Fascia Thickness Research Articles

UVA-1 phototherapy as adjuvant treatment for eosinophilic fasciitis: in vitro and in vivo functional characterization.

IntroductionEosinophilic fasciitis (EF) is a rare autoimmune disease causing progressive induration of dermal, hypodermal, and muscularis fascia. The exact pathogenesis is yet to be fully understood, and a validated therapy protocol still lacks. We here aimed to realize a clinical–functional characterization of these patients.Materials and methodsA total of eight patients (five males, 45 years average) were treated with adjuvant high‐dose UVA‐1 phototherapy (90 J/cm), after having received the standard systemic immunosuppressive protocol (oral methylprednisolone switched to methotrexate). Body lesion mapping, Localized Scleroderma Assessment Tool (LoSCAT), Dermatology Life Quality Index (DLQI), High‐Resolution Ultrasound (HRUS) (13‐17MHz), and ultra HRUS (55–70 MHz) were performed at each examination time taking specific anatomical points. Gene expression analysis at a molecular level and in vitro UVA‐1 irradiation was realized on lesional fibroblasts primary cultures.ResultsThe LoSCAT and the DLQI showed to decrease significantly starting from the last UVA‐1 session. A significant reduction in muscularis fascia thickness (−50% on average) was estimated starting from 3 months after the last UVA‐1 session and maintained up to 12 months follow‐up. Tissues was detected by HRUS. The UVA‐1 in vitro irradiation of lesional skin sites cells appeared not to affect their viability. Molecular genes analysis revealed a significant reduction of IL‐1ß and of TGF‐ß genes after phototherapy, while MMPs 1,2,9 gene expression was enhanced.CommentThese preliminary in vivo and in vitro findings suggest that UVA‐1 phototherapy is a safe and useful adjuvant therapy able to elicit anti‐inflammatory effects and stimulate tissue matrix digestion and remodeling at lesional sites.

Ultrasound Imaging of Brachial and Antebrachial Fasciae.

Knowledge about fasciae has become increasingly relevant in connection to regional anesthesiology, given the growing interest in fascial plane, interfascial, and nerve blocks. Ultrasound (US) imaging, thanks to high definition, provides the possibility to visualize and measure their thickness. The purpose of this study was to measure and compare, by US imaging, the thickness of deep/muscular fasciae in different points of the arm and forearm. An observational study has been performed using US imaging to measure brachial and antebrachial fasciae thickness at anterior and posterior regions, respectively, of the arm and forearm at different levels with a new protocol in a sample of 25 healthy volunteers. Results of fascial thickness revealed statistically significant differences (p < 0.0001) in the brachial fascia between the anterior and the posterior regions; in terms of the antebrachial fascia, no statistically significant difference was present (p > 0.05) between the regions/levels. Moreover, regarding the posterior region/levels, the brachial fascia had a greater thickness (mean 0.81 ± 0.20 mm) than the antebrachial fascia (mean 0.71 ± 0.20 mm); regarding the anterior region/levels, the antebrachial fascia was thicker (mean 0.70 ± 0.2 mm) than the brachial fascia (mean 0.61 ± 0.11 mm). In addition, the intra-rater reliability reported good reliability (ICC2,k: 0.88). US imaging helps to improve grading of fascial dysfunction or disease by revealing subclinical lesions, clinically invisible fascial changes, and one of the US parameters to reliably evaluate is the thickness in the different regions and levels.

Prediction of clinical response to corticosteroid or platelet-rich plasma injection in plantar fasciitis with MRI: A prospective, randomized, double-blinded study

PurposeThe purpose of this study was to identify association between magnetic resonance imaging (MRI) features and clinical data at baseline and six months following platelet-rich plasma (PRP) or corticosteroid (CS; cortivazol) injection in patients with plantar fasciitis, and to identify initial MRI criteria associated with a favorable clinical response to treatment. Material and methodsThe study was registered on ClinicalTrials.gov (NCT03857334). MRI examinations of 36 patients with plantar fasciitis lasting more than 3 months who were randomly assigned to receive ultrasound-guided PRP (PRP group, 20 patients) or CS (CS group, 18 patients) injection were quantitatively and qualitatively analyzed with respect to plantar fascia thickness, plantar fascia hyperintensity on T2-weighted STIR (HSTIR) images, calcaneal bone marrow and surrounding soft tissues. Clinical evaluation including visual analytic scale (VAS) assessment and MRI examinations were obtained before and 6 months after treatment. Good clinical response was defined as pain VAS decrease > 50% at 6 months. ROC curves with AUC measurements were used to determine cut-off points. ResultsIn the whole study population, an association was found between MRI features (deep soft tissue and calcaneal bone marrow HSTIR) and pain VAS scores for the first steps of the day (P = 0.028 and P = 0.007, respectively). No significant radioclinical associations on post-treatment MRI examinations were found in either group. Initial coronal thickness of plantar fascia was associated with a good clinical response in the CS group (P < 0.01). ROC curve analysis found that 7-mm or thicker plantar aponeurosis at initial MRI was predictive of good clinical response in patients with CS treatment (Youden index = 0.6). PRP infiltrations were effective regardless of fascia thickness (73% of patients with ≤ 7 mm aponeurosis and 67% for thicker ones). ConclusionInitial facia thickness (> 7 mm) is predictive of good clinical response six months after CS injection, whereas PRP injection shows effectiveness regardless of fascia thickness.

Irregularity in Plantar Fascia, Muscle Edema and Tendon Thickness in Patients with High-Risk for Diabetic Foot.

To investigate the alterations in the plantar fascia (PF), intrinsic muscles, and tendons in the feet of patients at high risk for developing diabetic foot. The healthy feet of 22 patients with type 2 diabetes, who had developed diabetic foot ulcers on a single foot without any pathology on the contralateral extremity, and those of 22 healthy volunteers were evaluated by magnetic resonance imaging. The volume of the Achilles tendon (AT), the surface area of the PF, the thickness of AT, flexor hallucis longus, flexor digitorum longus, tibialis posterior, and peroneus longus tendons, irregularity in the PF, and edema of intrinsic foot muscles were examined. Nineteen patients (86%) had irregularity in the PF, whereas none of the healthy controls had any (p<0.001). Intrinsic muscle edema was more common in the group with diabetes (p=0.006). The volume of AT and the surface area of PF were decreased in patients with peripheral arterial disease (PAD) (p<0.05). Patients with diabetes mellitus but without PAD had a larger surface area of PF than that of controls (p<0.05). There were no differences in the volume of AT, the surface area of the PF, and other tendon thickness between the groups. Irregularity in the PF and muscle edema may indicate a high risk for the diabetic foot. The presence of PAD may lead to regression in the structure of AT and PF.

Evaluation of plantar fasciitis improvement after shock wave therapy in calcaneal spur patients by musculoskeletal ultrasonography

BackgroundPlantar fasciitis due to calcaneal spur is a common cause of heel pain and functional disability, and its management presents a huge challenge for clinicians which results sometimes in unpleasant clinical outcomes. The efficacy of extracorporeal shock wave therapy (ESWT) as an alternative therapeutic option to surgical management after failure of conservative treatment has been addressed. Our aim was to evaluate the efficacy of ESWT in the treatment of plantar fasciitis in calcaneal spur patients using ultrasonography.ResultsThe mean plantar fascia (PF) thickness was statistically significantly higher in the calcaneal spur patient group (5.66 ± 1.14 mm) than in the healthy control group (2.40 ± 0.35 mm), (P = 0.001). Significant PF thickness reduction, visual analog scale (VAS), and Roles and Maudsley score (RMS) improvement were observed (P < 0.001) after 4 sessions of ESWT.ConclusionPF thickness increases significantly in calcaneal spur patients and responds to treatment. ESWT decreases the thickness of the PF and improves pain and function significantly.

Fascial thickness and stiffness in hypermobile Ehlers-Danlos syndrome.

There is a high prevalence of myofascial pain in people with hypermobile Ehlers-Danlos Syndrome (hEDS). The fascial origin of pain may correspond to changes in the extracellular matrix. The objective of this study was to investigate structural changes in fascia in hEDS. A series of 65 patients were examined prospectively-26 with hEDS, and 39 subjects with chronic neck, knee, or back pain without hEDS. The deep fascia of the sternocleidomastoid, iliotibial tract, and iliac fascia were examined with B-mode ultrasound and strain elastography, and the thicknesses were measured. Stiffness (strain index) was measured semi-quantitatively using elastography comparing fascia to muscle. Differences between groups were compared using one-way analysis of variance. hEDS subjects had a higher mean thickness in the deep fascia of the sternocleidomastoid compared with non-hEDS subjects. There was no significant difference in thickness of the iliac fascia and iliotibial tract between groups. Non-hEDS subjects with pain had a higher strain index (more softening of the fascia with relative stiffening of the muscle) compared with hEDS subjects and non-hEDS subjects without back or knee pain. In myofascial pain, softening of the fascia may occur from increase in extracellular matrix content and relative increase in stiffness of the muscle; this change is not as pronounced in hEDS.

Comparison of the Effect of Ultrasound-Guided Injection of Botulinum Toxin Type A and Corticosteroid in the Treatment of Chronic Plantar Fasciitis: A Randomized Controlled Trial.

The aim of the study was to compare the efficacy of ultrasound-guided injection of botulinum toxin type A with corticosteroid in patients with chronic plantar fasciitis (PF). This randomized controlled trial was conducted on 35 patients with chronic plantar fasciitis. Participants were randomly allocated into two groups: one group received methylprednisolone in to the plantar fascia ( n = 18) and the other group received botulinum toxin type A injection into the flexor digitorum brevis and quadratus plantae ( n = 17). All injections were performed under ultrasound guidance. Patients were evaluated using the Visual Analog Scale, Foot and Ankle Ability Measures, and plantar fascia thickness before the intervention, 3 wks, 12 wks, and 6 mos after the treatment. In both groups, patients' pain and function improved significantly up to 3 wks after injection. In the botulinum toxin type A group, morning Visual Analog Scale improved significantly at 12 wks after intervention and the improvement was sustained for another 3 mos. In the botulinum toxin type A group, Foot and Ankle Ability Measures-sports subscale improved in all evaluated points, whereas in the corticosteroid group, the improvement was significant only when comparing follow-ups values to baseline. Both ultrasound-guided botulinum toxin type A and corticosteroid injection were effective in the treatment of plantar fasciitis. Our study showed that the effects of botulinum toxin type A injection last longer than those of steroid injection.

Phonophoresis Plus Topical Nitroglycerin Versus Hydrocortisone for the Management of Plantar Fasciitis: A Randomized Controlled Trial

Background: Plantar fasciitis (PF), is the most common reason for inferior heel pain. Various approaches have been raised for the treatment of PF; however, none had substantial outcomes. The current study aims to assess and compare phonophoresis outcomes plus topical nitroglycerin versus phonophoresis plus topical hydrocortisone for PF management. Materials and Methods: The current randomized clinical trial was conducted on 65 patients with PF diagnosis, who underwent ten every-other-day treatment sessions with phonophoresis plus 20mg nitroglycerin (n=33) or 20mg hydrocortisone (n=32), respectively. The Modified Roles and Maudsley (RM) score and the visual analog scale (VAS) were compared between the two groups at baseline, three weeks, and two months after the interventions. Besides, the plantar fascia thickness was measured at baseline and two months after the intervention. Results: The baseline RM (P=0.067) and pain severity (P=0.057) was similar between the two groups, but other assessments revealed the superiority of phonophoresis plus topical nitroglycerin over topical hydrocortisone (P&lt;0.05). The reduction in plantar fascia thickness was more in phonophoresis plus nitroglycerin-treated patients as compared to the latter group (P&lt;0.001), but the requirement of additional doses of analgesia was remarkably more in hydrocortisone-treated patients (P&lt;0.001). Conclusion: Based on the current study, phonophoresis plus topical nitroglycerin was superior to phonophoresis plus topical hydrocortisone in pain relief, improved quality of life, and decreased fascia thickness. However, further investigations are required to achieve the ultimate outcomes for a more extended period. [GMJ.2021;10:e2072]

Phonophoresis Plus Topical Nitroglycerin Versus Hydrocortisone for the Management of Plantar Fasciitis: A Randomized Controlled Trial

Background: Plantar fasciitis (PF), is the most common reason for inferior heel pain. Various approaches have been raised for the treatment of PF; however, none had substantial outcomes. The current study aims to assess and compare phonophoresis outcomes plus topical nitroglycerin versus phonophoresis plus topical hydrocortisone for PF management. Materials and Methods: The current randomized clinical trial was conducted on 65 patients with PF diagnosis, who underwent ten every-other-day treatment sessions with phonophoresis plus 20mg nitroglycerin (n=33) or 20mg hydrocortisone (n=32), respectively. The Modified Roles and Maudsley (RM) score and the visual analog scale (VAS) were compared between the two groups at baseline, three weeks, and two months after the interventions. Besides, the plantar fascia thickness was measured at baseline and two months after the intervention. Results: The baseline RM (P=0.067) and pain severity (P=0.057) was similar between the two groups, but other assessments revealed the superiority of phonophoresis plus topical nitroglycerin over topical hydrocortisone (P&lt;0.05). The reduction in plantar fascia thickness was more in phonophoresis plus nitroglycerin-treated patients as compared to the latter group (P&lt;0.001), but the requirement of additional doses of analgesia was remarkably more in hydrocortisone-treated patients (P&lt;0.001). Conclusion: Based on the current study, phonophoresis plus topical nitroglycerin was superior to phonophoresis plus topical hydrocortisone in pain relief, improved quality of life, and decreased fascia thickness. However, further investigations are required to achieve the ultimate outcomes for a more extended period. [GMJ.2021;10:e2072]

Analysis of presacral tissue structure in LARS and the prevention of LARS by reconstruction of presacral mesorectum with pedicled greater omentum flap graft.

The greater omentum has played a unique biological role in regenerative surgery. The aim of our study was to alter the anterior sacral structure by filling the anterior sacral space with the greater omentum and evaluate its effect on the low anterior resection syndrome (LARS) after total mesorectal excision (TME) surgery for low rectal cancer. We retrospectively collected clinical data of patients with primary low rectal cancer who underwent TME and ileostomy closure in our hospital from March 2018 to March 2020. Spearman correlation analysis was conducted to analyze the correlation between postoperative mesorectal fascia (MRF) thickness and LARS score. Subsequently, we prospectively used a tipped greater omental flap graft to reconstruct the anterior rectal sacral structures (MRF reconstruction) in 17 patients and compared LARS scores and rectal compliance (RC) at week 12 after closure of the ileostomy in both groups. There were 47 patients with No-MRF reconstruction (31 males, mean age 60.68 ± 9.21years) and 17 with MRF reconstruction (10 males, mean age 49.82 ± 14.74years). Correlation analysis indicated that MRF thickness and RC were negatively correlated with LARS severity (p < 0.05). The LARS score of patients with MRF reconstruction at 12weeks was significantly better than that of those with No-MRF reconstruction (32.97 ± 2.65 vs. 26.94 ± 1.52, p = 0.001), and the RC of MRF reconstruction were lower (2.80 ± 0.55 vs. 3.67 ± 0.38, p = 0.001). In addition, MRF reconstruction and No-MRF reconstruction have the similar incidence of postoperative complications (p = 0.156). No hemorrhage or necrosis of the greater omentum flap was observed in any of the patients. Greater omentum flap transplantation can significantly improve the symptoms of LARS at 12weeks after ileostomy closure and we expect it to become a new surgical procedure for the treatment of low rectal cancer.

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No change in foot soft tissue morphology and skin sensitivity after three months of using foot orthoses that alter plantar pressure

Altering plantar load using foot orthoses (FOs) may alter the mechanical work required of internal structures and change the size of muscle and connective tissues. Skin sensitivity might also change as a result of altering mechanoreceptor stimulation. This study investigated the effects of FOs on foot soft tissue morphology and skin sensitivity over three months of use. Forty-one healthy participants wore prefabricated FOs (n = 23) or no insert (n = 18) for three months. The FOs were prescribed specific to each participant, using criteria of a change in peak pressure of 8% in the medial arch (pressure increase) and medial heel (pressure decrease). Ultrasound images were recorded pre- and post-FOs use to derive cross-sectional area and thickness of: abductor hallucis, flexor hallucis brevis, flexor digitorum brevis and the Achilles tendon at the insertion and mid-portion. Plantar fascia thickness was measured at the insertion and midfoot. The minimal detectable difference was established in piloting (n = 7). Skin sensitivity was measured with monofilaments at the dorsum (between the hallux and second toe), medial and lateral heel, medial and lateral arch and the 1st metatarsal head. The FOs increased peak pressure by 15% in the medial arch and reduced it by 21% in the medial heel. None of the changes in soft tissue measurements was greater than the minimal detectable difference and there were no effects of group and time. Skin sensitivity decreased over time at the 1st metatarsal head for both groups, but there was no group effect. Using FOs over three months did not change the foot tissues nor skin sensitivity. This study challenges the notion that FOs make muscles smaller.

Role of CT colonography in differentiating sigmoid cancer from chronic diverticular disease.

To evaluate the accuracy of computed tomography colonography (CTC) in differentiating chronic diverticular disease from colorectal cancer (CRC), using morphological and textural parameters. We included 95 consecutive patients with histologically proven chronic diverticular disease (n = 53) or CRC (n = 42) who underwent CTC. One radiologist, unaware of histological findings, evaluated CTC studies for the presence of potential discriminators including: maximum thickness, involved segment length, shouldering phenomenon, growth pattern, diverticula, fascia thickening, fat tissue edema, loco-regional lymph nodes, mucosal pattern. Another radiologist performed volumetric texture analysis on the involved segment. Several qualitative imaging parameters resulted to significantly correlated with colorectal cancer, including absence of diverticula in the affected segment, straightened growth pattern and shouldering phenomenon. A maximum wall thickness/involved segment length ratio < 0.1 had 98% specificity and 47% sensitivity in identifying diverticular disease. Regarding first-order texture analysis parameters, kurtosis resulted to be significantly different between the two groups. Absence of diverticula, straightened growth pattern and shouldering phenomenon are significantly associated with CRC (71-91% sensitivity; 82-91%).

Prevalence of Plantar Fasciitis Among Nurses at A Tertiary Care Centre in A Rural Area: A Cross Sectional Study

Background: The plantar fascia can further encounter a form of pathological degeneration called as plantar fasciitis that is one of the most common causes of heel pain. Plantar fasciitis is a multifactorial in origin and works as a mechanical overloading reaction to multiple instances of microtrauma. Purpose: This research will rule out the prevalence of plantar fasciitis in nurses both male and female with the help of windlass test and also make us aware about the correlation of plantar fasciitis among males and females. Methodology: A simple random sampling of 100 healthy nurses, 70 female nurses and 30 male nurses from Pravara Institute, Loni was included. The participants included were between age group of 20-50 years and were screened according to inclusion and exclusion criteria. Windlass test was performed in all the recruited participants. The test was done both in non-weightbearing (NWB) and weightbearing (WB) position. If pain was reproduced, the subject then marked the location of the pain. If pain was provoked then the test was considered positive. Result: The windlass test (weight bearing and non-weight bearing) showed that out of 100 participants 21% tested positive; out of which 17% females and 4% males responded positive in the study. Conclusion: The study concluded that female nurses are more prone to develop plantar fasciitis when compared with male nurses. KEY WORDS: Plantar fascia, Plantar fasciitis, Plantar fascia thickness, Pain, Nurses, Windlass test.

Ultrasonographic measurements of plantar fascia thickness and echogenicity in individuals with and without plantar fasciitis: Reliability and group differences

ObjectiveImaging techniques such as ultrasonography are beneficial for diagnosis of plantar fasciitis. The purpose of this study was to investigate intra-rater reliability of plantar fascia thickness and echogenicity in subjects with and without plantar fasciitis and to compare the measurements between the two groups. DesignSonographic evaluation of the plantar fascia was performed in prone position in 20 subjects without plantar fasciitis and 20 subjects with plantar fasciitis. The outcome measures extracted from the ultrasound images included plantar fascia thickness at the insertion, 1 cm and 3 cm distal from the insertion and plantar fascia echogenicity. The reliability of outcome measures was estimated for both groups using absolute and relative reliability variables. The two groups were compared using analysis of variance (ANOVA). ResultsICCs (3, 3) for intra-rater reliability of plantar fascia thickness and echogenicity were, respectively, ≥0.89 and ≥0.89 in the healthy controls and 0.87≥ and 0.90≥ in the plantar fasciitis group. The subjects with plantar fasciitis showed a thicker plantar fascia with lower echogenicity in all of measurement stations of plantar fascia compared to the healthy controls. ConclusionThe results of the present study indicated that ultrasonography is a reliable method to measure plantar fascia thickness and echogenicity. Furthermore, the findings showed that plantar fascia is affected not only at its insertion but also in other points remote from the insertion in patients with plantar fasciitis. These findings support the diagnostic value of ultrasonography in therapy and research of the patients with plantar fasciitis.

Clinical And Plantar Fascial Morphologic Changes After Proximal Medial Gastrocnemius Release Treatment of Recalcitrant Plantar Fasciitis.

Background:Magnetic resonance imaging (MRI) has been used as a diagnostic and prognostic instrument to evaluate the results of conservative treatment for plantar fasciitis. However, there are scarce data available relative to changes in the plantar fascia after operative treatment. The primary objective of this study is to evaluate the imaging changes in patients with recalcitrant plantar fasciitis treated operatively by means of proximal medial gastrocnemius release.Methods:Thirteen patients with recalcitrant plantar fasciitis were studied with MRI preoperatively and 1 year after operative treatment. Quantitative (plantar fascia thickness) and qualitative variables (hyperintensity in the plantar fascia, insertional calcaneus bone edema, a plantar fascia tear, and the presence of perifascial collections) were assessed by 2 musculoskeletal radiologists. Clinical results were also measured with American Orthopaedic Ankle & Society (AOFAS), visual analog scale (VAS) pain, and 36-Item Short Form Health Survey (SF-36) scales.Results:The mean plantar fascia thickness was 6.59 mm preoperatively and 6.37 mm postoperatively (P = .972). No statistically significant differences were found in any of the qualitative variables on comparing the pre- and postoperative periods. Patients reported clinical improvements in pain VAS, AOFAS measurement, and the physical subdomains of the SF-36 scale.Conclusion:Quantitative and qualitative variables assessed for the plantar fascia on MRI did not show any significant change after medial gastrocnemius release despite clear clinical improvement.Level of Evidence:Level II, perspective cohort study.

Manual Therapy Informed by the Fascial Distortion Model for Plantar Heel Pain: Results of a Single-Arm Prospective Effectiveness Study.

Objectives: Plantar heel pain (PHP) is the most common cause of heel pain and can be debilitating; 20% of patients are refractory to standard of care. The Fascial Distortion Model (FDM), a novel manual diagnostic and treatment strategy, is purported to be effective for chronic pain; however, no rigorous studies document its effectiveness. We assessed the FDM for care of PHP. Design: Single arm prospective effectiveness study. Settings/Location: Outpatient primary care clinic; Fort Gordon, GA. Subjects: Outpatient adults. Interventions: Participants received an FDM-informed diagnostic and treatment strategy to identify fascial "distortions" at the foot based on patient-reported pain patterns and palpatory examination and then to provide distortion-specific manual therapy at baseline and 1 week. Outcome Measures: Primary outcome measure (0, 1, and 16 weeks): the Foot Pain subscale on the validated Foot Health Status Questionnaire (FHSQ; 0-100 points on each of eight separate subscales); secondary outcome measures (0, 1, and 16 weeks): the seven remaining subscales on the FHSQ, visual analog pain scale (VAS, 0-100 points), and plantar fascia thickness of the most effected foot assessed by ultrasound (0 and 16 weeks). Analysis was performed per protocol using repeated-measures analysis of variance. Results: One hundred and ninety-seven participants were screened; 33 were enrolled. Twenty-eight participants received two FDM procedures. Compared with baseline, improvement on the FHSQ Foot Pain (33.8-23.6 points) and Foot Function (23.9-19.8 points) subscales and VAS (44.7-27.7 points) at 16 weeks was statistically significant (all p's < 0.001) and clinically important representing large effect sizes. Relative to baseline, 16-week ultrasound demonstrated reduced average plantar fascia thickness (0.6-0.9 mm [p = 0.001]). Demographic characteristics were unrelated to response. Satisfaction was high. There were no serious adverse events; side effects included consistent mild-to-moderate self-limited pain. Conclusions: Participants with PHP who received FDM-informed care reported significant and sustained improvement on validated foot pain and foot function measures; additional findings included decreased plantar fascial thickness. These results require corroboration in a larger randomized controlled study. Clinical Trial Registration No: DDEAMC17005.

Elasticity of the Achilles Tendon in Individuals With and Without Plantar Fasciitis: A Shear Wave Elastography Study.

The elastic properties of the Achilles tendon (AT) are altered in local injury or other diseases and in response to changes in mechanical load. Recently, elastography has been used to evaluate variations in tendon elastic properties, mainly among healthy individuals or athletes. Therefore, this study evaluated the biomechanical changes in ATs in individuals with and without plantar fasciitis (PF). The purposes were as follows: (1) to evaluate the passive stiffness of three regions of the AT which defined as 0 (AT0 cm), 3 (AT3 cm), and 6 cm (AT6 cm) above the calcaneal tuberosity in participants with and without PF, (2) to investigate the interplay between the passive stiffness in patients with PF and pain, (3) to detect optimal cut-off points of stiffness of the AT in assessing individuals with chronic PF, and (4) to determine the correlation between the plantar fascia thickness (PFT) and pain. This cross-sectional study included 40 participants (mean age = 51 ± 13 years). When the ankle was in a relaxed position, patients with PF experienced increased passive stiffness in AT0 cm (p = 0.006) and AT3 cm (P = 0.003), but not in the neutral position. Significant correlations were observed between pain and stiffness of AT (AT0 cm r = 0.489, P = 0.029; AT3 cm r = 487, P = 0.030; AT6 cm r = 0.471, P = 0.036), but not in the PFT (P = 0.557). Optimal cut-off stiffness was AT (452 kPa) in the relaxed ankle position. The plantar fascia of patients with PF was significantly thicker than that of the controls (P < 0.001). Findings from the present study demonstrate that tendon stiffness is a good indicator of the clinical situation of patients with PF. Monitoring passive tendon stiffness may provide additional information to assess severity of the condition and guide therapeutic. The treatment programs for PF should also be tailored to the distal AT, as conventional therapy might not be targeted to tight tendons.

Muscle shear wave elastography, conventional B mode and power doppler ultrasonography in healthy adults and patients with autoimmune inflammatory myopathies: a pilot cross-sectional study

BackgroundBefore the role of shear wave elastography (SWE) and B mode ultrasound (US) in the diagnosis of different forms of idiopathic inflammatory myopathies (IIM) can be investigated, normative data is required. This study aimed to describe and then compare normative SWE and B mode ultrasound metrics of muscles in healthy controls and patients with IIM.MethodsTwenty nine healthy adult controls and 10 IIM patients (5 with inclusion body myositis and 5 with necrotising autoimmune myopathy) underwent a full clinical examination, laboratory investigations, SWE and US measurements of selected proximal and distal limb muscles. Shear wave speed (SWS) and multiple US domains [echogenicity, fascial thickness, muscle bulk and power Doppler (PD)] were measured in both groups.ResultsIn healthy controls (n = 29; mean age 46.60 ± 16.10; 44.8 % female), age was inversely correlated with SWS at the deltoid (stretch) (Rs. -0.40, p = 0.030) and PD score at the deltoid (rest) (Rs. -0.40, P = 0.032). Those ≥ 50 years old had a lower SWS at the deltoid (stretch) compared to the < 50 year group (2.92 m/s vs. 2.40 m/s, P = 0.032). Age correlated with increased echogenicity in the flexor digitorum profundus (Rs. 0.38, P = 0.045). Females had a smaller muscle bulk in the deltoid (P = 0.022). Body mass index (BMI) was inversely associated with SWS in the deltoid (stretch) (Rs – 0.45, P = 0.026), and positively correlated with echogenicity in the deltoid (Rs. 0.69, P = 0.026). In patients ≥50 years of age, patients with IIM (mean age 61.00 ± 8.18; females 20.0 %) had a higher proportion of abnormal echogenicity scores at the flexor digitorum profundus (FDP) (40.00 % vs. 14.30 %, P = 0.022) and tibialis anterior (TA) (80.00 % vs. 28.60 %, P = 0.004). Fascial thickness was lower in the FDP (0.63mm vs. 0.50mm, p = 0.012) and TA (0.58mm vs. 0.45mm, P = 0.001).ConclusionsOur findings suggest there is scope for US techniques to be useful for diagnostic screening of affected muscles in patients with IIM, especially in those with suspected inclusion body myositis or necrotising autoimmune myopathy. We provide normative data for future studies into SWE and US techniques in skeletal muscle. The differences between IIM patients and controls warrant further study in a broader IIM patient cohort.

Effects of Two Foot-Ankle Interventions on Foot Structure, Function, and Balance Ability in Obese People with Pes Planus.

Obese people are prone to foot deformities such as flat feet. Foot management programs are important to prevent them. This study investigated the effects of two foot-ankle interventions on balance ability, foot arch, ankle strength, plantar fascia thickness, and foot functions in obese people with pes planus for four weeks. The experiment was designed as a randomized controlled trial. Twenty-four participants who met the inclusion criteria were selected, and they were randomly assigned to either a short foot group (SFG) or proprioceptive neuromuscular facilitation group (PNFG) according to foot-ankle intervention. Two interventions were commenced three times a week for 20 min over four weeks. The tests were conducted at two intervals: pre-intervention and at four weeks. The tests were conducted in the following order: the patient-specific functional scale test (PSFS), an ultrasound of the plantar fascia, the navicular drop test, balance test, and the four-way ankle strength test. Two groups showed significant differences in balance ability, foot arch, ankle strength, plantar fascia thickness, and foot functions between pre-test and post-test (p < 0.05). PNFG had significantly higher dorsiflexor and invertor strength than SFG (p < 0.05). SF and PNF interventions were effective to improve balance ability, foot arch, ankle strength, plantar fascia thickness, and foot functions in obese people with pes planus. Additionally, PNF intervention is more beneficial in increasing the dorsiflexor and invertor strength compared to SF intervention.