title: Hyperemia in plantar fasciitis determined by power Doppler ultrasound.
abstract: METHODS
  Cross-sectional observational study.
  
  
  OBJECTIVE
  To investigate the presence of soft tissue hyperemia in plantar fasciitis with power Doppler ultrasound.
  
  
  BACKGROUND
  Localized hyperemia is an established feature of tendinopathy, suggesting that neurovascular in-growth may contribute to tendon-associated pain in some patients. The presence of abnormal soft tissue vascularity can be assessed with Doppler ultrasound, and a positive finding can assist with targeted treatment plans. However, very little is known regarding the presence of hyperemia in plantar fasciitis and the ability of routine Doppler ultrasound to identify vascular in-growth in the plantar fascia near its proximal insertion.
  
  
  METHODS
  This observational study included 30 participants with plantar fasciitis unrelated to systemic disease and 30 age- and sex-matched controls. Ultrasound examination was performed with a 13- to 5-MHz linear transducer, and power Doppler images were assessed by 2 blinded investigators.
  
  
  RESULTS
  Hyperemia of the plantar fascia was present in 8 of 30 participants with plantar fasciitis and in 2 of 30 controls. The between-group difference for hyperemia, using a 4-point scale, was statistically significant, with participants with plantar fasciitis showing increased Doppler ultrasound signal compared to controls (Mann-Whitney U, P = .03). However, the majority of participants with plantar fasciitis with evidence of hyperemia demonstrated very mild color changes, and only 3 were found to have moderate or marked hyperemia.
  
  
  CONCLUSIONS
  Mild hyperemia can occur with plantar fasciitis, but most individuals will not exhibit greater soft tissue vascularity when assessed with routine Doppler ultrasound. Clinicians treating plantar fasciitis should not consider a positive Doppler signal as essential for diagnosis of the condition but, rather, as a feature that may help to refine the treatment plan for an individual patient.
authors.affiliation: Department of Podiatry, Faculty of Health Sciences, La Trobe University, Melbourne, Victoria, Australia.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: McMillan
authors.forename: Karl B
authors.initials: KB
authors.lastname: Landorf
authors.forename: Julie M
authors.initials: JM
authors.lastname: Gregg
authors.forename: Jason
authors.initials: J
authors.lastname: De Luca
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Cotchett
authors.forename: Hylton B
authors.initials: HB
authors.lastname: Menz
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D036981:Fasciitis, Plantar / Q000150:complications / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D006940:Hyperemia / Q000000981:diagnostic imaging* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D018608:Ultrasonography, Doppler