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

Evaluation of the effectiveness of ultrasound-guided corticosteroid injection treatment in plantar fasciitis using shear wave elastography

PURPOSE

To evaluate the effectiveness of ultrasound-guided corticosteroid injection in patients with plantar fasciitis (PF) and assess changes in shear wave elastography (SWE) measurements and clinical outcomes.

METHODS

Between March and August 2024, 66 patients (aged 27 to 67 years) diagnosed with PF were enrolled in the study. Plantar fascia thickness, shear wave velocity (SWV) in meters per second (m/s), and Young's modulus in kilopascals (kPa) were measured before the injection and at a 1-month follow-up. The correlation of these measurements with the Visual Analog Scale (VAS, 0-10) and the American Orthopedic Foot and Ankle Society (AOFAS) scores was analyzed.

RESULTS

Before treatment, the plantar fascia thickness, SWV, and Young's modulus were recorded as 5.02 ± 0.66 mm, 2.37 ± 0.22 m/s, and 18.64 ± 3.28 kPa, respectively. At the 1-month follow-up, these values significantly changed to 3.53 ± 0.39 mm, 3.39 ± 0.32 m/s, and 35.49 ± 7.25 kPa, respectively (p < 0.001 for all). A significant reduction in plantar fascia thickness and a significant increase in SWV and Young's modulus were observed. Additionally, improvements in VAS and AOFAS scores were strongly correlated with increases in SWV and Young's modulus (VAS-m/s: r = -0.632, p = 0.011; AOFAS-m/s: r = 0.695, p = 0.001; VAS-kPa: r = -0.673, p < 0.001; AOFAS-kPa: r = 0.798, p < 0.001).

CONCLUSION

Ultrasound-guided corticosteroid injection significantly increased plantar fascia stiffness, and SWE measurements strongly correlated with clinical improvements. SWE proves to be a valuable adjunctive tool for evaluating treatment response in PF.

Ultrasound Shear Wave Elastography of the Arch-Supporting Structures in Symptomatic Flatfoot: A Pilot Study

Background

The posterior tibial tendon (PTT), deltoid ligament, and spring ligament are often torn or attenuated in patients with progressive collapsing foot deformity. The goal of this pilot study was to measure the ultrasound shear wave velocity (SWV) of these arch-supporting structures in feet with varying degrees of deformity to improve our understanding of their role in the progression of deformity.

Methods

Two observers measured the SWV of the supramalleolar and inframalleolar PTT in long and short axes, in the tibiospring portion of the deltoid ligament, and in the superomedial band of the spring ligament in 8 neutrally aligned feet, 5 asymptomatic flatfeet, and 7 symptomatic flatfeet. Each measurement was repeated 3 times both with and without an applied eversion stress.

Results

Average SWV was lower at all locations in the symptomatic flatfeet compared with normal feet, but these differences were statistically significant only for the inframalleolar PTT and the spring ligament. Externally applied stress led to an increase in the SWV of the ligaments but a paradoxical decrease in the SWV in the supramalleolar PTT. The SWV of the PTT was lower along the short axis compared with the long axis.

Conclusion

SWV may be useful in evaluating the severity of degenerative disease of arch-supporting structures, but further study is needed before this technique can be applied clinically.

Level of Evidence

Level III, case-control study.

Plantar Fasciitis: An Updated Review

Plantar fasciitis (PF) is a common musculoskeletal disease. Histologic findings of patients with PF showed mainly chronic degenerative processes rather than inflammation. In addition to mechanical factors, such as repetitive stress and reduced ankle dorsiflexion, PF is also linked to rheumatologic diseases and genetic factors. Ultrasound is becoming a standard imaging technique for assessing PF. Major sonographic findings included increased plantar fascia thickness and hypoechoic plantar fascia. In addition to traditional B-mode ultrasound, sonoelastography can also be utilized to diagnose PF. Ultrasound can also be used to guide therapeutic interventions. Over 80% of patients with PF improved under nonsurgical treatment. Treatment options for PF include physical therapy, modalities (laser, therapeutic ultrasound), extracorporeal shock wave therapy (ESWT), injections, transcatheter arterial embolization, and surgery. For injections, corticosteroid was mostly used in the past but has been replaced gradually by other techniques such as platelet-rich plasma or dextrose prolotherapy. There is also more and more evidence about ESWT in treating PF. Surgery serves as an option for recalcitrant PF cases, and endoscopic fasciotomy seemed to have good outcomes. Ultrasound plays an important role in diagnosing of PF and evaluating the treatment effect, and the use of sonoelastography in addition to traditional B-mode ultrasound may help in the early detection of PF and assessment of the treatment effect.

Shear-wave elastography of the plantar fascia: a systematic review and meta-analysis

PURPOSE

To assess the efficacy of shear-wave elastography (SWE) of the plantar fascia (PF) in identifying plantar fasciitis.

METHODS

A literature search was conducted on the PubMed and Medline databases for articles published up to August 2022. The Newcastle-Ottawa scale was used to assess the risk of bias. We included original research studies in English dealing with the evaluation of patients with plantar fasciitis by means of SWE and including shear modulus (KPa) and/or shear-wave velocity (m/s). We compared healthy and pathologic PF stiffness using the standardised mean difference (SMD) in a random-effects model (95% CI).

RESULTS

Five studies were included with a total of 158 pathologic PFs and 134 healthy PFs. No significant publication bias was detected. Studies were highly heterogeneous (p < 0.00001; I² = 97%). Pathologic PFs showed significantly lower stiffness, with an SMD of - 3.00 m/s (95% confidence interval: - 4.95 to - 1.06, p = 0.002), compared to healthy PF.

CONCLUSION

Pathologic PFs present significantly lower stiffness than healthy PFs. However, the analysed studies are highly heterogeneous.