Granado Michael J, Lohman Everett B, Gordon Keith E, Daher Noha S
1School of Allied Health Professions, Loma Linda University, Loma Linda, CA 92350 USA.
2Department of Physical Therapy, Loma Linda University, Loma Linda, CA 92350 USA.
J Foot Ankle Res. 2018 May 29;11:20. doi: 10.1186/s13047-018-0267-0. eCollection 2018.
Ultrasound is an inexpensive method for quantifying plantar fascia thickness, especially in those with plantar fasciitis. Ultrasound has also been used to assess the effectiveness of various treatments for plantar fasciitis by comparing plantar fascia thickness before and after an intervention period. While a plantar fascia thickness over 4 mm via ultrasound has been proposed to be consistent with plantar fasciitis, some researchers believe the 4 mm plantar fascia thickness level to be a dubious guideline for diagnosing plantar fasciitis due to the lack of standardization of the measurement process for plantar fascia thickness. In particular, no universal guidelines exist on the positioning of the metatarsophalangeal (MTP) joints during the procedure and the literature also has inconsistent protocols. The purpose of this study is to investigate and compare the influence of MTP joint extension on plantar fascia thickness in healthy participants and those with unilateral plantar fasciitis.
The plantar fascia thickness of forty participants (20 with unilateral plantar fasciitis and 20 control) was measured via ultrasound three times at three different MTP joint positions: 1) at rest, 2) 30° of extension from the plantar surface, and 3) maximal extension possible.
The plantar fascia became significantly thinner as MTP joint extension increased in both the plantar fasciitis group ( < 0.001) and the control group ( < 0.001). In the plantar fasciitis group, the involved plantar fascia was 1.2 to 1.3 mm thicker (p < 0.001) than the uninvolved side depending on the MTP joint position. In the control group, the difference in plantar fascia thickness between the two sides was less than 0.1 mm ( < 0.92) at any MTP joint position.
MTP joint position can influence the ultrasound measurement of plantar fascia thickness. It is recommended that plantar fascia thickness measurements be performed with the toes at rest. If MTP joints must be extended, then the toes should be extended maximally and then noted to ensure subsequent ultrasound procedures are repeated. Standardizing the position of the MTP joints is not only important for attaining the most accurate thickness measurement of the plantar fascia, but is also important to researchers who use plantar fascia thickness to determine the effectiveness of various plantar fasciitis interventions.
超声是一种用于量化足底筋膜厚度的廉价方法，尤其适用于足底筋膜炎患者。通过比较干预期前后的足底筋膜厚度，超声还被用于评估各种治疗足底筋膜炎方法的有效性。虽然有人提出超声测量足底筋膜厚度超过4毫米与足底筋膜炎相符，但一些研究人员认为，由于足底筋膜厚度测量过程缺乏标准化，4毫米的足底筋膜厚度水平作为诊断足底筋膜炎的指导标准并不可靠。特别是，在测量过程中跖趾（MTP）关节的定位没有通用指南，并且文献中的测量方案也不一致。本研究的目的是调查和比较MTP关节伸展对健康参与者和单侧足底筋膜炎患者足底筋膜厚度的影响。
通过超声在三个不同的MTP关节位置对40名参与者（20名单侧足底筋膜炎患者和20名对照者）的足底筋膜厚度进行三次测量：1）休息时；2）从足底表面伸展30°时；3）尽可能最大程度伸展时。
在足底筋膜炎组（<0.001）和对照组（<0.001）中，随着MTP关节伸展增加，足底筋膜明显变薄。在足底筋膜炎组中，根据MTP关节位置，患侧足底筋膜比未患侧厚1.2至1.3毫米（p<0.001）。在对照组中，在任何MTP关节位置，两侧足底筋膜厚度差异均小于0.1毫米（<0.92）。
MTP关节位置会影响足底筋膜厚度的超声测量。建议在脚趾休息时进行足底筋膜厚度测量。如果必须伸展MTP关节，那么应将脚趾最大程度伸展，然后记录下来，以确保后续超声检查程序可重复进行。标准化MTP关节的位置不仅对于获得最准确的足底筋膜厚度测量很重要，对于使用足底筋膜厚度来确定各种足底筋膜炎干预措施有效性的研究人员也很重要。
