Fascia Thickness Research Articles

In Vivo Analysis of the Superficial and Deep Fascia

Key risk factors for hypertrophic scarring and surgical-site infections are high-tension wounds, fat necrosis, and dead space. All could be prevented by appropriate superficial fascia suturing. However, the as-yet poorly researched anatomy of the superficial fascia should be delineated. This study is the first to quantify the superficial fascia throughout the human body in vivo. Ultrasound was used to analyze the superficial and deep fascia of 10 volunteers at 73 points on 11 body regions, including the upper and lower trunk and limbs. Number, thickness and percentage of superficial fascia layers, and deep fascia and dermis thickness, were measured at each point. Seven hundred thirty ultrasound images were analyzed. Body regions varied markedly in terms of subcutaneous variables. Posterior chest had the thickest deep fascia and dermis and the highest average superficial fascia layer thickness [0.6 mm (95 percent CI, 0.6 to 0.7 mm)]. Anterior chest had the most superficial fascia layers [3.7 (95 percent CI, 3.5 to 3.8)]. Posterior and anterior chest had among the highest percentage of superficial fascia. Abdomen and especially gluteus had a low percentage of superficial fascia. Covariate analyses confirmed that posterior and anterior chest generally had higher superficial fascia content than gluteus and abdomen (both p < 0.001). They also showed that the dermis in the posterior and anterior chest increased proportionally to total fascia thickness. The superficial fascia, deep fascia, and dermis tend to be thick in high-tension areas such as the upper trunk. A site-specific surgical approach is recommended for subcutaneous sutures. Understanding the anatomical distribution of the superficial fascia and deep fascia will help surgeons optimize subcutaneous fasciae suturing, thereby potentially reducing the incidence of surgical-site infections and hypertrophic scars.

Role of shear wave elastography in the diagnostic evaluation of plantar fasciitis: a prospective case-control study.

To assess the advantage of the addition of shear wave elastography (SWE) to gray-scale sonography in the diagnosis of plantar fasciitis. 30 subjects between 18-60years of age with unilateral heel pain who were clinically suspected of having plantar fasciitis were included in this study. Their affected feet were taken as cases; while their contralateral feet served as controls. On gray-scale ultrasound, the thickness of plantar fascia, its echopattern, presence of hypoechoic areas, and perifasicular collections were recorded. SWE was done by placing seven ROIs within the plantar fascia; and the mean of their Young's modulus was taken in kPa. Plantar fascial thickening more than 4mm had 70% sensitivity and 66.7% specificity, echopattern had 90% sensitivity and 96.7% specificity, hypoechoic areas had 80% sensitivity and 96.7% specificity, and perifascial edema had 26.7% sensitivity and 100% specificity for diagnosing plantar fasciitis. Using the ROC curve, the cut-off value of Young's modulus for the diagnosis of plantar fasciitis was found to be ≤ 99.286kPa. This predicted plantar fasciitis with 97% sensitivity and 100% specificity. The primary diagnostic feature of ultrasound of plantar fascia thickness more than 4mm detected 21 out of 30 cases of plantar fasciitis; whereas elastography detected an additional 8 cases which would have been missed on B-mode ultrasound alone. SWE is a useful supplement and improves the diagnostic accuracy of gray-scale ultrasound in plantar fasciitis.

The relationship between ultrasonography with or without contrast and the clinical outcome in plantar fasciitis

Plantar fasciitis (PF) is a common disorder without objective parameters for disease severity. To investigate whether structural changes in the plantar fascia and heel fat pad determined by ultrasound scanning with or without contrast are related to outcome measures in patients with symptomatic PF and to investigate whether there is an association between changes in US findings and improvement in pain and function. All patients (n=90) in a randomized controlled trial treated with training and/or glucocorticosteroid injection were assessed for morning pain, function pain, Foot Function Index (FFI), and ultrasound measured thickness of the fascia and heel fat pad at entry and after 6months. Thirty patients were included in a longitudinal study that assessed pain, function, and microvascular volume (MV) by contrast-enhanced ultrasound at entry and after 5months of treatment. None of the ultrasound parameters at the initial examination were related to clinical outcomes at 5-6months. Changes in US measured thickness of the fascia but not the fat pad correlated with improvement in all outcome measures at 6months (FFI: r=0.30, p=0.005, morning pain: r=0.21, p=0.046, function pain: r=0.28, p=0.007). MV did not change despite significant improvement in symptoms. Changes in ultrasound measured fascia thickness are associated with clinical improvement in PF patients.

Muscle B mode ultrasound and shear-wave elastography in idiopathic inflammatory myopathies (SWIM): criterion validation against MRI and muscle biopsy findings in an incident patient cohort

BackgroundB mode ultrasound (US) and shear wave elastography (SWE) are easily accessible imaging tools for idiopathic inflammatory myopathies (IIM) but require further validation against standard diagnostic procedures such as MRI and muscle biopsy.MethodsIn this prospective cross-sectional study we compared US findings to MRI and muscle biopsy findings in a group of 18 patients (11 F, 7 M) with active IIM (dermatomyositis 6, necrotising autoimmune myopathy 7, inclusion body myositis 4, overlap myositis 1) who had one or both procedures on the same muscle. US domains (echogenicity, fascial thickness, muscle bulk, shear wave speed and power doppler) in the deltoid and vastus lateralis were compared to MRI domains (muscle oedema, fatty infiltration/atrophy) and muscle biopsy findings (lymphocytic inflammation, myonecrosis, atrophy and fibro-fatty infiltration). A composite index score (1–4) was also used as an arbitrary indicator of overall muscle pathology in biopsies.ResultsIncreased echogenicity correlated with the presence of fatty infiltration/atrophy on MRI (p = 0.047) in the vastus lateralis, and showed a non-significant association with muscle inflammation, myonecrosis, fibrosis and fatty infiltration/atrophy (p > 0.333) Severe echogenicity also had a non-significant association with higher composite biopsy index score in the vastus lateralis (p = 0.380). SWS and US measures of fascial thickness and muscle bulk showed poor discrimination in differentiating between pathologies on MRI or muscle biopsy. Power Doppler measures of vascularity correlated poorly with the presence of oedema on MRI, or with inflammation or fatty infiltration on biopsy. Overall, US was sensitive in detecting the presence of muscle pathology shown on MRI (67–100%) but showed poorer specificity (13–100%). Increased echogenicity showed good sensitivity when detecting muscle pathology (100%) but lacked specificity in differentiating muscle pathologies (0%). Most study participants rated US as the preferred imaging modality.ConclusionsOur findings show that US, in particular muscle echogenicity, has a high sensitivity, but low specificity, for detecting muscle pathology in IIM. Traditional visual grading scores are not IIM-specific and require further modification and validation. Future studies should continue to focus on developing a feasible scoring system, which is reliable and allows translation to clinical practice.

Ultrasound Imaging of the Superficial Fascia in the Upper Limb: Arm and Forearm.

The superficial fascia has received much attention in recent years due to its important role of compartmentalizing the subcutaneous tissue. Ultrasound (US) imaging, owing to its high definition, provides the possibility of better visualizing and measuring its thickness. The aim of this study was to measure and compare, with US imaging, the thickness of superficial fascia in the arm and forearm in different regions/levels. An observational study has been performed using US imaging to measure superficial fascia thickness in the anterior and posterior regions at different levels in a sample of 30 healthy volunteers. The results for superficial fascia thickness revealed statistically significant differences (p < 0.0001) in the arm between the anterior and posterior regions; in terms of forearm, some statistically significant differences were found between regions/levels. However, in the posterior region/levels of the arm, the superficial fascia was thicker (0.53 ± 0.10 mm) than in the forearm (0.41 ± 0.10 mm); regarding the anterior regions/levels, the superficial fascia of the arm (0.40 ± 0.10 mm) was not statistically different than the forearm (0.40 ± 0.12 mm). In addition, the intra-rater reliability was good (ICC2,k: 0.88). US helps to visualize and assess the superficial fascia inside the subcutaneous tissue, improving the diagnosis of fascial dysfunction, and one of the Us parameters to reliably assess is the thickness in different regions and levels.

Sonoelastographic evaluation of plantar fascia in patients with plantar fasciitis: A case–control study

Background: Plantar fascitis causes heel pain and the thickened fascia has specific morphological features that can be utilized for early diagnosis through sonoelastographic evaluation. Aims and Objectives: This case–control study was conducted to find out the role of sonoelastography in the diagnosis of plantar fasciitis (PF). Materials and Methods: A case–control study was conducted in the department of radiodiagnosis in a teaching medical college. Thirtyclinically diagnosed PF patients and thirty controls were recruited based on selection criteria. Shear wave elastography (SWE) was done for all participants and the thickness of plantar fascia and strain ratio was compared between the groups. Plantar fascia thickness (mm) and elasticity (stain ratio) were considered as the primary outcome variable. coGuide software was used for data analysis. Results: The mean age of the cases was 46.73±16.92 years and controls was 47.5±16.1 years. There was no statistical difference observed between cases and controls in age, sex, and body mass index. There was a statistically significant difference in thickness of the plantar fascia (P&lt;0.001) between cases (4.18±0.77 mm) and controls (3.33±0.71 mm). The difference in strain ratio between study groups was statistically significant (P&lt;0.001). The strain ratio had excellent predictive validity with the area under the curve of 0.929 (P&lt;0.001). Data were analyzed using co-Guide software, V.1.03. Conclusion: Ultrasound elastography can detect the thickening of the plantar fascia and strain ratio has excellent predictive validity in predicting PF.

Development and Clinical Evaluation of a Novel Foot Stretching Robot That Simultaneously Stretches Plantar Fascia and Achilles Tendon for Treatment of Plantar Fasciitis.

This paper presents the development and clinical evaluation of a foot stretching robot that simultaneously stretches the plantar fascia and Achilles tendon for the treatment of plantar fasciitis. The therapeutic effectiveness of the robot and feasibility of using metatarsophalangeal joint stiffness as an indicator of recovery were identified through the clinical evaluations. The robot implements an effective foot stretching protocol through a novel mechanism design that simultaneously stretches the plantar fascia and Achilles tendon using a single motor. Thirty patients with plantar fasciitis and fifteen healthy participants volunteered in the cross-sectional clinical evaluation, and nine patients from the patients group participated in the one-month clinical trial. Four main outcomes (Foot Function Index, Visual Analogue Scale-Foot and Ankle, plantar fascia thickness, and metatarsophalangeal joint stiffness) were used for the clinical evaluations. In the cross-sectional clinical evaluation, the symptomatic feet of patients showed moderate negative correlation between normalized metatarsophalangeal joint stiffness and plantar fascia thickness with statistical significance. In the one-month clinical trial, all the main outcomes showed significant improvement after using the developed robot. Comparing our results with previous studies also indicated a therapeutic superiority of our robot for treating plantar fasciitis. Our foot stretching robot had significant therapeutic effect on plantar fasciitis, and normalized metatarsophalangeal joint stiffness measured by our robot could be used as a monitoring indicator for recovery from plantar fasciitis. This study contributed to practical issues related to treatment of plantar fasciitis, and our results could be applied to effective treatment of plantar fasciitis and progressive monitoring of recovery.

Effect of Myofascial Release Technique on Lumbar Fascia Thickness and Low Back Pain: A Clinical Trial

Introduction: This study aims to evaluate the effect of lumbar myofascial release (MFR) technique on pain and thickness of the lumbar fascia tissue in patients with non-specific low back pain.&#x0D; Materials and Methods: In this clinical trial, 20 subjects with non-specific low back pain were treated by MFR on the lumbar region at 4 sessions. Low back pain severity and thickness of the lumbar fascia tissue were assessed by ultrasonographic imaging before and after the intervention.&#x0D; Results: Subjects showed significant reduction in lumbar fascia thickness (P=0.000) and low back pain severity (P=0.000).&#x0D; Conclusion: The lumbar MFR technique is effective in patients with non-specific low back pain due to reducing the lumbar fascia thickness and low back pain.

Functional and radiological outcome of autologous platelet rich plasma in chronic plantar fasciitis: A prospective study

Plantar fasciitis is one of the most common causes of foot pain. It results from sustained stress of weight bearing - hopping, jumping, running -which results in micro trauma to plantar fascia which further leads to plantar fasciitis. It constitutes 11% to 15% of all foot symptoms. Its prevalence is 8% to 10% in general population. It commonly affects at the age of 40 to 60 years. Recently platelet rich plasma was used in treating in degeneration, muscle and tendon injuries. Hence, the present study aimed to assess the treatment outcome of autologous platelet rich plasma injection in treatment of plantar fasciitis. In this prospective study, we enrolled 35 patients with plantar fasciitis coming to OPD or casualty. Patients satisfying inclusion criteria were selected based on consecutive sampling. 11 patients responded well to conservative management and 3 patients had loss of follow up. The different scoring systems were adopted such as VAS and AOFAS for pain assessment. The thickness of plantar fascia was determined by ultrasound technique. Autologous platelet rich plasma was prepared and the same was injected. The outcome analysis was done at 2 weeks, 3 months, and 6 months; and compared with pre injection values. From pre-injection to up to post-6 months period, the VAS reduction was statistically significant (P&amp;#60;0.0001). All the time interval, the AOFAS was increased which was statistically significant (P&amp;#60;0.001). The injection was effective in reducing the thickness of plantar fascia, which was found to be statistically significant at all the time intervals (P&amp;#60;0.001). Autologous PRP injection for chronic plantar fasciitis was found to be an effective treatment modality for chronic plantar fasciitis.

Effectiveness of dextrose prolotherapy for the treatment of chronic plantar fasciitis: A systematic review and meta-analysis of randomized controlled trials.

To systematically investigate the efficacy and safety of dextrose prolotherapy for treating chronic plantar fasciitis. EMBASE, PubMed, Scopus, and Google Scholar (from inception to December 9, 2021). Comprehensive review of randomized controlled trials investigating dextrose prolotherapy for chronic plantar fasciitis was done. Two investigators independently screened the titles, abstracts, and full texts and extracted data from eligible studies. The changes in visual analog scale (VAS) pain score, foot function index (FFI), American Orthopaedic Foot and Ankle Society (AOFAS) score, and plantar fascia thickness were analyzed. Reports of complications of the procedure were collected. Eight randomized controlled trials (RCTs) were included in the meta-analysis, analyzing 444 patients in total. The subgroup analysis showed that at short-term follow-up (<6months) dextrose prolotherapy was more effective in reducing VAS pain score compared to the non-active treatment control group including exercise and normal saline solution (NSS) injection. However, there was no difference in the change of VAS pain score between dextrose prolotherapy and active treatment control group, which included extracorporeal shock wave therapy (ESWT), steroid injection, and platelet-rich plasma (PRP) injection. Dextrose prolotherapy was more effective in reducing FFI, increasing AOFAS score, and reducing plantar fascia thickness at short-term (<6months) follow-up compared to other comparators. For long-term (≥6months) follow-up, there was no significant difference in the change in VAS pain score and FFI between the dextrose prolotherapy group and other comparators. No serious complication was reported. Dextrose prolotherapy is an effective treatment of chronic plantar fasciitis to reduce pain, improve foot functional score, and decrease plantar fascia thickness at short-term follow-up. Further studies in larger populations are needed to identify the optimal treatment regimen including dextrose concentration, volume, injection site, injection technique, and the number of injections required. The long-term effects of these treatments also require further examination.

Outcome of Local Corticosteroid Injection by Ultrasound- versus Palpation-Guided Technique in Plantar Fasciitis

Background: Plantar fasciitis is a common cause of heel pain. Conservative treatment is often effective, but in many cases, invasive procedures may be required. Local corticosteroid injection is the most frequently used invasive technique and can be given under ultrasound (USG) or palpation guidance. We sought to compare the outcome of local corticosteroid injection by USG and palpation guidance in plantar fasciitis. Methods: This was a prospective randomized study of patients who presented with heel pain between July 2015 and November 2016 and were screened for plantar fasciitis by USG. Patients with confirmed plantar fasciitis were managed conservatively for 4 weeks. The 60 consecutive patients not responding to the conservative treatment were randomized into two groups. Group A (n = 30) received a corticosteroid injection under USG guidance. Group B (n = 30) received a corticosteroid injection under palpation guidance. Patients were followed up at 3 and 6 weeks. We compared the visual analog scale score, plantar fascia thickness, and heel pad thickness in both groups. Results: There was significant pain relief in both groups after 3 and 6 weeks of local corticosteroid injection, with greater relief noted in the USG-guided group. There was a significant decrement in plantar fascia thickness in both groups after 3 and 6 weeks; however, a greater decrement was observed in the USG-guided group. Neither group showed a significant difference in heel pad thickness after 3 and 6 weeks. Conclusions: Ultrasound-guided injection provided better pain relief and a greater reduction in plantar fascia thickness than palpation-guided injection.

Childhood type 1 diabetes is associated with abnormal bone development.

ObjectiveTo describe bone mineral density (BMD), bone structure, and fracture prevalence in adolescents with type 1 diabetes (T1D) and explore their associations with glycemic control and microvascular complications.Research design and methodsCross sectional study of 64 adolescents (38 males) with T1D duration >10 years who underwent dual‐energy X‐ray absorptiometry (DXA), peripheral quantitative computed tomography (pQCT), fracture survey, plantar fascia thickness, and microvascular complications assessment.ResultsMean age was 16.6 ± 2.1 years, diabetes duration 12.8 ± 2.2 years and HbA1c 8.9 ± 1.7% (74 mmol/mol). Fracture prevalence was 50%. DXA areal BMD (Z‐score) was reduced for femoral neck (−0.5 ± 1.3, p = 0.008) and arm (−0.4 ± 1.0, p < 0.001), while total areal BMD and lumbar spine BMD were normal. In pQCT (Z‐score), trabecular volumetric BMD (vBMD) was reduced for tibia (−0.4 ± 0.8, p < 0.001) and radius (−0.8 ± 1.4, p < 0.001) whereas cortical vBMD was increased at both sites (tibia: 0.5 ± 0.6, p < 0.001, radius: 0.7 ± 1.5, p < 0.001). Muscle cross‐sectional area (CSA) was reduced for upper (−0.6 ± 1.2, p < 0.001) and lower (−0.4 ± 0.7, p < 0.001) limbs. DXA total areal BMD was positively correlated with BMI (p < 0.01) and age at T1D diagnosis (p = 0.04). Lower radial bone CSA, total and lumbar spine BMD were associated with autonomic nerve dysfunction. HbA1c, diabetes duration, fracture history and other microvascular complications were not significantly associated with bone parameters.ConclusionsAdolescents with childhood‐onset T1D have site‐specific bone deficits in upper and lower limbs but normal total and lumbar spine BMD. T1D appears to have differential effects on trabecular and cortical bone compartments. Future longitudinal analysis is warranted to examine whether these changes translate in to increased fracture risk.

A Prospective Study Comparing the Efficacy of Local Injection of Platelet-Rich Plasma (PRP) vs Methylprednisolone in Plantar Fasciitis

IntroductionPlantar fasciitis is a common musculoskeletal problem in Orthopaedic practice. Heel pain caused due to plantar fasciitis, if persistent, can cause distress to the patient, so the correct intervention at the right time is needed. Plantar fasciitis is also common in the rural population.ObjectivesTo compare the efficacy of local injection of platelet-rich plasma (PRP) and corticosteroid (CS) (methylprednisolone) in patients with chronic plantar fasciitis, and to evaluate the safety, side effect and complications of two different modalities of treatment.Materials and methodsThe study period was between August 2018 and September 2020. After obtaining proper written consent, 110 patients, who were above the age of 18 years and suffering from plantar fasciitis for more than three months, were included in the study. The patient characteristics including gender, age, weight, history of heel pain, duration of symptoms and types of prior treatment were noted. All the 110 patients were subjected to four parameter assessments before administration of the PRP/CS injections. Out of the 110 patients, 55 patients received PRP injection and 55 received CS - 2 ml (40 mg) methylprednisolone with 2 ml of sterile water injections. Post administration of injections, the patients' clinical, radiological, subjective and functional outcomes were assessed at the first, third and sixth month by using the Visual Analog Scale (VAS), Foot and Ankle Outcome Instrument Core Scale (FAI), Roles and Maudsley Scores (RMS), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot scale and ultrasonogram of plantar fascia thickness.DiscussionIn this study, 110 patients were screened and evaluated. Out of these 110 patients, five patients who received PRP and five who received CS were lost for follow-up. Out of the 110 patients, 59 were females and 41 were males. The majority of the patients were in the BMI range of 18.5 to 24.9, with a mean BMI of 23.6. Comparing the results in both the groups reflected an improvement in the group of patients who received PRP injections. Two patients had post-operative complications (superficial infection) in the PRP injection group, while 10 patients had post-procedure complications (five patients developed superficial infections, three patients developed skin depigmentation, and two patients had atrophy of fat pad) in the corticosteroid injections (CSI) group. Infections subsided in all the patients as observed during subsequent follow-up.ConclusionThis study shows that PRP administration is a good method of managing patients suffering from chronic plantar fasciitis, presenting with some discomfort following activity, with more than three months of symptoms and with a VAS score of more than 6 and plantar fascia thickness of 5 mm and failed conservative management. This is evidenced by a comparison of AOFAS, FAI score and thickness of plantar fascia using an ultrasonogram before and after the procedure. This study reflects better treatment outcomes with PRP injection compared to local steroid infiltration. This is the largest series of cases studied compared to other previously available studies in the literature. PRP injections may thus be used as a superior alternative to the already available treatments for chronic heel pain.

Comparison of yoga and dynamic neuromuscular stabilization exercise in chronic low back pain on magnetic resonance imaging of lumbar multifidus- protocol for a randomized controlled trial

BackgroundDegeneration of Lumbar muscle in chronic low back pain (CLBP) is characterized by an increase in fat infiltration of paraspinal muscle, decrease in the cross-sectional area (CSA) of lumbar multifidus muscle (LMM) and increased thickness of Thoracolumbar fascia (TLF) by 25%. The study objective is to compare the effects of yoga and dynamic neuromuscular stabilization (DNS) exercise on CSA, fat infiltration of LMM with magnetic resonance imaging (MRI), and TLF thickness using musculoskeletal ultrasound imaging (MSK-USI) in CLBP. MethodsOne hundred and forty-four participants with CLBP, which persisted longer than three months, will be recruited for this trial. Both group interventions focused on LMM. The experimental group will receive structured yoga sessions, and the Control Group will receive exercise based on DNS. In each group, exercises will be performed for 3–5 days/week and progressed for 12 weeks. Baseline data will be collected, followed by the recording of primary outcome measure (MRI) and secondary outcome measures (MSK-USI, Oswestry disability index, visual analogue score, optimism, self-efficacy, mood, physical activity, fear of movement, pain catastrophizing, and coping) at baseline and the end of 12th weeks. The normality of data will be verified. Based on the data distribution, within-group analysis and between-group analysis will be performed. DiscussionThis will be the first RCT to compare the effect of yoga and DNS exercise among chronic low back pain participants. This will provide evidence of these interventions' impact on CSA, fat infiltration of LMM, and thickness of TLF in CLBP. Registration numberCTRI/2021/08/035984 (This trial was registered prospectively).

Effectiveness and safety of warm needling therapy combined with electroacupuncture for patients with plantar heel pain syndrome: A protocol for systematic review and meta-analysis.

Background:Several studies have reported positive therapeutic effects of electroacupuncture, warm needling, or a combination of the 2 for heel pain; however, the quality of the evidence is limited by methodological limitations. Given that there are no high-quality meta-analyses or reviews incorporating the available evidence, the aim of this study was to systematically review the level I evidence in the literature to determine whether a combination of electroacupuncture and warm needling therapy is more beneficial than acupuncture alone in patients with plantar heel pain syndrome.Methods:From the inception to May 2022, the Wanfang, CNKI, EMBASE, PubMed, Web of Science, and Cochrane Library electronic databases will be searched using the key phrases “acupuncture”, “warm needling”, “electroacupuncture”, “heel pain”, “plantar pain”, and “prospective” for all relevant studies. The outcomes include pain, physical disability, plantar fascia thickness, and foot functional status. Quality assessment of all studies included in this review will be independently assessed by 2 reviewers using the Cochrane Collaborations tool. We consider significant heterogeneity between trials if I2 > 50%, and severe heterogeneity if I2 > 75%. When significant heterogeneity is indicated, we will find the source of heterogeneity by subgroup or sensitivity analysis.Results:The results of our review will be reported strictly following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines and the recommendations of the Cochrane Collaboration.Conclusions:We initially hypothesized that combination therapy would lead to better treatment outcomes.Registration number: 10.17605/OSF.IO/VWBYJ.

Effect of Age and BMI on Sonographic Findings of Plantar Fascia

Biomechanical dysfunction of the foot is most common cause of plantar fascia disorder and obesity and increasing age are well-known risk factors. Due to being inexpensive and quick, ultrasound imaging techniques are considered the modality of choice to assess plantar fascia. The aim of this study was to investigate the effect of age and body mass index (BMI) on sonographic findings of plantar fascia in normal population. Ultrasonography was used to measure the plantar fascia thickness of 148 healthy adults (54 males, 36.5% and 94 females, 63.5%) during a period of one year. The age, BMI, and walking distance of each participant were recorded and statistically analyzed. The mean plantar fascia thicknesses at 0.5, 1.0, and 2.0 cm distal to the insertion of the plantar fascia were 1.76 ± 0.32 mm, 2.50 ± 0.50 mm and 2.11 ± 0.41 mm respectively. The mean plantar fascia thickness for individuals ≥45 years and BMI ≥25 were significantly higher (p < .001) compared to individuals <45 years and BMI <25. In a normal population, the thickness of the plantar fascia determined by ultrasound measurement was less than 3 mm. We recommend using the position 1.0 cm distal to the calcaneal insertion of the plantar fascia as the reference point for diagnosing plantar fasciitis. The thickness of plantar fascia was significantly increased with age and BMI whereas gender, walking activity, exercise and running did not seem to affect the plantar fascia thickness.

Artificial Intelligence Technology Combined with Ultrasound-Guided Needle Knife Interventional Treatment of PF: Improvement of Pain, Fascia Thickness, and Ankle-Foot Function in Patients.

Objective To explore the effect of artificial intelligence (AI) technology combined with ultrasound-guided needle knife intervention in the treatment of plantar fasciitis (PF) on pain, fascia thickness, and ankle and foot function. Methods A total of 130 patients with PF treated in our hospital from January 2019 to April 2021 were enrolled. The patients were randomly assigned into the control group and the study group. The control group received ultrasound-guided needle knife interventional therapy, and the study group received AI technology combined with ultrasound-guided needle knife interventional therapy. The curative effect, VAS score, plantar fascia thickness, plantar fascia elasticity score, plantar fascia blood flow index, and AOFAS score were investigated. Results The total effective rate of the study group was higher compared to that of the control (P < 0.05). There exhibited no significant difference in VAS score before treatment, but the VAS score of the study group was lower compared to that of the control group at 2, 4, and 8 weeks after treatment. There exhibited no significant difference in plantar fascia thickness before treatment (P > 0.05), but after treatment, the plantar fascia thickness in the study group was lower compared to that in the control (P < 0.05). The plantar fascia thickness in the study group was lower compared to that in the control at 2, 4, and 8 weeks after treatment (P < 0.05). In terms of the plantar fascia elasticity score, there exhibited no significant difference before treatment (P > 0.05), but the plantar fascia elasticity score of the study group was lower compared to that of the control at 2, 4, and 8 weeks after treatment (P < 0.05). There exhibited no significant difference in plantar fascia blood flow index before treatment (P > 0.05), but after treatment, the plantar fascia blood flow index in the study group was higher compared to that in the control (P < 0.05). The plantar fascia blood flow index in the study group was higher compared to that in the control at 2, 4, and 8 weeks after treatment (P < 0.05). There exhibited no significant difference in the AOFAS score before treatment, but after treatment, the AOFAS score of the study group was higher compared to that of the control at 2, 4, and 8 weeks after treatment. Conclusion Patients with PF receive AI technology combined with ultrasound-guided needle knife interventional therapy, which can effectively relieve pain and improve fascia thickness and ankle-foot function. Thus, AI technology combined with ultrasound-guided needle knife interventional therapy has the advantages of convenient operation, safety, and effectiveness, which is worthy of clinical application.

Extracellular Matrix Content and Remodeling Does Not Differ Between Higher‐Responders and Lower‐Responders to Resistance Training

ObjectiveTo determine if markers of skeletal muscle extracellular matrix (ECM) content and ECM remodeling are indicators of hypertrophy in previously untrained collage aged males.HypothesesHigher‐responders (HR) to resistance training would demonstrate more malleable changes in assayed ECM markers than lower‐responders (LR).MethodsUntrained, college‐aged males (n=38, 21±3 years old) participated in 10 weeks of full‐body progressive resistance training (2x weekly) which included the leg press, bench press, leg extension, deadlift, and lat pulldown exercises. Participants completed a pre‐testing battery (DXA, ultrasound, pQCT and strength testing) and donated a vastus lateralis (VL) biopsy approximately one week prior to training. Participants completed post‐testing 72 hours following their last training bout, and this mimicked pre‐testing. Participants were then sorted into HR (n=10) and LR (n=10) based on changes in lean body mass, mid‐thigh cross‐sectional area (CSA), VL thickness, and deadlift strength changes. Muscle tissue from these 20 participants were processed for western blotting targeting MMP‐2, MMP‐9, MMP‐14, TIMP‐1, TIMP‐2, collagen‐1, and collagen‐4 protein levels. Global MMP activity was also performed on whole tissue lysates, and fascial thickness was measured from ultrasound images. All dependent variables were analyzed in SPSS (v22.0) using two‐way (group*time) repeated measures ANOVAs.ResultsNo significant group*time interactions or main effects of time were detected for MMP‐2, MMP‐9, TIMP‐1, TIMP‐2, Collagen‐1, or Collagen‐4 protein levels (p &gt; 0.05). MMP activity and VL fascial thickness also revealed no significant group*time interactions or main effects of time (p &gt; 0.05). A significant main effect of time (p = 0.009) and group*time interaction (p = 0.007) was detected for MMP‐14. Further analysis revealed a significant difference between HR and LR prior to training (p = 0.026) along with a significant decrease from pre to post in HR (p = 0.002)ConclusionsOur data suggest that skeletal muscle ECM markers did not differentiate higher‐responders versus lower‐responders to resistance training. However, MMP‐14 was responsive to resistance training and significantly different between response clusters prior to resistance training, and this warrants further investigation.

The impact of hydro‐dissection method in fascial plane delineation of dorsum of human hand

In recent Ayurveda Anatomy education, hydro‐dissection method (HDM) has made technical advancements. It has been introduced as part of regular Ayurveda Anatomy lab. The author undertook investigation of dorsum of an embalmed human hand, using HDM, to visualise and analyse the intricacies of fascial components.Designing and assembling of the hydro‐dissection unit: An instrumentation is prepared, simulating the Sushruta Samhita mentioned method of dissection, for the concerned study. The instrument maintains an optimal standard for hydro‐dissection, monitoring and maintaining the temperature, slipstream, pH of the water and asepsis. The instrument also facilitates adequate visualization of the specimen without compromising the austerity of the procedure.Hydro‐dissection method and hydro‐dissection instruments: A blunt dissection is done using brushes and scrapers of various dimensions which help in segregation and differentiation of structures seen during HDM. Photos and videos along with textual documentation will be performed during the entire duration of each session. Identification and confirmation of the structures will be done by experts. Side‐by‐side comparison with existing atlases will be also done.The dorsal fascia of the hand is situated on the dorsal tendons of dorsal aspect of hand. The superficial fascia or the subcutaneous tissue is described as a layer of loose areolar tissue or adipose tissue. The difference in the thickness of fascia of palmar and dorsal hand is attributed to the difference in the range of mobility of structures passing through these areas. In this experiment, the author has tried to determine the relations in the transitional zones between the mid hand and the fingers by a layer‐by‐layer dissection. The superficial fascia is identified as a double layer of superficial fat and deeper fibrous tissue. It is separated from deeper layers by loose areolar tissue. The deep fascia becomes extremely thin distally. Usually, when the deep fascia becomes thin, it cannot be prepared as a continuous layer beyond the mid hand. As it passes distally, the fascia tends to blend with the superficial fascia. In the current scenario, the author has identified remarkable progress in the dissection, using HDM by delineating various planes of the fascia along with the resident and traversing structures.

ANALYSIS OF CLINICAL PRESENTATION AND INVESTIGATIVE FINDINGS IN PLANTAR FASCIITIS IN TERITIARY CARE HOSPITAL.

Plantar fasciitis is common condition causing severe plantar pain, and the its rst classical striking symptoms and signs are severe plantar pain tenderness of the rst few steps after awakening and causing gait difculty. The early clinical, sonography and laboratory diagnosis conrmation parameters will denitely help in preventing complex plantar fasciitis and its chronicity leading to degeneration, fasciosis and sequalae. The key nding in sonovascular imaging incudes measurement of plantar fascia thickness, echogenicity vascularity and reactive uid. plantar fascial thichkness in mean normal is 0.25 cm and mean abnormal is 0.6 cm suggesting thickness. Above 0.25 cm with associated clinical ndings is signicant and the planning of treatment depends on stage of disease proving the early diagnosis has denite important role in prognosis and follow-up . Aim: To detect and diagnose and establish the Plantar fasciitis. Objectives: Primary objective: Early detection of plantar fasciitis for early intervention in management and preventing the chronicity and its sequelae. Secondary objective: Utilising the signs and symptoms and conrming with sonography, vascular doppler imaging and laboratory data about plantar fasciitis. Site of the study: Department of internal medicine, Department of Radiology and Department of orthopaedics, Apollo Hospitals, Greams road, Chennai-600006. Study period: March 2021 to March 2022 Inclusion criteria: Patients with early morning plantar pain and-clinically suspicious plantar facial minor repitative injury with and with out history of co morbidities. Exclusion criteria: fractures, ischaemic changes, infective abscess.