Additional diagnostic value of digital radiology in plantar fasciitis diagnosis
Background: Ultrasonography (USG) is regarded as the gold standard to differentiate normal plantar fascia and plantar fasciitis. Conventional radiography or plain X-ray is typically used to exclude differential diagnosis. Lately, conventional radiography has been digitalized and leads to better visualization of the soft tissue. However, it is not known whether digital radiography evaluation for calcaneus area, both qualitative and quantitative, has a similar diagnostic value as USG findings. Therefore, this study aimed to evaluate whether there is a strong correlation between digital radiographic and USG findings for diagnosing plantar fasciitis.
Methods: This is a cross sectional study examining adult patients (>18 years old) presenting with inferior heel pain. Plantar aponeurosis thickness was measured by digital radiography and ultrasonography; measurement was performed three times in each modality, and the average value was recorded. Fat stranding, presence of calcaneal enthesophyte, and microfracture were also evaluated in digital radiography. Measurement results were classified into plantar fasciitis diagnosis using the cut-off value 4 mm.
Results: There was no significant correlation between plantar aponeurosis thickness measured by digital radiography and by ultrasonography (r=0.069, p=0.688). There was no significant association between plantar fasciitis diagnosis by digital radiography and ultrasonography (p=0.162). However, digital radiography showed good sensitivity to detect plantar fasciitis using a cut-off value of >4 mm plantar fascia thickness.
Conclusion: Digital radiography might be used to aid definitive diagnosis for plantar fasciitis.
Nuran S, Semra D, Baki Y, Nevzat K, Sibel C. Clinical Utility of Sonography in Diagnosing Plantar Fasciitis. J Ultrasound Med. 2005; 24(8):1041–8. https://doi.org/10.7863/jum.2005.24.8.1041
Potter VAJ. Investigating Plantar Fasciitis. The Foot and Ankle Online Journal. 2009;2(11):4.
Ahn JM, El-Khoury GY. Radiologic Evaluation of Chronic Foot Pain. Am Fam Physician. 2007;76(7):975–983.
Wearing SC, Smeathers JE, Sullivan PM, Yates B, Urry SR, Dubois P. Plantar Fasciitis: Are Pain and Fascial Thickness Associated With Arch Shape and Loading?. Phys Ther. 2007;87(8):1002–8. https://doi.org/10.2522/ptj.20060136
www.idexx.com [Internet]. Computed Radiography in Perspective. [updated 2014 July 11; cited 2016 Feb 09]. Available from: https://www.idexx.com/.
Levy JC, Mizel MS, Clifford PD, Temple HT. Value of Radiographs in the Initial Evaluation of Nontraumatic Adult Heel Pain. Foot Ankle Int. 2006;27(6):427–30. https://doi.org/10.1177/107110070602700607
Osborne HR, Breidhl WH, Allison GT. Critical differences in lateral X-rays with and without a diagnosis of plantar fasciitis. J Sci Med Sport. 2006;9(3):231–7. https://doi.org/10.1016/j.jsams.2006.03.028
Abreu MR, Chung CB, Mendes L, Mohana BA, Trudell D, Resnick D. Plantar calcaneal enthesophytes: new observation regarding sites of origin based on radiographic, MR imaging, anatomic, and paleopathologic analysis. Skeletal Radiol. 2003;32(1):13–21. https://doi.org/10.1007/s00256-002-0585-x
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