Taiwan, ROC (W-SC, T-GW); Department of Physical Medicine and Rehabilitation, School of Medicine, Virginia Commonwealth University, Richmond, Virginia (HLL); and Defense and Veterans Brain Injury Center, Washington, DC (HLL).

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

All correspondence and requests for reprints should be addressed to: Tyng-Guey Wang, MD, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, 7 Chan-Shan South Road, 100, Taipei, Taiwan, ROC.

A 30-yr-old woman presented with a history of recurrent right heel pain for 8 mos. The pain was localized to the bottom of her foot, occurring in the mornings when taking her first few steps but gradually subsiding after normal ambulation. Physical examination revealed flattened arches in both feet without swelling or erythema. Palpation revealed tenderness at the insertion of the plantar fascia on the right medial tubercle of the calcaneus. Although the history was highly suggestive of plantar fasciitis, B-mode ultrasound demonstrated that her plantar fascia had normal echotexture and thickness (2.8 mm), unlike the traditional ultrasound findings in plantar fasciitis.1 There was no plantar fibroma. Under the impression that her plantar fascia was intact, no specific treatment was given. She was advised to avoid lengthy walks and to return to the clinic in 4 wks.

Even without excessive ambulation, the patient’s symptoms worsened in time, adversely influencing her quality-of-life. When she returned to our clinic, the physical examination was unchanged. Sonoelastography was therefore used to further evaluate her plantar fascia, revealing scattered yellow and green areas within the right symptomatic plantar fascia and red areas within the contralateral asymptomatic one (Fig. 1A, B). The results indicated that the right plantar fascia was softer and possibly weaker in supportive function than the left side. One month after prescribing a customized plastic insole that augmented her right foot arch, her symptoms subsided.

Figure 1
Figure 1
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Plantar fasciitis is the most common cause of heel pain.2 B-mode ultrasound of plantar fasciitis usually demonstrates thickening (thickness >4 mm at its insertion on the calcaneus) and reduced echogenicity of the plantar fascia.1 However, a previous study suggested that morphologic changes may not always be observed.3 In a recent study, the use of sonoelastography demonstrated plantar fascia softening in subjects presenting with characteristic symptoms of plantar fasciitis.4 A new ultrasound-based technique, sonoelastography, allows noninvasive estimation of tissue stiffness based on the fact that softer tissues have greater displacement than firmer tissues when externally compressed. In our case report of a patient with apparent plantar fasciitis, sonoelastography revealed a softening of the plantar fascia on the affected side, whereas conventional ultrasound reported normal plantar fascia echogenicity and thickness.

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REFERENCES

1. McMillan AM, Landorf KB, Barrett JT, et al.: Diagnostic imaging for chronic plantar heel pain: A systematic review and meta-analysis. J Foot Ankle Res 2009; 2: 32

2. Rompe JD: Plantar fasciopathy. Sports Med Arthrosc 2009; 17: 100–4

3. Cardinal E, Chhem RK, Beauregard CG, et al.: Plantar fasciitis: Sonographic evaluation. Radiology 1996; 201: 257–9

4. Wu CH, Chang KV, Mio S, et al.: Sonoelastography of the plantar fascia. Radiology 2011; 259: 502–7

© 2012 Lippincott Williams & Wilkins, Inc.

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