Ultrasonography with or without Contrast as a Prognostic and Objective Parameter in Plantar Fasciitis

Purpose or Learning Objective: Plantar fasciitis (PF) is a common disorder without objective parameters to describe disease severity. This study investigated whether structural changes in the plantar fascia and heel fat pad, determined by ultrasonography (US) scanning with or without contrast, can be used as prognostic markers for outcome in patients with symptomatic PF. It also explored whether there is an association between changes in US findings and improvement in pain and function.

Methods or Background: All 90 patients in a randomized controlled trial treated with training and/or a glucocorticosteroid (GCS) injection were assessed for morning pain, function pain, Foot Function Index (FFI), and US-measured thickness of the fascia and heel fat pad at entry and after 3 and 6 months. Thirty patients were included in a longitudinal study with assessment of pain, function, and measurement of microvascular volume (MV) by contrast-enhanced US before treatment and after 5 months.

Results or Findings: None of the US parameters at the initial examination were a prognostic marker for clinical outcome at 5 to 6 months. Changes in US-measured thickness of the fascia but not the fat pad correlated with improvement in all outcome measures at 3 months (FFI: r = 0.34, p = 0.001; morning pain: r = 0.30, p = 0.004; pain during function: r = 0.28, p = 0.007) and at 6 months (FFI: r = 0.30, p = 0.005; morning pain: r = 0.21, p = 0.046; function pain: r = 0.28, p = 0.007). Patients with < 4 mm thickness have almost no symptoms. Changes in MV did not correlate with improvement in symptoms, except for patients treated with GCS.

Conclusion: Changes in US-measured fascia thickness can be used as a measure for improvement in PF patients. Fascia thickness > 4 mm is a valid threshold for painful PF.

Publication History

Article published online:
02 June 2022