Fascial Lesion
ESSENTIAL INFORMATION
Key Differential Diagnosis Issues
Helpful Clues for Common Diagnoses
Probably caused by repetitive microtrauma ± microvascular injury
Common in runners (10%)
Affects central band attachment to medial calcaneal tuberosity
Manifested as thickening of plantar fascia at calcaneal insertion
> 4.3-mm thickness considered abnormal
± plantar calcaneal spur
Small foci of dystrophic calcification as well as small intrafascial tears can sometimes be seen in thickened fascia at calcaneal insertion
± edema, reduced lobulation, thinning, or early fibrosis of overlying subcutaneous heel fat pad
Minimal focal hyperemia in < 10% of patients with plantar fasciitis
Associated calcaneal bone marrow edema ± inflammation at plantar fascial insertional area not visible with US
Many different treatments
Decrease in plantar fascial thickness occurs with improvement in symptoms following treatment
Focal nodular fibroblastic proliferation of plantar fascia away from calcaneal insertion
Most commonly affects central band of plantar fascia in midfoot region
Discrete fusiform-shaded nodule expanding plantar fascia
Long axis of fibroma usually aligned with long axis of plantar fascia band
Posterior acoustic enhancement (20%)
Internal vascularity (10%)
Calcification or visible tears not feature
Does not infiltrate beyond plantar fascia
Helpful Clues for Less Common Diagnoses
Affects localized area of fascia rather than extending across width of fascia
Typically affects proximal and middle 1/3 of fascia
Acute tears characterized by focal disruption of fascia, perifascial edema, and inflammation
Chronic tears characterized by focal disruption, tendon thickening, perifascial fibrosis, and hyperemia
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Fascial Lesion
