Age / Sex : 55 / F

Age / Sex : 55 / F

Chief complaint : Left heel pain for two months

plantar fasciits

Discussion

Findings:

Radiography reveals a plantar calcaneal spur. MR images show marked thickening of the proximal plantar fascia with increased intrasubstance signal intensity in T2-weighted images. Note also the perifascial edema, which has low signal intensity in T1-wieghted images, high signal intensity in fat-suppressed T2-weighted images, and diffuse enhancement in postcontrast T1-weighted images.

Differential Diagnosis:

Plantar Fibromatosis

 Plantar Fascia Rupture

Diagnosis: :
Plantar fasciitis

Discussion:

 Plantar fasciitis is the most common cause of plantar heel pain. This condition can arise either from the stress of repetitive trauma or as an enthesopathy in association with seronegative spondyloarthropathies (ankylosing spondylitis, Reiter syndrome, psoriatic arthritis).

The stress-related form of plantar fasciitis is more common and generally occurs in obese middle-aged or elderly patients as a result of repetitive trauma from athletic activities, excessive job-related standing and walking, changes in walking surfaces, or changes in shoewear. It may also occur in young persons who engage in sports activities that involve running or jumping. In these situations, microtears occur, mainly in the origin of the plantar fascia, and elicit a local inflammatory reaction.

Pain on the undersurface of the heel on weight bearing is the principal complaint. The pain is often worse when weight is borne after a period of rest (eg, in the morning) and eases with walking. Localized tenderness without swelling is present over the anteromedial portion of the plantar surface of the calcaneus. Passive dorsiflexion of the toes often exacerbates the discomfort.

Radiography may reveal a plantar calcaneal spur, although this entity may also be observed in asymptomatic adults. The etiologic significance of this spur remains controversial, but most authors believe that it is not the primary cause of pain.

MR imaging characteristics of plantar fasciitis include fascial thickening that is often fusiform and typically involves the proximal portion and extends to the calcaneal insertion, and increased signal intensity of the proximal plantar fascia, which demonstrates intermediate signal intensity on T1-weighted or proton-density–weighted images and high signal intensity on T2-weighted or STIR images. Other MR imaging findings that indicate plantar fasciitis include edema of the adjacent fat pad and underlying soft tissues and limited marrow edema within the medial calcaneal tuberosity. STIR MR imaging is often the most sensitive in the detection of both fascial and perifascial edema, which appear as poorly marginated areas of high signal intensity.

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