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Detecting plantar fasciitis on lateral x-ray

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  #1  
Old 16th May 2006, 02:14 PM
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Default Detecting plantar fasciitis on lateral x-ray

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Critical differences in lateral X-rays with and without a diagnosis of plantar fasciitis.
J Sci Med Sport. 2006 May 10;
Quote:
Plantar fasciitis is a clinical diagnosis and is often combined with some form of imaging to validate the diagnosis. The clinical utility of lateral X-rays lies in the fact that they are relatively inexpensive and may contribute to ruling out other osseous causes of pain. In this study 106 (27 plantar fasciitis (PF) and 79 controls) plain non-weight bearing lateral X-rays were examined by a blind examiner to document the key features of the lateral X-ray between images of individuals with and without plantar fasciitis. As expected calcaneal spurs were observed in both groups (85% PF and 46% controls). However, plantar fascia thickness and fat pad abnormalities resulted in the best group differentiation (p<0.0001) with sensitivity of 85% and specificity of 95% for plantar fasciitis. It was concluded that the key radiological features that differentiate the groups were not spurs but rather changes in the soft tissues. If it is deemed necessary to confirm the diagnosis of typical plantar fasciitis with imaging, a lateral non-weight bearing X-ray should be the first choice investigation especially if these key features are noted.

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Old 16th May 2006, 02:53 PM
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Can someone explain why non weight bearing is the preferred option to assess this issue?
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Old 16th May 2006, 02:57 PM
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Mark - I do not know, but maybe the soft tissue changes that they were seeing are only visible NWB. Maybe when WB, these changes are "stretched" or "compressed" and are not detectable.
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Old 16th May 2006, 03:06 PM
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I assumed that was the case but I just wanted to make sure there was nothing else involved. As I always request weight bearing views for all assessments which I was taught at Uni i.e. AP and lateral WB while NWB medial oblique and if needed lateral oblique.

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Old 16th May 2006, 03:09 PM
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The advantages of a WB x-ray generally out weigh the need for a NWB and I am not sure that the need to order a NWB for suspected plantar fasciitis can really be justified. After all, how often is the clinical diagnosis in doubt?
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Old 25th May 2006, 06:04 AM
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I always perform NWB films for diagnosis of plantar fascitis. This I do for several reasons. First, it is much easier to see any soft tissue changes such as bursal sacs, and the approximate insertion can be identified as well if the film is of good quality. Second, if there are any bony changes, these are far more evident as well.

Finally, since I often perform EPF type procedures on these patients following failed conservative therapy, the non weightbearing view is good for measuring the distance from the plantar aspect of the foot to the tip of the "spur" and from the posterior aspect of the foot to the tip of the "spur". This triangulation method will give you the place to make a vertical incision which VERY accurately places the medial incision. Taking the non weightbearing film initially avoids the need for another film preoperatively.
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Old 25th May 2006, 09:56 AM
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Dear All

I have a patient who has suffered exquisitely tender Plantar faciitis for 8 months. Apart for some respite after initial fitting of orthoses there has been little improvement. Radiographs and ultra sound show no significant heel spur or soft tissue trauma. She has had steroid injection,all types of heel pads foot and ankle manipulation and mobilisation, phsyiotherapy with our physio,including ultra sound and hot wax. Low dye taping to resist eversion and arch lowering, which gives some relief, cross frictions, icing, contrast bathing.
The orthopaedic consultant is looking at Plantar faciotomy but we want to avoid this if possible. What about ESW, is it very effective. I don't know anywhere that uses it.
Xray and U/S did show thickened Achilles tendon, even thought it was only tender to palpate but this has responded well to the treatment . stretching and manips have increased ankle d/flex RoM by 10dgs.
Any suggestions as to what further treatment may help!!

Thanks dave
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Old 25th May 2006, 10:25 AM
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Quote:
Originally Posted by David Smith
Dear All

I have a patient who has suffered exquisitely tender Plantar faciitis for 8 months. Apart for some respite after initial fitting of orthoses there has been little improvement. Radiographs and ultra sound show no significant heel spur or soft tissue trauma. She has had steroid injection,all types of heel pads foot and ankle manipulation and mobilisation, phsyiotherapy with our physio,including ultra sound and hot wax. Low dye taping to resist eversion and arch lowering, which gives some relief, cross frictions, icing, contrast bathing.
The orthopaedic consultant is looking at Plantar faciotomy but we want to avoid this if possible. What about ESW, is it very effective. I don't know anywhere that uses it.
Xray and U/S did show thickened Achilles tendon, even thought it was only tender to palpate but this has responded well to the treatment . stretching and manips have increased ankle d/flex RoM by 10dgs.
Any suggestions as to what further treatment may help!!

Thanks dave
Dave:

Recalcitrant plantar fasciitis often responds well to 4-8 weeks of immobilization in a cam-walker style boot or below-knee fiberglass walking cast. Extra-corporal shockwave therapy (ESWT) seems to be about 50% effective when used by podiatrists here locally in Sacramento. Partial plantar fasciotomy works well (about 75% in my hands) but has many more potential negative sequella for the patient. I would certainly give a trial of bracing or casting for 4-8 weeks before plantar fasciotomy is considered but would have no problems with a partial plantar fasciotomy if all other therapeutic measures have been tried and the patient understands the potential problems from plantar fasciotomy.

Remember, from a tissue-stress type approach, that plantar heel pain can be caused both by increased compression stress on the plantar heel structures by ground reaction force (GRF) acting directly on the heel and/or by increased tensile stress on the plantar aponeurosis or plantar intrinsics that attach to the plantar calcaneus by GRF acting on the plantar forefoot. It is wise to always consider the compression/tension stress etiology dichotomy of plantar heel pain when designing appropriate mechanical therapy for the patient with this painful and often disabling pathology.
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