Plantar Fasciitis and Fibromatosis

Plantar Fasciitis and Fibromatosis

KEY FACTS

Terminology

• Plantar fascia = multilayered fibrous aponeurosis, 1-2 mm thick, with medial, central, and lateral bands

Imaging

• Plantar fasciitis
• Plantar fibromatosis

Diagnostic Checklist

• Likelihood of plantar fasciitis increases with increasing thickness of plantar fascia at calcaneal insertion
- Heel fat pat atrophy is most common differential diagnosis
• Plantar fibromatosis = distinct plantar fascial nodule separate from calcaneal insertion
- Plantar fascial tear is most similar differential diagnosis

Longitudinal US shows a normal central band of the plantar fascia attached to the medial calcaneal tuberosity . The thickness (3.7 mm) of the plantar fascia is measured at the leading edge of the calcaneum . The normal thickness is < 4.3 mm.

Longitudinal US shows a normal central band of the plantar fascia attached to the medial calcaneal tuberosity . The thickness (3.7 mm) of the plantar fascia is measured at the leading edge of the calcaneum . The normal thickness is < 4.3 mm.

Longitudinal US shows a moderately thickened (5.3 mm) central band of the plantar fascia at the attachment to the medial calcaneal tuberosity . This is consistent with moderate-severity plantar fasciitis.

Longitudinal US shows a moderately thickened (5.3 mm) central band of the plantar fascia at the attachment to the medial calcaneal tuberosity . This is consistent with moderate-severity plantar fasciitis.

Longitudinal US shows a normal plantar fascia at the midfoot level. The flexor digitorum brevis muscle is attached to the deep surface of the plantar fascia. The subcutaneous fat of the sole is superficial.

Longitudinal US shows a normal plantar fascia at the midfoot level. The flexor digitorum brevis muscle is attached to the deep surface of the plantar fascia. The subcutaneous fat of the sole is superficial.

Longitudinal US shows a medium-sized (12-mm wide x 4-mm deep x 18-mm long) fibroma within the cental band of the plantar fascia at the midfoot region. Moderate posterior enhancement is present. Additional plantar fibroma was present elsewhere in the feet.

Longitudinal US shows a medium-sized (12-mm wide x 4-mm deep x 18-mm long) fibroma within the cental band of the plantar fascia at the midfoot region. Moderate posterior enhancement is present. Additional plantar fibroma was present elsewhere in the feet.

TERMINOLOGY

Synonyms

• Plantar fasciitis: Jogger’s heel, tennis heel, policeman’s heel, heel spur syndrome, calcaneal spur syndrome, plantar fasciopathy
• Plantar fibromatosis: Ledderhose disease, plantar fibroma

Definitions

• Plantar fascia = multilayered fibrous aponeurosis, 1-2 mm thick, with medial, central, and lateral bands
• Plantar fasciitis: Degeneration ± fibroblastic proliferation of plantar fascia insertion to medial tuberosity of calcaneus
- As there is no clear inflammatory component, plantar fasciopathy may be more favorable term
• Plantar fibromatosis: Nodular fibroblastic proliferation of plantar fascia separate from calcaneus

IMAGING

General Features

• Best diagnostic clue
- Plantar fasciitis: Thickened plantar fascial insertion
- Plantar fibromatosis: Nodular thickening of plantar fascia
• Location
- Plantar fasciitis: Medial tuberosity calcaneus
  - – Bilateral in 1/3
- Plantar fibromatosis: Affects medial (60%) or central bands (40%) of plantar fascia
  - – Bilateral in 1/3
  - – Multiple on symptomatic side in 1/4
• Size
- Plantar fasciitis: Fascial thickness > 4.5 mm
- Plantar fibromatosis
• Morphology
- Plantar fasciitis: Fascial thickening at calcaneal insertion
- Plantar fibromatosis: Discrete well-defined plantar fascia nodule

Radiographic Findings

• Radiography
- Plantar fasciitis: Plantar calcaneal spur present in ~ 50% of patients with plantar fasciitis
  - – Also found in asymptomatic subjects
  - – Consider enthesopathy when fluffy periostitis, erosion, and sclerosis are present

MR Findings

• T1WI
- Plantar fasciitis: Hypo – or isointense plantar fascial thickening at calcaneal insertion
- Plantar fibromatosis: Isointense plantar fascial nodule
• T2WI
- Plantar fibromatosis: Hypo- to isointense nodule along plantar fascia
• STIR
- Plantar fasciitis

Ultrasonographic Findings

• Plantar fasciitis
• Plantar fibromatosis

Tags: Diagnostic Ultrasound Musculoskeletal

Apr 9, 2020 | Posted by admin in MUSCULOSKELETAL IMAGING | Comments Off

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