Objective: The aim of the study was to assess the role of ultrasonography in the diagnosis of plantar fasciitis in comparison to the diagnostic magnetic resonance imaging (MRI) in patients with chronic heel pain.

Methods: This study was conducted on 21 patients clinically diagnosed as plantar fasciitis from November 2013 till February 2015. Five age- and sex-matched asymptomatic volunteers served as a control group. Patients were examined by sagittal ultrasonography and conventional MRI (T1WI, T2WI and PDW-SPAIR sequences). MRI was considered the gold standard for diagnosis. And the sonographic appearances of the plantar fascia were compared with MRI findings. Plantar fascia thickness was also measured by both imaging modalities.

Results: The plantar fascia was thicker in symptomatic feet (2.50 – 9.30 mm; 6.00± 1.54) than in the control group (1.70 – 3.80 mm; 3.08± 0.91) as measured by ultrasound. Other sonographic signs used for the diagnosis of plantar fasciitis in the study were compared to MRI findings. The diagnostic accuracy was 85.71% for abnormal focal thickening and abnormal echogenicity within the plantar fascia, 76.19 % for soft tissue edema and the lowest diagnostic accuracy of ultrasound was in the detection of associated calcaneal spur (38.10%). Compared with MRI, ultrasonography showed 89.47 %% sensitivity and 50% specificity in assessing plantar fasciitis, with overall diagnostic performance of 85.71%.These findings were tabulated and discussed in relation to other literature.

Conclusion: Although MRI is the modality of choice in the diagnosis of plantar fasciitis, diagnostic accuracy of ultrasound is comparable to that of MRI and it could be the initial imaging modality to confirm clinically suspected plantar fasciitis. MRI may be reserved for equivocal cases, symptomatic cases with negative ultrasound results and when complex pathology is suspected.

Keywords: MRI, plantar fasciitis, ultrasound.

1. Singh D, Angel J, Bentley G, Trevino S. Fortnightly review: plantar fasciitis. Br Med J1997; 315:172-5.
2. Ragab EMS, Othman AMA. Platelets rich plasma for treatment of chronic plantar fasciitis. Arch Orthop Trauma Surg 2012; 132: 1065–70.
3. Tanz SS. Heel pain. ClinOrthop 1963; 28:169-78.
4. Karr SD. Subcalcaneal heel pain. OrthopClin North Am 1994; 25:161–73.
5. Gerster JC, Vischer TL, Bennani A, Fallet GL. The painful heel: comparative study in rheumatoid arthritis, ankylosing spondylitis, Reiter’s syndrome,and generalized osteoarthritis. Ann Rheum Dis 1977; 36:343–8.
6. Buckup K. Clinical tests for musculoskeletal system. New York: Thieme;
7. Barret SL, O’Malley R. Plantar fascitis and other causes of heel pain. AmFam Physician 1999; 59:2200–6.
8. McMillan AM, Landorf KB, Barrett JT, Menz HB, Bird AR. Diagnostic imaging for chronic plantar heel pain: a systematic review and meta-analysis. J Foot Ankle Res 2009;2:32.
9. Schepsis A, Leach RE, Gorzyca J. Plantar fasciitis: etiology, treatment, surgical results, and review of the literature. ClinOrthopRel Res 1991; 266:185–96.
10. Cheng JW, Tsai WC, Yu TY, Huang KY. Reproducibility of sonographic measurement of thickness and echogenicity of the plantar fascia. J Clin Ultrasound 2012; 40: 14–9.
11. Wu CH, Chang KV, Mio S, Chen WS, Wang TG. Sonoelastography of the plantar fascia. Radiology 2011; 259: 502–7.
12. Fabrikant JM, Park T. Plantar fasciitis (fasciosis) treatment outcome study: plantar fascia thickness measured by ultrasound and correlated with patient self-reported improvement. Foot 2011; 21: 79–83.
13. Berkowitz JF, Kier R, Rudicel S. Plantar fasciitis: MR imaging. Radiology 1991; 179:665–7.
14. Cardinal E, Chhem RK, Beauregard CG, Aubin B, Pellitier M. Plantar fasciitis: sonographic evaluation. Radiology 1996; 201: 257–9.
15. Akfirat M, Sen C, Gunes T. Ultrasonographic appearance of the plantar fasciitis. Clin Imaging 2003; 27(5):353-7.
16. Abdel Wahab N, Fathi S, Al Emadi S, Mahdi S. High resolution ultrasonographic diagnosis of plantar fasciitis: a correlation of ultrasound and magnetic resonance imaging. Int J Rheum Dis 2008;11(3):279-86.
17. Blankenbaker DG, De Smet AA. The role of ultrasound in the evaluation of sports injuries of the lower extremities. Clin Sports Med 2006; 25: 867–97.
18. Gibbon WW. Plantar fasciitis: US imaging (letter). Radiology 1992; 182:
19. Kier R. Magnetic resonance imaging of plantar fasciitis and other causes of heel pain. MagnReson Imaging Clin N Am 1994; 2: 97–107.
20. Narvaez JA, Narvaez J, Ortega R, Aguilera C, Sanchez A, Andia E. Painful heel: MR imaging findings. Radiographics 2000;20(2):333-52.
21. Theodorou DJ, Theodorou SJ, Resnick D. MR imaging of abnormalities of the plantar fascia. Semin Musculoskelet Radiol 2002; 6(2):105–18.
22. Roger B, Grenier P. MRI of plantar fasciitis. EurRadiol 1997; 7:1430–5.
23. Kane D,   Greaney   T,   Shanahan    M,    Duffy   G,   Bresnihan    B,    Gibney   R,    et al. The role of ultrasonography in the diagnosis and management of idiopathic  plantar fasciitis. Rheumatology 2001; 40(9):1002-8.
24. Gibbon WW, Long G. Ultrasound of the plantar aponeurosis (fascia). Skeletal Radiol 1999; 28(1):21-6.
25. Erdem CZ, Sarikaya S, Erdem LO, Ozdolap S, Gundogdu S. MR imaging features of foot involvement in ankylosing spondylitis. Eur J Radiol 2005; 53: 110–9.
26. Sabir N, Demirlenk S, Yagci B, Karabulut N, Cubukcu S. Clinical ultility of sonography in diagnosing plantar fasciitis. J Ultrasound Med 2005; 24: 1041–8.
27. Tsai W, Chiu MF, Wang C, Tang F, Wong M. Ultrasound evaluation of plantar fasciitis. Scand J Rheumatol 2000; 29: 255–9.
28. Ozdemir H, Yilmaz E, Murat A, Karakurt L, Poyraz AK, Ogur E. Sonographic evaluation of plantar fasciitis and relation to body mass index. Eur J Radiol 2005; 54(3):443-7.

Mai Darwish

Department of Radio-diagnosis, Faculty of Medicine, Alexandria University, Egypt