The use of diagnostic ultrasound is increasing in use in podiatry offices worldwide. The ability to quickly visualize anatomical structures in real-time has helped podiatrists better serve their patients. One of the many benefits of ultrasound is aiding in the treatment of heel pain associated with plantar fasciitis. Plantar fasciitis is inflammation of a thick band of tissue that runs across the bottom of your foot and connects your heel bone to your toes. Ultrasound for plantar fasciitis has many benefits, including being able to rule out other causes of heel or arch pain, establishing an accurate diagnosis, providing the patient with visual information to help them in treatment decisions, and it can track the progress of previous treatments.
Directly visualizing the plantar fascia on ultrasound is relatively quick and easy. A healthy plantar fascia will appear thin, maintain a normal pattern, and have distinct borders as it attaches to the heel bone. Plantar fasciitis will present with a thickened hypoechoic (dark) fascia with some loss of distinct borders and normal fibrillar pattern.
Understanding these features can help differentiate from other sources of heel pain. Being able to visualize the plantar fascia on ultrasound can confirm the diagnosis, and the absence of such signs is an indication for further evaluation.
Ultrasound evaluation of the heel can help rule out other causes of heel pain. Soft tissue masses can cause plantar heel or arch pain. Plantar fibromas, for example, are easily visualized and evaluated on ultrasound. Ganglion cysts may cause irritation and pain, but may not always be seen grossly. Foreign bodies that are not visualized on x-rays can be seen on ultrasound. A Plantar Vein thrombosis can have a variety of clinical presentations, one of which is plantar heel pain. The principal method for evaluating and diagnosing a plantar vein thrombosis is, in fact, ultrasound. Other masses, such as neurilemmomas have been documented as causes of heel pain. Many soft tissue pathologies can mask themselves as plantar fasciitis, and ultrasound is another tool to confirm a diagnosis.
Ultrasound can also help the patient and podiatrist in deciding the best course of treatment. Visualizing the affected fascial band and comparing it to the other foot, can give powerful information on the extent of the pathology. A measurement of the plantar fascia, along with the same measurement on the healthy side, can let a patient see the extent of the fasciitis. A patient deciding between an injection or more conservative treatment, like stretching and NSAIDS, is given more information to assist in that choice. Ultrasound also helps in assessing if a current course of treatment is working. Did the current treatment work? Is further treatment indicated? Ultrasound can help answer those questions.
Another advantage of using ultrasound is being able to identify the location of the fasciitis. Though this can be done clinically, the ultrasound has the added advantage of being able to direct injections into the area of inflammation through ultrasound-guided injections. Being able to pinpoint the treatment greatly increases the quality of the treatment.
As podiatrists, our goal is to improve the health of our patients, and by doing so improve their quality of life. By implementing the use of ultrasound in cases of plantar fasciitis, we are able to provide real-time information on severity to aid the patient in treatment choices, rule out other, possibly devastating, causes of heel pain, and improve the quality of the treatment.
1 – Nuran Sabir, MD, Semra Demirlenk, MD, Baki Yagci, MD, Nevzat Karabulut, MD, sibel
Sibel Cubukcu, MD: Clinical Utility of Sonography in Diagnosis Plantar Fascitis, J Utrasound Med 2005; 24:1041-1048
2 – Barros MV, Labropoulos N.: Plantar Vein Thrombosis—Evaluation by Ultrasound and Clinical Outcome, ANGIOLOGY, February/March 2010 61: 82-85, first published on July 21, 2009
3 – Marui T, Yamamoto T, Akisue T, et al: Neurilemmoma in the foot as a cause of heel pain: a report of two cases. FootAnkle Int 25:107–111, 2004