Skeletal Radiol DOI 10.1007/s00256-015-2215-4
SCIENTIFIC ARTICLE
Plantar fascia softening in plantar fasciitis with normal B-mode sonography Chueh-Hung Wu 1,2 & Wen-Shiang Chen 1 & Tyng-Guey Wang 1
Received: 21 March 2015 / Revised: 1 June 2015 / Accepted: 30 June 2015 # ISS 2015
Abstract Objective To investigate plantar fascia elasticity in patients with typical clinical manifestations of plantar fasciitis but normal plantar fascia morphology on B-mode sonography. Materials and methods Twenty patients with plantar fasciitis (10 unilateral and 10 bilateral) and 30 healthy volunteers, all with normal plantar fascia morphology on B-mode sonography, were included in the study. Plantar fascia elasticity was evaluated by sonoelastographic examination. All sonoelastograms were quantitatively analyzed, and less red pixel intensity was representative of softer tissue. Pixel intensity was compared among unilateral plantar fasciitis patients, bilateral plantar fasciitis patients, and healthy volunteers by one-way ANOVA. A post hoc Scheffé’s test was used to identify where the differences occurred. Results Compared to healthy participants (red pixel intensity: 146.9±9.1), there was significantly less red pixel intensity in the asymptomatic sides of unilateral plantar fasciitis (140.4± 7.3, p=0.01), symptomatic sides of unilateral plantar fasciitis (127.1±7.4, p60 (indicating the optimal compression force) on the elastogram were selected for recording. Three images of each plantar fascia were recorded. For each plantar fascia, the mean values of the red, green, and blue components in the three images were used for statistical analysis.
Imaging analysis We selected a standardized rectangular area to perform quantitative imaging analysis. This rectangle was located 2 mm proximal to the inferior border of the insertion of the plantar fascia on the calcaneus on the short side and 1 cm distal to the insertion on the long side. Image J software (version 1.42q, National Institutes of Health, Bethesda, MD, USA) was used to develop the color histogram from the elastogram of each plantar fascia. Each pixel was separated by the Image J program into red, green, and blue components (intensity: 0–255); higher values indicated more intense color. The color histogram was then used to compute the mean intensity of each component of the pixels (i.e., red, green, and blue) within the standardized area. This imaging analysis method was shown to be reliable [13].
Skeletal Radiol Table 1 Subject demographics (mean±standard deviation) Male: female ratio Age (years) Weight (kg) Body mass index (kg/m2)
Healthy
Unilateral plantar fasciitis
Bilateral plantar fasciitis
P value
11:19 41.6±13.9 60.3±11.1 22.2±2.6
4:6 45.1±12.5 61.7±12.4 22.5±3.1
4:6 46.5±10.8 58.6±11.6 21.5±3.2
0.58 0.82 0.74
Statistical test by one-way ANOVA
Statistical analysis All statistical analyses were performed using SAS version 9.3 for Windows (SAS Institute Inc., Cary, NC, USA). One-way ANOVA was used to determine the significance of differences among the three groups (healthy subjects, patients with unilateral fasciitis, and patients with bilateral fasciitis) with respect to age, weight, and body mass index. ANOVA was also used to determine the significance of differences in plantar fascia thickness and red, green, and blue pixel intensity between asymptomatic sides for patients with unilateral plantar fasciitis, symptomatic sides for patients with unilateral plantar fasciitis, and both sides for patients with bilateral plantar fasciitis. A post hoc Scheffé’s test was used to identify where the differences occurred. The data were expressed as mean±standard deviation. The level of significance was set at p
SCIENTIFIC ARTICLE
Plantar fascia softening in plantar fasciitis with normal B-mode sonography Chueh-Hung Wu 1,2 & Wen-Shiang Chen 1 & Tyng-Guey Wang 1
Received: 21 March 2015 / Revised: 1 June 2015 / Accepted: 30 June 2015 # ISS 2015
Abstract Objective To investigate plantar fascia elasticity in patients with typical clinical manifestations of plantar fasciitis but normal plantar fascia morphology on B-mode sonography. Materials and methods Twenty patients with plantar fasciitis (10 unilateral and 10 bilateral) and 30 healthy volunteers, all with normal plantar fascia morphology on B-mode sonography, were included in the study. Plantar fascia elasticity was evaluated by sonoelastographic examination. All sonoelastograms were quantitatively analyzed, and less red pixel intensity was representative of softer tissue. Pixel intensity was compared among unilateral plantar fasciitis patients, bilateral plantar fasciitis patients, and healthy volunteers by one-way ANOVA. A post hoc Scheffé’s test was used to identify where the differences occurred. Results Compared to healthy participants (red pixel intensity: 146.9±9.1), there was significantly less red pixel intensity in the asymptomatic sides of unilateral plantar fasciitis (140.4± 7.3, p=0.01), symptomatic sides of unilateral plantar fasciitis (127.1±7.4, p60 (indicating the optimal compression force) on the elastogram were selected for recording. Three images of each plantar fascia were recorded. For each plantar fascia, the mean values of the red, green, and blue components in the three images were used for statistical analysis.
Imaging analysis We selected a standardized rectangular area to perform quantitative imaging analysis. This rectangle was located 2 mm proximal to the inferior border of the insertion of the plantar fascia on the calcaneus on the short side and 1 cm distal to the insertion on the long side. Image J software (version 1.42q, National Institutes of Health, Bethesda, MD, USA) was used to develop the color histogram from the elastogram of each plantar fascia. Each pixel was separated by the Image J program into red, green, and blue components (intensity: 0–255); higher values indicated more intense color. The color histogram was then used to compute the mean intensity of each component of the pixels (i.e., red, green, and blue) within the standardized area. This imaging analysis method was shown to be reliable [13].
Skeletal Radiol Table 1 Subject demographics (mean±standard deviation) Male: female ratio Age (years) Weight (kg) Body mass index (kg/m2)
Healthy
Unilateral plantar fasciitis
Bilateral plantar fasciitis
P value
11:19 41.6±13.9 60.3±11.1 22.2±2.6
4:6 45.1±12.5 61.7±12.4 22.5±3.1
4:6 46.5±10.8 58.6±11.6 21.5±3.2
0.58 0.82 0.74
Statistical test by one-way ANOVA
Statistical analysis All statistical analyses were performed using SAS version 9.3 for Windows (SAS Institute Inc., Cary, NC, USA). One-way ANOVA was used to determine the significance of differences among the three groups (healthy subjects, patients with unilateral fasciitis, and patients with bilateral fasciitis) with respect to age, weight, and body mass index. ANOVA was also used to determine the significance of differences in plantar fascia thickness and red, green, and blue pixel intensity between asymptomatic sides for patients with unilateral plantar fasciitis, symptomatic sides for patients with unilateral plantar fasciitis, and both sides for patients with bilateral plantar fasciitis. A post hoc Scheffé’s test was used to identify where the differences occurred. The data were expressed as mean±standard deviation. The level of significance was set at p
