About dynamic ultrasound study of chronic plantar fascitis.
In a previous post I wrote about the examination of the plantar aponeurosis;
repetitive traumas produce microtears of some fibers of the plantar aponeurosis, not only close to the site of its attachment but also distally, due to the own foot biomechanics of the patients.
Today I show you the case of a chronic partial rupture of plantar aponeurosis in 20-year-old male soccer player.
Ge Stir (left) and Coronal T2w (right) Mri sequences (0.3 Tesla).
Axial T2w (left) and Coronal Fast Stir (right) Mri scans of the same patient (0.3 Tesla).
As usually I also perform the dynamic ultrasound exam, togheter with elastosonosgraphy evaluation.
The elastosonography examination better depicts the presence of a granulation tissue (green colour) as happened after a partial tear inside the fibrous scar of a chronic plantar fascitis.
Dr. Robert Donatelli author of “The Biomechanics of the Foot and Ankle” described the following phases of gait during stance: heel contact, weight acceptance, midstance, push-off and propulsion, and toe-off. The plantar fascia prevents foot collapse thanks to its anatomical orientation and tensile strength; it is subdivided into central, medial, and lateral components as it gradually widens and courses distally. The central, or major, component of the plantar aponeurosis is the largest, thickest, and strongest. It is triangular and divides into five bands at the midmetatarsal level. Plantar fascia pain results from excessive traction forces applied to the calcaneus. Every time that you’ll perform a plantar aponeurosis ultrasound examination, don’t forget to think at the foot biomechanics and releate dysfunction to plantar fascia abnormalities. Overpronation or underpronation foot abnormalities? Wath’s best for plantar aponeurosis study? Mri or ultrasound exam? I usually perform both. Take a look at the images below and see why.
Sagittal dynamic ultrasound scan of a runner with degenerative rupture of the plantar aponeurosis mayor component; it is evident the irregularity of cortical bone insertion.
Axial T2w and Sagittal T1w Mri scans (0.3 Tesla) of the same patient.
Sagittal Ge Stir Mri (0.3 Tesla) and Ultrasound scan. The Mri image is essential in case of suspected stress reaction injuries to the calcaneal insertion.