Moustafa Asmaa Mahmoud Ali, Hassanein Eshrak, Foti Calogero
Physical medicine, Rheumatology and Rehabilitation Department, Ain Shams University, Cairo, Egypt; Physical and Rehabilitation Medicine, Department of Clinical Sciences and Translational Medicine, "Tor Vergata" University, Rome, Italy.
Radio-diagnosis Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Muscles Ligaments Tendons J. 2016 Feb 13;5(4):289-96. doi: 10.11138/mltj/2015.5.4.289. eCollection 2015 Oct-Dec.
although plantar fascia thickening is well documented as a sonographic criterion for the diagnosis of plantar fasciitis (PF), however it was less evaluated as an objective measure of response to treatment. It is unknown to what extent if any different responses to different treatments are related to the ultrasound (US) morphology changes. We aimed to evaluate changes in US findings in correlation to pain reported.
this prospective observational trial included 21 plantar fasciitis patients (26 feet), resistant to conservative treatment for at least 2 months. Plantar fascia thickness and echogenicity were evaluated, compared to asymptomatic feet and correlated with visual analogue scale (VAS) and Heel Tenderness Index (HTI), before and after dexam-ethasone (DXM) iontophoresis in group I, and DXM injection in group II.
increased thickness and reduced echogenicity were constant in symptomatic feet, with high statistical significant difference compared to asymptomatic side. Correlation between plantar fascia thickness with VAS and HTI before and after treatment showed statistically significant positive correlation (p<0.05). ROC curve test showed that reduction of plantar fascia thickness by US in response to DXM had 100% sensitivity, 65.2% specificity and 69% accuracy, with higher specificity and accuracy than VAS.
US changes showed concurrent validity correlated with self-reported clinical improvement. Accordingly, ultrasound can be considered an objective useful tool for monitoring response to corticosteroid in patients with plantar fasciitis.
尽管足底筋膜增厚作为超声诊断足底筋膜炎（PF）的标准已有充分记录，但作为治疗反应的客观指标，其评估较少。不同治疗的不同反应与超声（US）形态学变化之间的关系尚不清楚。我们旨在评估超声检查结果的变化与报告的疼痛之间的相关性。
这项前瞻性观察性试验纳入了21例足底筋膜炎患者（26只脚），这些患者对保守治疗至少2个月无效。在第一组进行地塞米松（DXM）离子导入治疗和第二组进行DXM注射前后，评估足底筋膜厚度和回声性，并与无症状的脚进行比较，并与视觉模拟量表（VAS）和足跟压痛指数（HTI）相关联。
有症状的脚足底筋膜厚度增加和回声性降低是持续存在的，与无症状侧相比有高度统计学显著差异。治疗前后足底筋膜厚度与VAS和HTI之间的相关性显示出统计学显著的正相关（p<0.05）。ROC曲线测试表明，超声检查显示的足底筋膜厚度因DXM治疗而减少具有100%的敏感性、65.2%的特异性和69%的准确性，其特异性和准确性高于VAS。
超声变化显示出与自我报告的临床改善相关的同时效度。因此，超声可被认为是监测足底筋膜炎患者对皮质类固醇治疗反应的一种客观有用的工具。
