Abstract
Introduction: To study the sonographic appearance of plantar fascia in clinically suspected cases of plantar fasciitis (PFs) using both quantitative and qualitative parameters, and to establish the correlation between plantar fasciitis, body mass index (BMI) and heel pad thickness (HPT).
 Methods: In this case controlled analytical study, we sonographically evaluated 100 patients with clinical plantar fasciitis (unilateral: 90, bilateral: 10 with mean age 46.9yrs) and control group of 60 (120 heels) healthy volunteers with mean age 45.3yrs. Plantar Fascia Thickness (PFT), HPT, hypoechogenity, biconvexity, perifascial fluid, intrafascial calcification and subcalcaneal spurs were evaluated sonographically. PFT was measured 5mm distal to the calcaneal insertion of plantar aponeurosis. The unloaded HPT was measured from the skin surface to the nearest calcaneal tuberosity.
 Results: Mean Plantar Fascia Thickness (PFT) and Heel Pad Thickness (HPT) are greater on the symptomatic side for patients with unilateral and bilateral PFs than on the asymptomatic side for patients with unilateral PFs, and also control subjects (PFT values are 4.41 ± 0.59, 4.63 ± 0.55, 2.83 ± 0.36, 2.62± 0.37 mm, and HPT values 17.64 ± 1.07, 17.28 ± 1.10, 16.91 ± 1.06, 16.73 ± 1.13 mm, respectively) (p <0.0001). Mean BMI values of the case and control groups are 26.14 ± 1.9 and 24.42 ± 0.89 Kg/m2, respectively (p <0.05). We found hypoechogenicity of plantar fascia in 80 cases (72.7%), calcaneal spur in 69 cases (62.7%), biconvexity in 11 cases (10%) and perifascial fluid in 16 cases (14.5%) within the plantar fasciitis group (110 symptomatic heels).
 Conclusion: Increased plantar fascia thickness, increased heel pad thickness and hypoechogenicity of plantar fascia are consistent sonographic findings in plantar fasciitis. Its occurrence has significant relation to high BMI.
Highlights
Planter fasciitis is one of the most common causes of heel pain
Studies were done in the past to evaluate the correlation between plantar fasciitis and body mass index (BMI) as well as heel pad thickness (HPT)
This shows that the occurrence of plantar fasciitis is more common in middle aged females (71 out of 100 patients in the age range between 4050yrs)
Summary
Planter fasciitis is one of the most common causes of heel pain. The objective of this study is to study the sonographic appearance of plantar fascia in clinically suspected cases and to establish the correlation between plantar fasciitis, body mass index (BMI) and heel pad thickness (HPT). Thickened plantar fascia is a well-established sonographic criteria for the diagnosis and has been previously reported in several studies.[10,11,12,13,14,15] Studies were done in the past to evaluate the correlation between plantar fasciitis and body mass index (BMI) as well as heel pad thickness (HPT) They had recruited only small numbers of cases and often lacked good comparison to well-controlled subjects.[11,14] HPT which plays an important role in shock absorption on ambulation, has not been sufficiently addressed in published studies. This study was done to evaluate both quantitative and qualitative sonographic parameters of plantar fascia in plantar fasciitis, to establish it’s correlation with BMI and HPT in patients with a clinical diagnosis and to compare these findings with those of demographically-matched, asymptomatic control subjects
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