Critical differences in lateral X-rays with and without a diagnosis of plantar fasciitis


      Plantar fasciitis is a clinical diagnosis and is often combined with some form of imaging to validate the diagnosis. The clinical utility of lateral X-rays lies in the fact that they are relatively inexpensive and may contribute to ruling out other osseous causes of pain. In this study 106 (27 plantar fasciitis (PF) and 79 controls) plain non-weight bearing lateral X-rays were examined by a blind examiner to document the key features of the lateral X-ray between images of individuals with and without plantar fasciitis. As expected calcaneal spurs were observed in both groups (85% PF and 46% controls). However, plantar fascia thickness and fat pad abnormalities resulted in the best group differentiation (p < 0.0001) with sensitivity of 85% and specificity of 95% for plantar fasciitis. It was concluded that the key radiological features that differentiate the groups were not spurs but rather changes in the soft tissues. If it is deemed necessary to confirm the diagnosis of typical plantar fasciitis with imaging, a lateral non-weight bearing X-ray should be the first choice investigation especially if these key features are noted.


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        • Kibler W.B.
        • Goldberg C.
        • Chandler T.J.
        Functional biomechanical deficits in running athletes with plantar fasciitis.
        Am J Sports Med. 1991; 19: 66-71
        • Barrett S.J.
        • O’Malley R.
        Plantar fasciitis and other causes of heel pain.
        Am Fam Physician. 1999; 59: 2200-2206
        • Yozsa S.
        • Lehnert B.
        • Resnick D.
        Imaging of the rearfoot.
        J Am Podiatr Med Assoc. 1999; 89: 292-301
        • McCarthy D.J.
        • Gorecki G.E.
        The anatomical basis of inferior calcaneal lesions: a cryomicrotomy study.
        J Am Podiat Assos. 1979; 69: 527-536
        • Cardinal E.
        • et al.
        Plantar fasciitis: sonographic evaluation.
        Radiology. 1996; 201: 257-259
        • Gibbon W.W.
        • Long G.
        Ultrasound of the plantar aponeurosis (fascia).
        Skeletal Radiol. 1999; 28: 21-26
        • Kane D.
        • et al.
        The role of ultrasonography in the diagnosis and management of idiopathic plantar fasciitis.
        Rheumatology (Oxford). 2001; 40: 1002-1008
        • Ozdemir H.
        • et al.
        The role of bone scintigraphy in determining the etiology of heel pain.
        Ann Nucl Med. 2002; 16: 395-401
        • Tudor G.R.
        • et al.
        The role of bone scintigraphy and plain radiography in intractable plantar fasciitis.
        Nucl Med Commun. 1997; 18: 853-856
        • Kier R.
        Magnetic resonance imaging of plantar fasciitis and other causes of heel pain.
        Magn Reson Imaging Clin N Am. 1994; 2: 97-107
        • Narvaez J.A.
        • et al.
        Painful heel: MR imaging findings.
        Radiographics. 2000; 20: 333-352
        • Roger B.
        • Grenier P.
        MRI of plantar fasciitis.
        Eur Radiol. 1997; 7: 1430-1435
        • Hopkins W.G.
        Measures of reliability in sports medicine and science.
        Sports Med. 2000; 30: 1-15
        • Chigwanda P.C.
        A prospective study of Plantar fasciitis in Harare.
        Cent Afr J Med. 1997; 43: 23-25
        • Pyasta R.T.
        • Panush R.S.
        Common painful foot syndromes.
        Bull Rheum Dis. 1999; 48: 1-4
        • Akfirat M.
        • Sen C.
        • Gunes T.
        Ultrasonographic appearance of the plantar fasciitis.
        Clin Imaging. 2003; 27: 353-357
        • Berkowitz J.F.
        • Kier R.
        • Rudicel S.
        Plantar fasciitis: MR imaging.
        Radiology. 1991; 179: 665-667
        • Anderson J.
        • Steinweg J.
        • Read J.
        Atlas of imaging in sports medicine (392).
        McGraw-Hill, 1999
      1. Hamish R Osborne, Garry T Allison. Treatment of plantar fasciitis by low-Dye taping and iontophoresis – short-term results of a double blinded, randomised, placebo controlled clinical trial of dexamethasone and acetic acid. Br J Sports Med 2006, doi:10.1136/bjsm.2005.021758.