title: Ultrasound scanning for recalcitrant plantar fasciopathy. Basis of a new classification.
abstract: OBJECTIVE
  The treatment of recalcitrant plantar fasciopathy is often empirical. Imaging is usually in the form of radiographs, if undertaken at all. The aim of this study is to characterise the disease pattern in recalcitrant cases of plantar fasciopathy. This allows classification of the pathology, which in turn allows meaningful evaluation of current and future treatments.
  
  
  METHODS
  One hundred and twenty-five consecutive feet with symptoms of 'plantar fasciitis' lasting longer than 6 months (all of which had failed to improve with a stepwise conservative management protocol) had confirmed plantar fasciopathy on ultrasound scanning. The disease characteristics were evaluated based on the scan findings.
  
  
  RESULTS
  Of the patients evaluated, 66 % had typical insertional disease. The remaining 34 % had atypical distal fascia disease; 22 % had mixed insertional and distal disease, and 12 % had pure distal disease. Patients with pure distal disease were found to have either distal thickening or discrete fibromata.
  
  
  CONCLUSIONS
  In this cohort of recalcitrant cases, ultrasound scans detected a high proportion of atypical non-insertional plantar fascia disease. This would not be detected without imaging studies, and therefore we recommend the use of ultrasound scanning in cases of recalcitrant plantar heel pain that have failed proper first-line management, in order to confirm the clinical diagnosis and to classify the disease as either insertional or non-insertional plantar fasciopathy (or mixed disease). Only in this way can treatments for this group of patients be systematically evaluated against different disease patterns to determine their effectiveness.
authors: Royal Surrey County Hospital, Guildford, Surrey, UK. edieong83@gmail.com
authors: Edmund
authors: E
authors: Ieong
authors: John
authors: J
authors: Afolayan
authors: Andrew
authors: A
authors: Carne
authors: Matthew
authors: M
authors: Solan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D036981:Fasciitis, Plantar / Q000145:classification / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000379:methods* / Q000706:statistics & numerical data*; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult