Clinical details: 45 yr old male with pain undersurface of foot , more so, after resting (in the morning after overnight resting) and exacerbated pain on passive dorsiflexion of toes shows on MRI, enlarged and heterogeneous edema of plantar fascia with involvement of soft tissues in the vicinity with no discontinuity or subcalcaneal spur, consistent with degenerative variety of Plantar fasciitis.
Teaching points by Dr MGK Murthy
1. Plantar fascia is thick aponeurosis (connective tissue ) from medial calcaneal tuberosity to the proximal phalanges with three components : medial, central(largest) (referred to as aponeurosis) and lateral. It bears approximate 14%load of foot apart from supporting the arch and acting to keep "windlass mechanism "of foot in conjunction with Tendoachilles
2. Fasciitis is low-grade inflammatory process involving the plantar aponeurosis with or without involvement of the perifascial structures. It can be repetitive micro trauma(most common) or degenerative or enthesopathy varieties.
3. MR extremely sensitive with delineation of fascial and perifascial edema , apart from thickening (proximal more than distal) and edema of the adjacent fat and soft tissues, marrow edema medial calcaneal tuberosity. Treatment is conservative/Steroidal injections/molded foot wear etc
4. Lack of edema differentiates fibromatosis (non malignant thickening of fascia) and xanthoma shows typical T1 hyperintensity.
Plantar fasciitis-MRI Reviewed by Sumer Sethi on Friday, September 05, 2014 Rating: