Gatz Matthias, Betsch Marcel, Quack Valentin, Bejder Ljudmila, Schrading Simone, Tingart Markus, Dirrichs Timm
Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany.
Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany.
J Sports Med Phys Fitness. 2020 Aug;60(8):1137-1147. doi: 10.23736/S0022-4707.20.10702-3.
Plantar fasciitis is a common cause of heel pain. Monitoring therapy effects is challenging with conventional B-mode ultrasound. Shear wave elastography (SWE) provides important diagnostic information beyond B-mode, with typically lower tissue stiffness in symptomatic plantar fascia. Up to now little is known about SWE features for therapy monitoring in plantar fasciitis. We evaluated the clinical effects of a 3-month physical therapy based treatment and its influence on B-mode and SWE ultrasound findings in patients suffering from plantar fasciitis, correlating ultrasound findings to score-based symptom development.
Prospective, IRB-approved clinical study in plantar fasciitis patients undergoing a 3-month physical therapy based treatment. Measurement time points were before (T0), after 1 (T1) and 3 (T2) months of treatment, consisting of clinical orthopedic (FFI, AOFAS-Score) and multimodal radiologic sonographic examinations (B-mode/SWE) using a high-resolution linear 18-MHz probe.
A total of 33 patients with 43 symptomatic plantar fascia were included. We found a significant (P<0.001) clinical score improvement (AOFAS +14, FFI-Pain -21, FFI-Function -18) between T0 and T2. Mean initial thickness (T0) of symptomatic plantar fascia was 4.2 (±1.2) mm, compared to 3.2 (±0.7) mm at the asymptomatic contralateral side (P<0.001). No significant thickness changes were seen at T1 (4.2±1.1 mm) and T2 (4.5±1.3 mm), even though clinical scores improved significantly. Mean initial stiffness (T0) of symptomatic plantar fascia was 59.57 (±43.3) kPa, compared to 83.23 (±47.3) kPa at the asymptomatic contralateral side (P<0.001). In contrast to B-mode ultrasound, SWE values increased significantly between T0 (59.6±43.3 kPa), T1 (82.6±47.3 kPa) and T2 (102.5±47.2 kPa) (P<0.001-0.009), with positive correlations for AOFAS/FFI-Pain/Function scores (r=0.285-0.473, P<0.001-0.002).
A physical therapy based treatment relieves plantar fasciitis symptoms during a 3-month period. In line with symptom reduction, stiffness (Young's-moduli) of plantar fascia increased significantly, while B-mode ultrasound revealed no measurable changes during the healing process. Shear wave elastography was able to quantify plantar fascia pathologies and their recovery under therapy.
足底筋膜炎是足跟疼痛的常见原因。用传统B超监测治疗效果具有挑战性。剪切波弹性成像（SWE）能提供超越B超的重要诊断信息，症状性足底筋膜的组织硬度通常较低。目前对于足底筋膜炎治疗监测的SWE特征了解甚少。我们评估了基于物理治疗的3个月疗程的临床效果及其对足底筋膜炎患者B超和SWE超声检查结果的影响，并将超声检查结果与基于评分的症状发展相关联。
对接受基于物理治疗的3个月疗程的足底筋膜炎患者进行前瞻性、经机构审查委员会批准的临床研究。测量时间点为治疗前（T0）、治疗1个月后（T1）和3个月后（T2），包括临床骨科检查（足部功能指数、美国足踝外科协会评分）以及使用高分辨率18兆赫线性探头进行的多模态放射超声检查（B超/SWE）。
共纳入33例患者的43条症状性足底筋膜。我们发现T0至T2之间临床评分有显著改善（P<0.001）（美国足踝外科协会评分提高14分，足部功能指数疼痛评分降低21分，足部功能指数功能评分降低18分）。症状性足底筋膜的平均初始厚度（T0）为4.2（±1.2）毫米，无症状对侧为3.2（±0.7）毫米（P<0.001）。T1（4.2±1.1毫米）和T2（4.5±1.3毫米）时厚度无显著变化，尽管临床评分显著改善。症状性足底筋膜的平均初始硬度（T0）为59.57（±43.3）千帕，无症状对侧为83.23（±47.3）千帕（P<0.001）。与B超不同，SWE值在T0（59.6±43.3千帕）、T1（82.6±47.3千帕）和T2（102.5±47.2千帕）之间显著增加（P<0.001 - 0.009），与美国足踝外科协会/足部功能指数疼痛/功能评分呈正相关（r = 0.285 - 0.473，P<0.001 - 0.002）。
基于物理治疗的疗程在3个月内可缓解足底筋膜炎症状。与症状减轻一致，足底筋膜的硬度（杨氏模量）显著增加，而B超显示愈合过程中无可测量变化。剪切波弹性成像能够量化足底筋膜病变及其在治疗下的恢复情况。
