Fascia Thickness Research Articles

Validity of Ultrasound Imaging Versus Magnetic Resonance Imaging for Measuring Anterior Thigh Muscle, Subcutaneous Fat, and Fascia Thickness.

The aim of the present study was to determine the validity of ultrasound (US) imaging versus magnetic resonance imaging (MRI) for measuring anterior thigh muscle, subcutaneous adipose tissue (SAT), and fascia thickness. Twenty healthy, moderately active participants (aged 49.1 ± 9.74 (36–64) years), underwent imaging of the anterior thigh, using ultrasound and MRI modalities on the same day. Images were analyzed offline to assess the level of agreement between US and MRI measurements. Pearson’s correlation coefficient showed an excellent relationship between US imaging and MRI for measuring muscle (r = 0.99, p < 0.01), SAT (r = 0.99, p < 0.01), and non-contractile tissue (SAT combined with perimuscular fascia) thickness (r = 0.99, p < 0.01). Perimuscular fascia thickness measurement showed a poor correlation between modalities (r = 0.39, p < 0.01). Intra-class correlation coefficients (ICC3,1) also showed excellent correlation of the measurements with ICC = 0.99 for muscle thickness, SAT, and non-contractile tissue, but not for perimuscular fascia, which showed poor agreement ICC = 0.36. Bland and Altman plots demonstrated excellent agreement between US imaging and MRI measurements. Criterion validity was demonstrated for US imaging against MRI, for measuring thickness of muscle and SAT, but not perimuscular fascia alone on the anterior thigh. The US imaging technique is therefore applicable for research and clinical purposes for muscle and SAT.

An investigation of the relationship between plantar pressure distribution and the morphologic and mechanic properties of the intrinsic foot muscles and plantar fascia

BackgroundThe purpose of this study was to investigate the relationship between plantar pressure distribution and the stiffness, thickness, and cross-sectional area of the plantar fascia (PF) and abductor hallucis (AbH), flexor hallucis brevis (FHB), and flexor digitorum brevis (FDB) muscles. MethodsThe present study included a total of 41 healthy females between the ages of 20 and 34 years. Plantar pressure during static standing position was measured using a pedobarography system (MatScan, Tekscan, Inc., South Boston, Massachusetts, USA). Peak pressure, mean pressure, maximum force (Max-F), contact area (Con-A), pressure time integral, and force time integral (FTI) were measured. The thickness, cross-sectional area and stiffness of the intrinsic foot muscles and PF were measured using an ACUSON S3000 Ultrasound System and a 9L4 probe (4–9 MHz) (Siemens Medical Solution, Mountain View, CA, USA). Shear Wave Velocity (SWV) of the intrinsic foot muscles and PF was measured using a customized software program (Virtual Touch Imaging and Quantification; Siemens Medical Solution). ResultsCon-A had a moderate correlation with the thickness and cross-sectional area of PF, AbH, FHB, and FDB. A fair to moderate correlation was found between heel Max-F and the thickness and cross-sectional area of PF, AbH, FHB, and FDB. There is no significant correlation between the SWV of the assessed tissues and plantar pressure distribution parameters. Body mass and BMI had a fair to good correlation with Mean-P, Con-A, heel Max-F, midfoot Max-F, metatarsal Max-F, FTI, thickness, and cross-sectional area of the PF and assessed muscles SignificanceThe results suggest that abnormal force, contact area, and higher body mass may cause hypertrophy of the PF and foot intrinsic muscles.

Plantar fasciitis in patients with type 1 and type 2 diabetes: A contemporary cohort study

ObjectiveHyperglycemia leads to increase advanced glycation end products (AGEs) in patients with type 1 and type 2 diabetes. Subsequently, formation of AGEs can cause increased plantar fascial thickness (PFT), an imaging feature of plantar fasciitis (PF). This study evaluates the prevalence of PF in a contemporary cohort of type 1 diabetes and type 2 diabetes patients managed according to current standards, compared to patients without diabetes. Research design and methodsThis is a five-year prevalence study in a large tertiary health system (approximately 535,000 patients/visits/year) with a single electronic medical record (EMR), applying a cohort discovery tool and database screen (Data Direct) with use of ICD-9 and ICD-10 codes. All patients with a PF diagnosis between 01/01/2011 and 01/01/2016 were included and divided into 3 groups: type 1 diabetes (7148 patients), type 2 diabetes (61,632 patients), and no diabetes (653,659 patients). Prevalence rates were calculated, accounting for other risk factors including BMI and gender using Fisher's exact test. ResultsThe overall prevalence of PF in the entire study population was 0.85%. Prevalence rates were higher in patients with diabetes, particularly with type 2 diabetes (42% and 64% higher compared with patients with type 1 diabetes and no diabetes respectively). Individually, PF rates were 0.92% in type 1 diabetes and 1.31% in type 2 diabetes compared with 0.80% in patients with no diabetes (Type 1 vs. no diabetes p = 0.26; Type 2 vs. no diabetes p ≪ 0.0001; Type 1 vs. Type 2 diabetes p = 0.0054). Females in all groups had higher prevalence of PF than males (p ≪ 0.0001 for all), with those patients with diabetes having higher prevalence rates than those without diabetes. Patients with higher BMI levels (BMI ≥ 30 kg/m2) were also more likely to have PF in all categories except males with type 1 diabetes (p = 0.40). ConclusionsIn this large contemporary population managed in a tertiary health system, prevalence rates of PF were substantially higher in patients with diabetes compared with no diabetes, particularly in type 2 diabetes. Female gender and higher BMI were also associated with higher prevalence of PF in this cohort.

Tumbling Triceps in Gymnastics

HISTORY: 21 year old female, D-1 gymnast, with 2 weeks of tight and achy right triceps pain. Athlete noted pain after practice, denies specific injury. Her pain is worse with resisted elbow extension. She is treating conservatively, rehabbing with ATC with strengthening both shoulder and arm, and is now tolerating forward tumbling, but soreness remains with backward tumbling. She feels she has plateaued in progress. PE: Grossly unremarkable, no ecchymosis or swelling. She has tenderness to triceps muscle belly without palpable muscle defect. ROM and strength are intact at her shoulder and elbow. She is neurologically intact distally. DDX:Triceps tear, triceps tendinopathy, shoulder pathology TEST & RESULTS: MSK US-proximal, mid belly of long head of triceps muscle fiber disruption with 2 cm fiber gap and hematoma. Extensive hyperemia in zone of injury and 8 cm of fascial thickening. Active contraction demonstrates fiber gap without contraction at zone of injury and abnormal contraction of surrounding fibers. FINAL/WORKING DX: Acute tear of right triceps, long head, grade 2b TREATMENT & OUTCOMES: Platelet-rich plasma injection into triceps tear followed by compression and 2 days rest. Progressive, sport-specific, pain-free strengthening with ATC guidance. Athlete avoided weight bearing on hands and stretching of triceps. She tolerated dance and trampoline work without issue. Upon reaching 80% speed/power without pain or functional limitation, 2 weeks after diagnosis, we performed serial US exams to evaluate tissue healing and guide progressive muscle loading. 2 week US demonstrated decreased fascial thickening, 2 cm fiber gap w/hyperemia persisted. Absent contraction at site of injury remained, abnormal contraction of surrounding fibers was improved. Continued rehab, did not progress beyond 80% at this time regardless of pain-free status. 4 week US revealed resolution of hematoma and fascial edema. Mild hyperemia remained at zone of injury. Some abnormal contraction at site of injury present, and normalized contraction of surrounding fibers. Athlete was released to gradually RTP under ATC guidance. Athlete progressed overhead loading, reached 100% power/speed and was advanced to forward and eventually backward tumbling. She tolerated full RTP 8 weeks after initial US. Athlete remains without re-injury.

Comparison of effects of low-level laser therapy and extracorporeal shock wave therapy in plantar fasciitis treatment: A randomized, prospective, single-blind clinical study.

The aim of this study is to compare the efficacy of extracorporeal shock wave therapy (ESWT) and low-level laser therapy (LLLT) in terms of fascia thickness, heel pain, and foot functions in patients with plantar fasciitis (PF). Between April 2015 and October 2015, a total of 34 patients (5 males, 29 females; mean age 51.5±10.8 years; range, 18 to 65 years) with PF were randomized into two treatment groups to receive either ESWT or LLLT using closed envelope method. The patients were evaluated before and after treatment and one month after treatment using the visual analog scale (VAS)-pain, Foot Function Index (FFI), and plantar fascia thickness measured by ultrasonography. A significant improvement in the VAS-pain and FFI scores and plantar fascia thickness was observed in both groups after treatment and one month after treatment, compared to pre-treatment values (p<0.05). Changes over time in these outcome parameters were not different between study groups (p>0.05). Our study results suggest that both ESWT and LLLT seem to be effective on pain, foot functions, and fascia thickness in the treatment of PF.Presented at the 26th National Congress of Physical Medicine and Rehabilitation, April 25-29, 2017 Antalya, Turkey.

Parameters and Effects of Photobiomodulation in Plantar Fasciitis: A Meta-Analysis and Systematic Review.

Objective: This systematic review and meta-analysis updated the effects of photobiomodulation therapy (PBMT) on pain, the Foot Function Index (FFI), and the effects on fascial thickness in adults with acute or chronic plantar fasciitis (PF). Methods: A systematic literature search was conducted in the PubMed (Public/Publisher MEDLINE), EMBASE (Excerpta Medica Database), and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases. Two researchers independently screened titles and abstracts of the retrieved studies for eligibility. A random-effects model was used for this meta-analysis. Subgroup meta-analyses were conducted to evaluate the influence of PBMT in pain and foot function under investigation and the study design on the overall weighted mean effect size. Results: From a total of 3865 studies, 7 randomized controlled trials were selected after final review and 4 were selected for meta-analysis. There was a significant difference between PBMT and control for Visual Analog Scale (Chi2 = 29.30; p < 0.00001) with an I2 value of 90% in favor of PBMT versus the control. The overall effect of PBMT was statistically significant (p < 0.02) with PBMT favoring for thickness of the plantar fascia reduction. FFI between PBMT and control group [Chi2 -83.46, df = 1 (p < 0.00001)]; I2 = 99% in favor of the PBMT. Conclusions: This meta-analysis presents evidence that PBMT is an effective treatment modality to reduce pain and improvement of foot function in patients with chronic PF, however, a broad discrepancy was found in the PBMT dosimetry. The ideal treatment parameters for PF need to be elucidated.

Ultrasonography Features of the Plantar Fascia Complex in Patients with Chronic Non-Insertional Achilles Tendinopathy: A Case-Control Study.

Purpose: The goal of the present study was to assess, by ultrasound imaging (USI), the thickness of the plantar fascia (PF) at the insertion of the calcaneus, mid and forefoot fascial locations, and the calcaneal fat pad (CFP) in patients with Achilles tendinopathy (AT). Methods: An observational case-control study. A total sample of 143 individuals from 18 to 55 years was evaluated by USI in the study. The sample was divided into two groups: A group composed of the chronic non-insertional AT (n = 71) and B group comprised by healthy subjects (n = 72). The PF thicknesses at insertion on the calcaneus, midfoot, rearfoot and CFP were evaluated by USI. Results: the CFP and PF at the calcaneus thickness showed statistically significant differences (P < 0.01) with a decrease for the tendinopathy group with respect to the control group. For the PF midfoot and forefoot thickness, no significant differences (P > 0.05) were observed between groups. Conclusion: The thickness of the PF at the insertion and the CPF is reduced in patients with AT measured by USI.

Comparison of Foot Structure, Function, Plantar Pressure and Balance Ability According to the Body Mass Index of Young Adults.

ObjectivesThis study compared foot arch height, plantar fascia thickness, a range of motion assessments of the ankle joint, strength of the ankle joint, plantar pressure, and balance between obese and normal weight young adults.MethodsFifty-two participants were required for the present study design to achieve 80% power, 0.8 effect size (η2), and an alpha level of 0.05. The participants were categorized to normal weight or obese groups based on BMI (≤ 24 kg/m2 and ≥ 25 kg/m2, respectively). The foot and ankle disability index and Sport survey were completed by the participants before the measurements. Foot arch height was measured using the navicular drop test, and plantar fascia thickness was measured using ultrasound. Plantar pressure and balance tests were also conducted, followed by ankle joint range of motion and strength tests.ResultsFoot arch height and plantar fascia thickness was significantly higher in the obese group compared with the normal weight group (p < 0.01). There were significant differences in eversion of ankle strength, plantar pressure in the big toe and heel and anterior-posterior balance between normal and obese weight groups (p < 0.05).ConclusionObese young adults had more abnormalities in the medial longitudinal arch, plantar fascia, and plantar pressure as well as weakened ankle eversion strength and balance problems compared with the normal weight group.

Active Muscle Trigger Points Are Associated with Pain and Related Disability in Patients with Plantar Heel Pain: A Case-Control Study.

Pain experienced by patients with plantar heel pain has been associated with fascia thickness. It is possible that referred muscle pain may also be related to symptoms experienced by these patients. Our aim was to systematically investigate if the referred pain elicited by trigger points in the leg and foot musculature reproduces the symptoms in individuals with plantar heel pain and to determine the association of trigger points (TrPs) with pain and related disability. A case-control study was conducted. Thirty-five individuals with unilateral chronic plantar heel pain and 35 matched comparable healthy controls participated. An assessor blinded to the subject's condition explored TrPs in the flexor hallucis brevis, adductor hallucis, quadratus plantae, and internal gastrocnemius. Pain and related disability were assessed with a numerical pain rating scale (0-10), the Foot Function Index, and the Foot Health Status Questionnaire. The number of TrPs for each patient with plantar heel pain was 4 ± 3 (2.5 ± 2 active TrPs, 1.5 ± 1.8 latent TrPs). Healthy controls only had latent TrPs (mean = 1 ± 1). Active TrPs in the quadratus plantae (N = 20, 62.5%), and flexor hallucis brevis (N = 19, 59%) were the most prevalent in patients with plantar heel pain. A greater number of active, but not latent, TrPs was associated with higher foot pain variables (0.413 < rs < 0.561, P < 0.01), higher impact of foot pain (0.350 < rs < 0.473, P < 0.05) and worse related disability (-0.447 < rs < -0.35456, P < 0.05). The referred pain elicited by active TrPs in the foot muscles reproduced the symptoms in patients with plantar heel pain. A greater number of active TrPs was associated with higher pain and related disability in patients with plantar heel pain.

Ultrasound elastographic assessment of plantar fascia in runners using rearfoot strike and forefoot strike

Forefoot strike is increasingly being adopted by runners because it can better attenuate impact than rearfoot strike. However, forefoot strike may overload the plantar fascia and alter the plantar fascia elasticity. This study aimed to use ultrasound elastography to investigate and compare shear wave elasticity of the plantar fascia between rearfoot strikers and forefoot strikers. A total of 35 participants (21 rearfoot strikers and 14 forefoot strikers), who were free of lower limb injuries and diseases, were recruited from a local running club. Individual foot strike patterns were identified through the measured plantar pressure during treadmill running. The B-Mode ultrasound images and shear wave elastographic images of the plantar fascia were collected from each runner. Two independent investigators reviewed the images and examined the plantar fascia qualitatively and quantitatively. The results demonstrated an overall good agreement between the investigators in the image review outcomes (ICC:0.96–0.98, κ: 0.89). There were no significant differences in the fascial thickness (p = 0.50) and hypoechogenicity on the gray-scale images (p = 0.54) between the two groups. Shear wave elastography showed that forefoot strikers exhibited reduced plantar fascia elasticity compared to rearfoot strikers (p = 0.01, Cohen’s d = 0.91). A less elastic fascial tissue was more easily strained under loading. Tissue overstrain is frequently related to the incidence of plantar fasciitis. While further study is needed for firm conclusions, runners using forefoot strike were encouraged to enhance their foot strength for better protection of the plantar fascia.

SONOGRAPHIC EVALUATION OF PLANTAR FASCIA FOLLOWING LOW-LEVEL LASER THERAPY IN PLANTAR FASCIITIS

Background: Plantar fasciitis is the most common cause of inferior heel pain resulted from repeated trauma leading to a microscopic tear in the plantar fascia. There is a need to study the non-invasive nature of low-level laser therapy in reducing pain and enhance healing. Therefore the study aimed to find out the efficacy of low-level laser therapy in plantar fasciitis. Methods: The study design is a pre-post experimental design. Thirty patients(21 females & 9 males) with plantar fasciitis who fulfilled the inclusion criteria participated in the study. Baseline parameters using musculoskeletal ultrasonogram of the plantar fascia, numerical pain rating scale, ankle joint mobility testing and foot and ankle ability measure questionnaire were recorded. Subjects in the control group received ultrasonic therapy, while the experimental group received irradiation of Low-Level Laser Therapy (LLLT) for two weeks comprising 12 sessions and the above-specified outcome measures were re-evaluated after two weeks. Results: The results showed significant improvement in pain severity (p<0.04) and ankle dorsiflexion range of motion (p<0.00) and ankle ability measure but no significant change in plantar fascia thickness following low-level laser therapy was observed. A positive correlation (r=0.9) was found between plantar fascia thickness and post foot and ankle ability measure-ADL scores (p=0.02). Conclusion: The findings suggest that low-level laser therapy helps in pain reduction and improving range of motion in plantar fasciitis with minimal effect on the thickness of plantar fascia.

Topographical Pressure Pain Sensitivity Maps of the Feet Reveal Bilateral Pain Sensitivity in Patients With Unilateral Plantar Heel Pain.

Plantar heel pain is one of the most common foot pain conditions treated by health care providers. To investigate differences in topographical pressure pain sensitivity maps of the feet between patients with unilateral plantar heel pain and healthy individuals, and to determine the relationship between topographical pressure maps, pain intensity, disability, and fascia thickness. Thirty-five patients with unilateral plantar heel pain and 35 matched healthy controls participated in this cross-sectional, case-control study. Pressure pain thresholds (PPTs) were assessed over 7 plantar locations on each foot. Topographical pressure pain sensitivity maps of the plantar region were generated using the averaged PPT of each assessed point. Pain and related disability were assessed with a numeric pain-rating scale (0-10) and the Foot and Ankle Ability Measure, respectively. Plantar fascia thickness was measured via ultrasound. All outcomes were obtained by an assessor blinded to the participants' condition. Topographical pressure sensitivity maps revealed lower bilateral PPTs in patients with plantar heel pain compared to healthy controls, and a higher PPT on the calcaneus bone (P<.01). Women had lower PPTs than men in all areas (P<.001). Individuals with plantar heel pain also had thicker fascia, but only on the affected side, compared to healthy controls. Higher pressure pain sensitivity in the foot was associated with higher pain intensity at first step in the morning and thicker fascia at the calcaneus bone. People with unilateral plantar heel pain had generalized bilateral pressure pain sensitivity in the plantar region of the foot. Greater pain intensity and fascia thickness were associated with higher pressure pain sensitivity in people with plantar heel pain. Case-control study, level 4. J Orthop Sports Phys Ther 2019;49(9):640-646. Epub 26 Mar 2019. doi:10.2519/jospt.2019.8813.

Plantar fasciitis treated with endoscopic partial plantar fasciotomy—One-year clinical and ultrasonographic follow-up

BackgroundEndoscopic operations for plantar fasciitis generally have good clinical outcome. The aim of this study was to record the effect of endoscopic partial fasciotomy and heel spur removal and evaluate by ultrasonography whether the fascia regenerates and the heel spur reforms. MethodsEleven consecutive patients were evaluated before and 3, 6 and 12 months after surgery. Operations were performed endoscopically using a deep fascial approach with a medial and a lateral portal. Bony spurs were removed and the medial half of the plantar fascia was transected. All patients followed a standardized rehabilitation program. ResultsMedian Foot Function Index values decreased from 119 pre-surgery to 69 and 12 (p=0.004), at 3 months and 1year post-operatively respectively. Median VAS-score for first step pain was likewise reduced from median 71mm to 29mm and 7mm (p=0.004), respectively. Median fascial thickness at the medial insertion was 6.0mm (range 4.6–6.8mm) pre-operatively. A heel spur was present in 9 cases. One year postoperatively a well-defined fascia in the area of resection was demonstrated in 8 cases. In the rest of the cases scar tissue made it impossible to clearly outline the fascia. Nine of the feet showed good medial fascial tensioning. There was no evidence of recurrence of the bony spur. ConclusionsEndoscopic partial plantar fascia resection reduced pain symptoms and increased function significantly 3 months after operation, with additional effect achieved 12 months after surgery. Based on ultrasonography the resected fascia regenerated/healed, and a calcaneal spur did not recur.

Medical Image Analysis Based on T2 Mapping and Intravoxel-Incoherent-Motion Diffusion-Weighted Imaging in the Diagnosis of Plantar Fasciitis

Objective: Plantar fasciitis is the most common cause of heel pain, which often influence the patient's daily activities. An early and quantitative evaluation helps an effective treatment in plantar fasciitis. Our aims were to explore the feasibility of T2 mapping and intravoxel-incoherent-motion diffusion-weighted imaging (IVIM-DWI) in the quantitative evaluation of plantar fasciitis. Methods: A 3.0T MR scanner was performed on 23 feet of 18 patients with plantar fasciitis and 24 feet of 19 healthy subjects. The imaging protocol consisted of conventional sequences including coronal and sagittal T1- and T2-weighted imaging (T2WI) with and without fat saturation, as well as T2 mapping and IVIM-DWI. The fascial thickness, effusion, tissue edema and other related manifestations were noted. The quantitative parameters including D, D*, f, and T2 values were measured in the fascia, muscle, and subcutaneous fat pad, respectively. Two independent t-test was mainly used for statistical analysis.Results: Qualitatively, bone spur, subcutaneous effusion, and soft tissue edema around the plantar fascia were observed; the fascias were thickened; and the signal intensity of T2WI of soft tissues increased in the patients compared to the healthy subjects. Quantitatively, both D and T2 values were found significant differences in the fascia, muscle, and fat pad between the patients and healthy subjects, except D *; and f values. Conclusions: Both T2 mapping and IVIM-DWI had high clinical values in the quantitative evaluation of plantar fasciitis. D and T2 values may be useful surrogate markers in predicting the severity of plantar fasciitis clinically.

Platelet-Rich Plasma in Treatment of Plantar Fasciitis: Randomized Double-Blinded Placebo Controlled Study

The use of PRP injection for treatment of plantar fasciitis resulted in significant improvement in pain according to VAS, PRS, and FFI and a reduction in the thickness of the plantar fascia as measured by US, compared to the saline group.

Role of platelet-rich plasma versus corticosteroid injection in the treatment of plantar fasciitis: A comparative study

Introduction: Platelet-rich plasma (PRP) is promoted nowadays as an ideal autologous biological blood-derived product. It enhances wound healing, bone healing, tendon healing and is currently being widely used. Aims and Objectives: A prospective cohort study was conducted to assess the efficacy of autologous PRP injection and to compare it with corticosteroid injection in the treatment of plantar fasciitis (PF). Materials and Methods: Fifty patients were included in the study and divided into two groups. Group I (25 patients) received PRP injection and Group II (25 patients) were given steroid injection. Patients were clinically assessed at different intervals. Functional outcome was evaluated on the basis of the visual analog scale (VAS) and foot and ankle ability measure (FAAM) scores. Plantar fascia thickness was assessed pre- and post-injection by ultrasound. Results: PRP and corticosteroid injection groups at the initial visit had VAS score of 8.86 and 8.60, respectively, which was reduced to 1.52 and 3.10 at the end of 6 months. The PRP and corticosteroid injection groups at the initial visit had FAAM score of 29.2 and 30.8, respectively, which increased to 84.2 and 68.3 at the end of 6 months. After injection, the PRP group had a significant reduction (34.80%) in the thickness of plantar fascia as compared to corticosteroid group (29.54%). Conclusion: Treatment of PF with PRP extract reduces pain and significantly increases function, exceeding the effect of steroid on long-term follow-up.

Thickness of the Plantar Fascia in Asymptomatic Subjects.

Objectives:The objectives of this study are to determine the average and extreme values of the thickness of plantar fascia (PF) and to evaluate its correlations with anthropometric parameters and walking activity.Materials and Methods:Analytic study of 226 feet. On these feet, the thickness of the PF was measured on ultrasound; and its correlation with the age, height, weight, body mass index (BMI), gender, and daily walking of the participants were studied.Results:Thickness of the PF was symmetrical; the extreme values were 1.8 mm and 4.3 mm with an average of 3 mm ± 0.5. There was positive correlation of PF thickness with age, height, weight, BMI, and daily walking (P < 0.05). The variation of the PF thickness with gender was not significant (P > 0.05).Conclusion:Thickness of PF has a close correlates with age, height, weight, BMI, and walking activity.

Noninvasive in Vivo Study of the Morphology and Mechanical Properties of Plantar Fascia Based on Ultrasound

The overall distributions of the plantar fascia thickness and Young’s modulus in the ten subjects were systematically investigated in this paper using two-dimensional ultrasound and shear wave elastography (SWE). The statistical analyses showed that ICC1,1 of the plantar fascia thickness and Young’s modulus ranged from 0.950 to 0.991, with the 95% CI in the range of 0.953–0.996. This result indicated that the thickness and Young’s modulus exhibited excellent retest reliability. The conclusion that both the thickness, $d$ , and Young’s modulus, $E$ , of the plantar fascia showed a simple and specific spatial dependence on the characteristics of the gradient distribution can be drawn. As the plantar fascia extends from the calcaneus to the five toes, both the thickness, $d$ , and Young’s modulus, $E$ , of the five bundles of plantar fascia showed a downward trend of a negative exponential function, and the thickness, $d$ , and Young’s modulus, $E$ , were the largest at the tubercle of the calcaneus and closest to the lowest value at the tubercles of the five metatarsal bones. The coefficient of determination (R2) of the fitting curve of thickness, $d$ , and Young’s modulus, $E$ , was higher than 0.959 in all ten subjects. The distribution characteristics of the plantar fascia thickness, $d$ , and Young’s modulus, $E$ , showed good consistency in the healthy subjects in this paper. The conclusions of this paper may provide more accurate references and a basis for material mechanics data for plantar fascia diseases (such as fasciitis) and foot mechanical models (such as finite element models).

Radial extracorporeal shock wave device appearance does not influence clinical outcomes: A randomized controlled trial.

To determine whether the appearance of a radial extracorporeal shock wave device affects clinical outcomes in chronic plantar fasciitis. Randomized controlled parallel assessor-blinded clinical trial. A total of 135 patients were assigned to 3 groups: group I, standard radial extracorporeal shock wave device; group II, standard radial extracorporeal shock wave device modified to give a more sophisticated appearance; group III, standard radial extracorporeal shock wave device modified to give a more austere appearance. The radial extracorporeal shock waves emitted by the 3 devices were identical. Primary outcome was foot function, measured with the Foot Function Index. Secondary outcomes were pain at different times, measured with a visual analogue scale, and plantar fascia thickness, measured with ultrasound. All variables decreased significantly from baseline assessment, in all 3 groups and at all time-points: 1, 2, 4 and 14 months after the last session (p < 0.001). There were no significant differences between groups for any of the variables assessed. Device appearance had no statistically significant influence on clinical outcomes in patients with chronic plantar fasciitis treated with radial extracorporeal shock wave therapy.

Case of acute unilateral emphysematous pyelonephritis and bacteraemia on treatment with canagliflozin

Despite the fact that sodium glucose cotransporter 2 inhibitors (SGLT2-i) have proven efficacy in controlling hyperglycaemia and reducing cardiovascular outcomes, their adverse effects on the urogenital tract remain a concern.1...