Diagnostic Accuracy of High-Resolution Ultrasound in Clinically Suspected Pakistani Patients with Plantar Fasciitis

Abstract

Background: Plantar fasciitis is the term used for inflammation of plantar fascia which is serious and common problem in young individuals, which leads to impaired mobility and hampered quality of life. There is a lack of availability of local research data therefore current study aims to establish the accuracy of high-resolution sonography in diagnosing patients with plantar fasciitis. The importance of ultrasound as the first line of investigation lies in its cost effectiveness as most of our population belongs to lower socioeconomic status. Objective: The objective of this study was to assess the diagnostic accuracy of high-resolution ultrasound in clinically suspected patients of plantar fasciitis. Study Design: Comparative analytical study. Settings: Department of Radiology, FJMU/Sir Ganga Ram Hospital, Lahore Pakistan. Duration: April 2022 to September 2022. Methods: This was conducted in the, from.  Total 50 patients who were suspected cases of plantar fasciitis clinically, were assessed with high resolution ultrasound by using 7 MHz linear array transducer on Toshiba Applio 300. All patients with chronic heel pain of more than 3 months duration, with or without heel pad tenderness on clinical examination were included in this study. While patients with long standing neuromuscular diseases, systemic inflammatory arthritis and diabetes mellitus were those who were excluded from our study. Results: In patients of plantar fasciitis, plantar fascia thickness was significantly increased (in 84% patients) on ultrasound (maximum measuring 6.1mm and mean 5.3 mm). Near calcaneal insertion of plantar fascia, at its proximal end, fascia was diffusely hypo-echoic in symptomatic (81%) patients. In a few patients, evidence of calcification, fluid collection (63%) and fascia rupture (47%) was noted. The sensitivity of high resolution ultrasound to detect plantar fasciitis was 97 %, specificity was calculated as 100 % and diagnostic accuracy was 86%. Conclusion: We recommend ultrasound as an accurate, low cost and non-invasive imaging modality for verification of clinical diagnosis of plantar fasciitis because of the fact that common sonographic findings of plantar fasciitis are increased thickness (> 4mm) with decreased echogenicity of plantar fascia.