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Remote Fellowship – Foot & Ankle Fundamentals – 11/2/2020

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Diagnosis

Plantar Fasciitis with Partial Tear

Case Discussion

Plantar fasciitis is inflammation and degeneration of the plantar fascia and is one of the most common causes of heel pain.

The plantar fascia is a strong connective tissue complex that helps maintain the longitudinal arch of the foot. It consists of medial, central, and lateral bands that originate from the medial tubercle of the calcaneus and extend distally to insert at the level of the metatarsophalangeal joints.

The MRI appearance of a normal, asymptomatic plantar fascia is a thin homogeneous hypointense band on both T1 and T2 weighted sequences with an average thickness of 4 mm.

MRI findings of plantar fasciitis include: Plantar fascial thickening, most commonly at the calcaneal origin, edema of the adjacent fat pad and underlying soft tissue structures, intrasubstance intermediate signal intensity on T1 weighted images, and increased signal intensity on T2 weighted sequences. Chronic plantar fasciitis may cause sufficient intrasubstance degeneration to allow partial or complete plantar fascial tears. An acute tear of the plantar fascia will have intermediate signal intensity on T1 weighted sequences, and increased signal intensity on T2 weighted sequences, reflecting hemorrhage, inflammation, or edema.

Key Images

Plantar fasciitis with a partial plantar fascial tear in a 59-old-woman with previous plantar fasciitis, complaining of right ankle pain for 2 months

A. Sagittal T2 fat saturated image of the right foot shows marked swelling of the proximal plantar fascia (red arrow) and a focal full thickness, incomplete tear (yellow arrow). There is also marked reactive edema/periostitis of the plantar calcaneus (blue arrow) and surrounding soft tissues.

References

  1. Theodorou DJ, Theodorou SJ, Kakitsubata K, Lektrkul N, Gold GE, Roger B, Resnick D. Plantar fasciitis and fascial rupture: MR imaging findings in 26 patients supplemented with anatomic data in cadavers. RagioGraphics 2000; 20:S181-197
  2. Draghi F, Gitto S, Bortolotto C, Draghi AG, Belometti GO. Imaging of plantar fascia disorders: Findings on plain radiography, ultrasound and magnetic resonance imaging. Insights Imaging 2017; 8:69-78