Bisi-Balogun Adebisi, Rector Michael
J Am Podiatr Med Assoc. 2017 Sep;107(5):375-381. doi: 10.7547/16-042.
We sought to develop a standardized protocol for ultrasound (US) measurements of plantar fascia (PF) width and cross-sectional area (CSA), which may serve as additional outcome variables during US examinations of both healthy asymptomatic PF and in plantar fasciopathy and determine its interrater and intrarater reliability.
Ten healthy individuals (20 feet) were enrolled. Participants were assessed twice by two raters each to determine intrarater and interrater reliability. For each foot, three transverse scans of the central bundle of the PF were taken at its insertion at the medial calcaneal tubercle, identified in real time on the plantar surface of the foot, using a fine wire technique. Reliability was determined using intraclass correlation coefficients (ICC), standard errors of measurement (SEM), and limits of agreement (LOA) expressed as percentages of the mean. Reliability of PF width and CSA measurements was determined using PF width and CSA measurements from one sonogram measured once and the mean of three measurements from three sonograms each measured once.
Ultrasound measurements of PF width and CSA showed a mean of 18.6 ± 2.0 mm and 69.20 ± 13.6 mm respectively. Intra-reliability within both raters showed an ICC > 0.84 for width and ICC > 0.92 for CSA as well as a SEM% and LOA% < 10% for both width and CSA. Inter-rater reliability showed an ICC of 0.82 for width and 0.87 for CSA as well as a SEM% and LOA% < 10% for width and a SEM% < 10% and LOA% < 20% for CSA. Relative and absolute reliability within and between raters were higher when using the mean of three sonographs compared to one sonograph.
Using this novel technique, PF CSA and width may be determined reliably using measurements from one sonogram or the mean of three sonograms. Measurement of PF CSA and width in addition to already established thickness and echogenicity measurements provides additional information on structural properties of the PF for clinicians and researchers in healthy and pathologic PF.
我们试图制定一种标准化方案，用于超声（US）测量足底筋膜（PF）的宽度和横截面积（CSA），这在对健康无症状的PF以及足底筋膜炎进行超声检查时，可作为额外的结果变量，并确定其观察者间和观察者内的可靠性。
招募了10名健康个体（20只脚）。每位参与者由两名评估者各评估两次，以确定观察者内和观察者间的可靠性。对于每只脚，在跟骨内侧结节处PF中央束的插入点进行三次横向扫描，通过细钢丝技术在足底表面实时识别该插入点。使用组内相关系数（ICC）、测量标准误差（SEM）以及以均值百分比表示的一致性界限（LOA）来确定可靠性。PF宽度和CSA测量的可靠性通过一次测量的一张超声图像的PF宽度和CSA测量值以及每张超声图像各测量一次的三张超声图像测量值的均值来确定。
PF宽度和CSA的超声测量结果分别显示平均值为18.6±2.0毫米和69.20±13.6平方毫米。两位评估者的观察者内可靠性显示，宽度的ICC>0.84，CSA的ICC>0.92，宽度和CSA的SEM%和LOA%均<10%。观察者间可靠性显示，宽度的ICC为0.82，CSA的ICC为0.87，宽度的SEM%<10%且LOA%<10%，CSA的SEM%<10%且LOA%<20%。与一张超声图像相比，使用三张超声图像的均值时，评估者内和评估者间的相对和绝对可靠性更高。
使用这种新技术，可通过一张超声图像的测量值或三张超声图像测量值的均值可靠地确定PF的CSA和宽度。除了已确定的厚度和回声性测量外，PF CSA和宽度的测量为健康和病理性PF的临床医生和研究人员提供了有关PF结构特性的额外信息。
