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Review
. 2023 Oct 6;31(4):268-274.
doi: 10.4103/jmu.jmu_2_23. eCollection 2023 Oct-Dec.

Plantar Fasciitis: An Updated Review

Wen-Che Tseng  1 , Yun-Chang Chen  2 , Tsung-Min Lee  2 , Wen-Shiang Chen  2   3
Affiliations
Review

Plantar Fasciitis: An Updated Review

Wen-Che Tseng et al. J Med Ultrasound. .

Abstract

Plantar fasciitis (PF) is a common musculoskeletal disease. Histologic findings of patients with PF showed mainly chronic degenerative processes rather than inflammation. In addition to mechanical factors, such as repetitive stress and reduced ankle dorsiflexion, PF is also linked to rheumatologic diseases and genetic factors. Ultrasound is becoming a standard imaging technique for assessing PF. Major sonographic findings included increased plantar fascia thickness and hypoechoic plantar fascia. In addition to traditional B-mode ultrasound, sonoelastography can also be utilized to diagnose PF. Ultrasound can also be used to guide therapeutic interventions. Over 80% of patients with PF improved under nonsurgical treatment. Treatment options for PF include physical therapy, modalities (laser, therapeutic ultrasound), extracorporeal shock wave therapy (ESWT), injections, transcatheter arterial embolization, and surgery. For injections, corticosteroid was mostly used in the past but has been replaced gradually by other techniques such as platelet-rich plasma or dextrose prolotherapy. There is also more and more evidence about ESWT in treating PF. Surgery serves as an option for recalcitrant PF cases, and endoscopic fasciotomy seemed to have good outcomes. Ultrasound plays an important role in diagnosing of PF and evaluating the treatment effect, and the use of sonoelastography in addition to traditional B-mode ultrasound may help in the early detection of PF and assessment of the treatment effect.

Keywords: Dextrose prolotherapy; extracorporeal shock wave therapy; plantar fasciitis; platelet-rich plasma; sonoelastography; ultrasound.

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Conflict of interest statement

Prof. Wen-Shiang Chen, an editor at Journal of Medical Ultrasound, had no role in the peer review process of or decision to publish this article. The other authors declared no conflicts of interest in writing this paper.

Figures

Figure 1
Figure 1
Windlass test. The patient stays in a weight-bearing position, and the examiner passively extends the first metatarsophalangeal joint of the great toe. The test is positive if pain is provoked
Figure 2
Figure 2
(a) Measurement of the plantar fascia thickness. The thickness is measured at the origin of the plantar fascia at the calcaneus (thickness = 3.75mm). (b) Thickened plantar fascia in a patient with plantar fasciitis (thickness = 4.15mm). (c) A hypoechoic mass was accidentally found in the plantar fascia, compatible with a plantar fibroma. C: Calcaneus
Figure 3
Figure 3
(a) In-plane approach of echo-guided injection to the plantar fascia (b) Out-of-plane approach of echo-guided injection to the plantar fascia
Figure 4
Figure 4
Elastography of the plantar fascia
See this image and copyright information in PMC

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