Hi, I'm Wade Johnson, sports medicine physiatrist with Mayo Clinic Health System in Mankato, Minnesota. Today's case involves a runner with six weeks of right heel pain. Plane radiographs were obtained and AP and lateral images can be seen here. There was no fracture identified. You can see a calcaneal enthesophyte on the planar surface where the planar fascia inserts on the calcaneus, and this can often be seen in cases of planar fasciopathy. However, a lot of times patients with planar fasciopathy will present with normal radiographic imaging. A decision was made to pursue a diagnostic ultrasound, and it is important to remember to visualize structures of interest in multi-planar view. The planar fascia should be visualized in both long and short axis, and a normal planar fascia will have a thickness of four millimeters or less. You can see the planar fascia inserting on the medial calcaneal tubercle highlighted here. The planar fascia will also have a uniform sonographic appearance. Visualizing the planar fascia in short axis from its insertion at the medial calcaneal tubercle distally through its foot allows you to visualize the planar fasciopathy in its entirety, and you can use anisotropy to differentiate between the fascia and overlying fat pad if you have issues with similar echogenicity, and you can utilize Doppler to visualize any hyperemia. The lateral cord of the planar fascia should also be evaluated from its insertion at the lateral aspect of the medial calcaneal tubercle to its insertion at the base of the fifth metatarsal. You can see that highlighted here. These patients will most often present with more lateral and midfoot pain, however. Back to the patient in our case, you can see by static long axis image of the central cord of the planar fascia on the left and the video evaluating the central cord from its medial most aspect to its lateral most aspect on the right, the thickened planar fascia tissue, as well as the mixed echogenicity and foci of anechogenicity concerning for partial tearing. Transverse or short axis imaging of the planar fascia allows you to, again, confirm the presence of mixed echogenicity and foci of anechogenicity concerning for tears. It allows you to, again, visualize the thickened planar fascia. And finally, measuring the thickness of this patient's plantar fascia, you can see both long and short axis on the left and right. Respectively, the plantar fascia measuring a thickness of six millimeters consistent with the diagnosis of plantar fasciopathy.

3rd Edition, CASE 17

3rd Edition

Foot

plantar fasciopathy

heel pain

diagnostic ultrasound

calcaneal enthesophyte

Mayo Clinic