Pictorial ReviewGetting to the heel of the problem: plantar fascia lesions
Introduction
The plantar fascia is a thick, multilayered, inelastic band of fibrous tissue that courses along the plantar surface of the foot. It contains medial, central, and lateral components. The term “plantar fascia” often refers to the large central component. This attaches to the medial tuberosity of the Os calcis and extends anteriorly becoming broader and thinner. In the region of the metatarsal heads, the plantar fascia divides into five processes, one for each of the toes. Each of these processes divides opposite the metatarsophalangeal articulation into two strata, superficial and deep. The superficial stratum of each process is connected to the dermis by skin ligaments (retinacula cutis). These ligaments reach the skin of the ball of the foot proximal to, and in the floors of the furrows that separate the toes from the sole. The deeper stratum divides into two slips that embrace the side of the flexor tendons of the toes. The lateral and medial portions of the plantar aponeurosis are thinner than the central portion, and cover the sides of the sole of the foot. Some authors refer only to two branches omitting the medial, but referring to the central as the medial. In this article, the three-branch approach will be used.
The primary function of the plantar fascia is to act as a bowstring and maintain the longitudinal arch of the foot.
Section snippets
Normal imaging anatomy
The normal plantar fascia is easily visualized using magnetic resonance imaging (MRI) or ultrasound. On plain radiography, the fascia can be seen between layers of surrounding fat, but its internal structure is not defined. Bony spur formation at the fascial origin is also seen on plain radiographs, but the presence of a spur does not necessarily indicate fascial disease. The normal plantar fascia is seen on MRI as a thin band with low signal intensity on all pulse sequences (Fig. 1). It is
Lesions of the plantar fascia
The principle plantar fascia lesions are: plantar fasciitis, plantar fascia rupture, plantar fibromatosis, and plantar xanthoma. We will also address foreign-body reactions, enthesopathy, and diabetic fascial disease.
Conclusion
Plantar fascia lesions are responsible for a fair proportion of disabling heel pain. We have presented a review illustrated with MRI and ultrasound imaging in an attempt to highlight the variety of possible plantar fascial lesions. Although both imaging methods excel at imaging the plantar fascia, ultrasound has the added ability of allowing guided treatment at the time of imaging.
References (26)
Magnetic resonance imaging of plantar fasciitis and other causes of heel pain
Magn Reson Imaging Clin N Am
(1994)- et al.
Long-term ultrasonic follow-up of plantar fasciitis patients treated with steroid injection
Joint Bone Spine
(2005) - et al.
Extracorporeal shock wave therapy for chronic painful heel syndrome: a prospective, double blind, randomized controlled trial assessing the efficacy of a new electromagnetic shock wave device
J Foot Ankle Surg
(2007) - et al.
Plantar fasciitis: MR imaging
Radiology
(1991) - et al.
MRI of plantar fasciitis
Rofo
(1999) - et al.
Extracorporeal shock wave application for chronic plantar fasciitis associated with heel spurs: prediction of outcome by magnetic resonance imaging
J Rheumatol
(2000) - et al.
Plantar fasciitis: sonographic evaluation
Radiology
(1996) - et al.
Steroid injection for heel pain: evidence for short term effectiveness. A randomized controlled trial
Rheumatology
(1999) - et al.
A systematic review of treatments for the painful heel
Rheumatology
(1999) - et al.
Interventions for treating plantar heel pain
Cochrane database Syst Rev
(2003)
Role of high resolution ultrasound in guiding treatment of idiopathic plantar fasciitis with minimally invasive techniques
Radiol Med (Torino)
Long-term results of extracorporeal shock wave therapy treatment for plantar fasciitis
Am J Sports Med
Extracorporeal shock wave therapy for plantar fasciitis: randomised controlled multicentre trial
BMJ
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ACR Appropriateness Criteria® Chronic Foot Pain
2020, Journal of the American College of RadiologyCitation Excerpt :US has been shown to be useful in the diagnosis of complete and partial tears of the plantar fascia [57]. Some authors regard US to be superior to MRI in differentiating true fiber interruption and tearing of the plantar fascia from edema [58]. Bone scintigraphy is a sensitive but not specific technique to detect occult fractures because of its capability to detect increased osteoblastic activity.
Effect of Extracorporeal Shockwave Therapy on Passive Ankle Stiffness in Patients With Plantar Fasciopathy
2018, Journal of Foot and Ankle SurgeryShall We Inject Superficial or Deep to the Plantar Fascia? An Ultrasound Study of the Treatment of Chronic Plantar Fasciitis
2017, Journal of Foot and Ankle SurgeryVisualization of the Plantar Aponeurosis
2017, PM and RCitation Excerpt :Typically, plantar xanthomas are associated with symmetric bilateral Achilles tendon xanthomas [8]. On US and MRI, plantar xanthomas appear as fusiform thickening of the PA with a speckled internal architecture [8]. Both US and MRI can be used in the assessment of the PA in the context of plantar foot pain.