Abstract
No consensus exists concerning the diagnostic role or cutoff value of the Achilles tendon thickness on ultrasonography (US) for the diagnosis of insertional Achilles tendinopathy. This study sought to assess the diagnostic utility of US measurement of the thickness and echogenicity of the Achilles tendon for the insertional Achilles tendinopathy in patients with heel pain, and to compare the results with those of the plantar fascia for the plantar fasciitis. We conducted US examinations in consecutive patients who presented with unilateral or bilateral heel pain at the foot clinic of a single tertiary hospital from February 2016 to December 2020. Each US evaluation assessed the thickness and echogenicity of the insertion area of the Achilles tendon and plantar fascia. We retrospectively compared these parameters between patients with insertional Achilles tendinopathy or plantar fasciitis and normal controls and analyzed the diagnostic utility of these parameters. Based on clinical diagnosis, 44 feet were diagnosed with insertional Achilles tendinopathy, 109 feet were diagnosed with plantar fasciitis, and 32 feet were classified as normal. There was a significant difference in the thickness of the plantar fascia between the plantar fasciitis and normal control groups (p = 0.032). There was also a significant difference in the echogenicity of the plantar fascia between the plantar fasciitis and normal groups (p < 0.001). However, there was no significant difference in the thickness of the insertional area of the Achilles tendon between the insertional Achilles tendinopathy and normal groups (p = 0.132). There was a significant difference in the echogenicity of the insertional area of the Achilles tendon between the insertional Achilles tendinopathy and normal groups (p < 0.001). US measurement of the thickness of the insertional area of the Achilles tendon might not reflect the clinical status of insertional Achilles tendinopathy, unlike that of plantar fasciitis.
Highlights
A retrospective chart review was performed for 77 consecutive patients with a clinical diagnosis of plantar fasciitis or insertional Achilles tendinopathy who visited at the foot clinic of Kangbuk Samsung Hospital with heel pain and underwent bilateral US examinations of the Achilles tendon and plantar fascia from February 2016 to December 2020
A total of 44 feet were diagnosed with insertional Achilles tendinopathy, 109 feet were diagnosed with plantar fasciitis, and 32 feet were classified as normal controls (Figure 1)
There was a significant difference in the thickness of the plantar fascia between the plantar fasciitis and normal groups (p = 0.032) (Table 1)
Summary
The differential diagnosis of heel pain is extensive, including plantar fasciitis, plantar fibromatosis, heel pad syndrome, Achilles tendinopathy, and Haglund’s deformity with or without bursitis [1]. Among these conditions, plantar fasciitis and Achilles tendinopathy are the two most common diagnoses rendered for heel pain. The specific anatomical location of the pain helps with diagnosis. Both diseases are diagnosed through history-taking and physical examination. Running-related injuries predominantly involve Achilles tendinopathy and plantar fasciitis in the foot and ankle area, supporting the potential for coexistence of both diseases [4]
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