Plantar fascia enthesitis: Clinical, radiographic and ultrasound findings in patients with axial spondyloarthritis

Abstract

Aim of the workTo assess the clinical, radiographic and sonographic presentation of plantar fascia in axial spondyloarthritis (ax-SpA) and to identify the radiographic and ultrasonographic signs most associated with clinical disease parameters. Patients and methodsThe study included 74 patients with ax-SpA. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Functional Index (BASFI) and Ankylosing Spondylitis Quality of Life (ASQoL) were assessed. Clinical assessment of plantar fascia included the plantar fascia palpation pain severity on a visual analogic scale (VAS); and the enthesitis-specific scores: The Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) and the Spondyloarthritis Research Consortium of Canada (SPARCC) score. All patients were explored by lateral heel radiographs and musculoskeletal ultrasound (US) at plantar fascia insertions. ResultsThe mean age was 36 ± 11.4 years. Plantar fascia enthesis was painful in 17% of cases. Standard radiographs showed plantar fascia involvement in 37% and US in 71% of patients. The clinical involvement of plantar fascia correlated with BASDAI (p = 0.02), as well as BASFI (p = 0.03) and ASQoL (p < 0.0001). X-ray enthesophyte was the most related to plantar fascia pain palpation (p < 0.01), MASES(p < 0.001) and SPARCC(p < 0.05). US entheseal thickening was related with pain palpation (p < 0.001) and MASES (p < 0.05). US enthesophyte was related with palpation pain (p < 0.05). Bony erosion was related to SPARCC (p < 0.05). ConclusionPlantar fascia in ax-SpA is often asymptomatic and associated with disease activity and functional impairment. The presence of enthesophyte was the radiographic sign most associated with clinical enthesitic involvement. Entheseal thickening, enthesophyte and bony erosion were the sonographic signs most associated with enthesitic.