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Ultrasound scanning for recalcitrant plantar fasciopathy. Basis of a new classification

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Abstract

Objective

The treatment of recalcitrant plantar fasciopathy is often empirical. Imaging is usually in the form of radiographs, if undertaken at all. The aim of this study is to characterise the disease pattern in recalcitrant cases of plantar fasciopathy. This allows classification of the pathology, which in turn allows meaningful evaluation of current and future treatments.

Materials and methods

One hundred and twenty-five consecutive feet with symptoms of ‘plantar fasciitis’ lasting longer than 6 months (all of which had failed to improve with a stepwise conservative management protocol) had confirmed plantar fasciopathy on ultrasound scanning. The disease characteristics were evaluated based on the scan findings.

Results

Of the patients evaluated, 66 % had typical insertional disease. The remaining 34 % had atypical distal fascia disease; 22 % had mixed insertional and distal disease, and 12 % had pure distal disease. Patients with pure distal disease were found to have either distal thickening or discrete fibromata.

Conclusion

In this cohort of recalcitrant cases, ultrasound scans detected a high proportion of atypical non-insertional plantar fascia disease. This would not be detected without imaging studies, and therefore we recommend the use of ultrasound scanning in cases of recalcitrant plantar heel pain that have failed proper first-line management, in order to confirm the clinical diagnosis and to classify the disease as either insertional or non-insertional plantar fasciopathy (or mixed disease). Only in this way can treatments for this group of patients be systematically evaluated against different disease patterns to determine their effectiveness.

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References

  1. Karabay N, Toros T, Hurel C. Ultrasonographic evaluation in plantar fasciitis. J Foot Ankle Surg. 2007;46(6):442–6.

    Article  PubMed  Google Scholar 

  2. Aquino A, Payne C. Function of the plantar fascia. Foot. 1999;9(2):73–8.

    Article  Google Scholar 

  3. Lemont H, Ammirati KM, Usen N. Plantar fasciitis: a degenerative process (fasciosis) without inflammation. J Am Podiatr Med Assoc. 2003;93(3):234–7.

    PubMed  Google Scholar 

  4. Jarde O, Diebold P, Havet E, Boulu G, Vernois J. Degenerative lesions of the plantar fascia: surgical treatment by fasciectomy and excision of the heel spur. A report on 38 cases. Acta Orthop Belg. 2003;69(3):267–74.

    PubMed  Google Scholar 

  5. Puddu G, Ippolito E, Postacchini F. A classification of Achilles tendon disease. Am J Sports Med. 1976;4(4):145–50.

    Article  PubMed  CAS  Google Scholar 

  6. Maffulli N, Khan KM, Puddu G. Overuse tendon conditions: time to change a confusing terminology. Arthroscopy. 1998;14(8):840–3.

    Article  PubMed  CAS  Google Scholar 

  7. Riddle DL, Schappert SM. Volume of ambulatory care visits and patterns of care for patients diagnosed with plantar fasciitis: a national study of medical doctors. Foot Ankle Int. 2004;25(5):303–10.

    PubMed  Google Scholar 

  8. Riddle DL, Pulisic M, Pidcoe P, Johnson RE. Risk factors for plantar fasciitis: a matched case-control study. J Bone Joint Surg Am. 2003;85-A(5):872–7.

    PubMed  Google Scholar 

  9. Riddle DL, Pulisic M, Sparrow K. Impact of demographic and impairment-related variables on disability associated with plantar fasciitis. Foot Ankle Int. 2004;25(5):311–7.

    PubMed  Google Scholar 

  10. Rano JA, Fallat LM, Savoy-Moore RT. Correlation of heel pain with body mass index and other characteristics of heel pain. J Foot Ankle Surg. 2001;40(6):351–6.

    Article  PubMed  CAS  Google Scholar 

  11. Prichasuk S, Subhadrabandhu T. The relationship of pes planus and calcaneal spur to plantar heel pain. Clin Orthop Relat Res. 1994;306:192–6.

    PubMed  Google Scholar 

  12. Wolgin M, Cook C, Graham C, Mauldin D. Conservative treatment of plantar heel pain: long-term follow-up. Foot Ankle Int. 1994;15(3):97–102.

    PubMed  CAS  Google Scholar 

  13. Crawford F, Thomson C. Interventions for treating plantar heel pain. Cochrane Database Syst Rev. 2003;3:CD000416.

    PubMed  Google Scholar 

  14. Davis PF, Severud E, Baxter DE. Painful heel syndrome: results of nonoperative treatment. Foot Ankle Int. 1994;15(10):531–5.

    PubMed  CAS  Google Scholar 

  15. Martin RL, Irrgang JJ, Conti SF. Outcome study of subjects with insertional plantar fasciitis. Foot Ankle Int. 1998;19(12):803–11.

    PubMed  CAS  Google Scholar 

  16. Flanigan RM, Nawoczenski DA, Chen L, Wu H, DiGiovanni BF. The influence of foot position on stretching of the plantar fascia. Foot Ankle Int. 2007;28(7):815–22.

    Article  PubMed  Google Scholar 

  17. DiGiovanni BF, Nawoczenski DA, Lintal ME, Moore EA, Murray JC, Wilding GE, et al. Tissue-specific plantar fascia-stretching exercise enhances outcomes in patients with chronic heel pain. A prospective, randomized study. J Bone Joint Surg Am. 2003;85-A(7):1270–7.

    PubMed  Google Scholar 

  18. Griffith JF, Wong TY, Wong SM, Wong MW, Metreweli C. Sonography of plantar fibromatosis. AJR Am J Roentgenol. 2002;179(5):1167–72.

    PubMed  Google Scholar 

  19. Gibbon WW, Long G. Ultrasound of the plantar aponeurosis (fascia). Skeletal Radiol. 1999;28(1):21–6.

    Article  PubMed  CAS  Google Scholar 

  20. Jeswani T, Morlese J, McNally EG. Getting to the heel of the problem: plantar fascia lesions. Clin Radiol. 2009;64(9):931–9.

    Article  PubMed  CAS  Google Scholar 

  21. Akfirat M, Sen C, Günes T. Ultrasonographic appearance of the plantar fasciitis. Clin Imaging. 2003;27(5):353–7.

    Article  PubMed  Google Scholar 

  22. Griffith JF, Wong SM, Li EK. Ultrasound evaluation of plantar fasciitis. Scand J Rheumatol. 2001;30(3):176–7.

    Article  PubMed  CAS  Google Scholar 

  23. Healey K, Chen K. Plantar fasciitis: current diagnostic modalities and treatments. Clin Podiatr Med Surg. 2010;27(3):369–80.

    Article  PubMed  Google Scholar 

  24. Buchbinder R, Ptasznik R, Gordon J, Buchanan J, Prabaharan V, Forbes A. Ultrasound-guided extracorporeal shock wave therapy for plantar fasciitis: a randomized controlled trial. JAMA. 2002;288(11):1364–72.

    Article  PubMed  Google Scholar 

  25. Rompe JD, Cacchio A, Weil Jr L, Furia JP, Haist J, Reiners V, et al. Plantar fascia-specific stretching versus radial shock-wave therapy as initial treatment of plantar fasciopathy. J Bone Joint Surg Am. 2010;92(15):2514–22.

    Article  PubMed  Google Scholar 

  26. Jozsa L, Kannus P. Histopathological findings in spontaneous tendon ruptures. Scand J Med Sci Sports. 1997;7(2):113–8.

    Article  PubMed  CAS  Google Scholar 

  27. Jarvinen TA, Kannus P, Maffulli N, Khan KM. Achilles tendon disorders: etiology and epidemiology. Foot Ankle Clin. 2005;10(2):255–66.

    Article  PubMed  Google Scholar 

  28. Jarvinen M, Jozsa L, Kannus P, Jarvinen TL, Kvist M, Leadbetter W. Histopathological findings in chronic tendon disorders. Scand J Med Sci Sports. 1997;7(2):86–95.

    Article  PubMed  CAS  Google Scholar 

  29. Khan KM, Maffulli N. Tendinopathy: an Achilles' heel for athletes and clinicians. Clin J Sport Med. 1998;8(3):151–4.

    Article  PubMed  CAS  Google Scholar 

  30. Astrom M, Rausing A. Chronic Achilles tendinopathy. A survey of surgical and histopathologic findings. Clin Orthop Relat Res. 1995;316:151–64.

    PubMed  Google Scholar 

  31. Leadbetter WB. Cell-matrix response in tendon injury. Clin Sports Med. 1992;11(3):533–78.

    PubMed  CAS  Google Scholar 

  32. Maffulli N, Wong J, Almekinders LC. Types and epidemiology of tendinopathy. Clin Sports Med. 2003;22(4):675–92.

    Article  PubMed  Google Scholar 

  33. Bestwick CS, Maffulli N. Reactive oxygen species and tendinopathy: do they matter? Br J Sports Med. 2004;38(6):672–4.

    Article  PubMed  CAS  Google Scholar 

  34. Goodship AE, Birch HL, Wilson AM. The pathobiology and repair of tendon and ligament injury. Vet Clin North Am Equine Pract. 1994;10(2):323–49.

    PubMed  CAS  Google Scholar 

  35. Selvanetti A, Cipolla M, Puddu G. Overuse tendon injuries: basic science and classification. Oper Tech Sports Med. 1997;5(3):110–7.

    Article  Google Scholar 

  36. Arndt AN, Komi PV, Brüggemann G, Lukkariniemi J. Individual muscle contributions to the in vivo achilles tendon force. Clin Biomech. 1998;13(7):532–41.

    Article  Google Scholar 

  37. Robert FK. The implications of the adaptable fatigue quality of tendons for their construction, repair and function. Comp Biochem Physiol - Part A: Mol Integr Physiol. 2002;133(4):987–1000.

    Article  Google Scholar 

  38. Schepsis AA, Leach RE, Gorzyca J. Plantar fasciitis. Etiology, treatment, surgical results, and review of the literature. Clin Orthop Relat Res. 1991;266:185–96.

    PubMed  Google Scholar 

  39. Tountas AA, Fornasier VL. Operative treatment of subcalcaneal pain. Clin Orthop Relat Res. 1996;332:170–8.

    Article  PubMed  Google Scholar 

  40. Snider MP, Clancy WG, McBeath AA. Plantar fascia release for chronic plantar fasciitis in runners. Am J Sports Med. 1983;11(4):215–9.

    Article  PubMed  CAS  Google Scholar 

  41. Puttaswamaiah R, Chandran P. Degenerative plantar fasciitis: a review of current concepts. Foot. 2007;17(1):3–9.

    Article  Google Scholar 

  42. Clain MR, Baxter DE. Achilles tendinitis. Foot Ankle. 1992;13(8):482–7.

    PubMed  CAS  Google Scholar 

  43. McNally EG, Shetty S. Plantar fascia: imaging diagnosis and guided treatment. Semin Musculoskelet Radiol. 2010;14(3):334–43.

    Article  PubMed  Google Scholar 

  44. Sabir N, Demirlenk S, Yagci B, Karabulut N, Cubukcu S. Clinical utility of sonography in diagnosing plantar fasciitis. J Ultrasound Med. 2005;24(8):1041–8.

    PubMed  Google Scholar 

  45. 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 (Oxford). 2001;40(9):1002–8.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Royal Surrey County Hospital, Egerton Road, Guildford, Surrey, GU2 7XX, UK

    Edmund Ieong, John Afolayan, Andrew Carne & Matthew Solan

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  1. Edmund Ieong
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  2. John Afolayan
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  3. Andrew Carne
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  4. Matthew Solan
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Correspondence to Andrew Carne.

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Ieong, E., Afolayan, J., Carne, A. et al. Ultrasound scanning for recalcitrant plantar fasciopathy. Basis of a new classification. Skeletal Radiol 42, 393–398 (2013). https://doi.org/10.1007/s00256-012-1470-x

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  • DOI: https://doi.org/10.1007/s00256-012-1470-x

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