Ultrasound elastography for the evaluation of plantar fasciitis: A systematic review and meta-analysis

Purpose: This meta-analysis aimed to investigate the utility of ultrasound (US) elastography in the assessment of plantar fasciitis (PF). Methods: We searched PubMed, Embase, and Scopus and systemically reviewed clinical studies that used US elastography for imaging PF. The primary outcome was the comparison of plantar fascia stiffness between healthy controls and patients with PF, quantified using the weighted mean difference (WMD) and standardized mean difference (SMD). Results: Eleven studies were included in the final systematic review and meta-analysis. In six studies that employed shear wave elastography, patients with PF had a lower shear wave velocity, with a WMD of-1.772 m/ s (95 % confidence interval [CI],-2.663 to-0.880) and an SMD of-1.239 m/s (95 % CI,-1.876 to-0.603), compared to those with asymptomatic heels. One study using the strain ratio showed that the WMD and SMD of patients with diseased heels vs healthy controls were-0.400 (95 % CI,-0.850 to 0.050) and-0.442 (95 % CI,-0.946 to 0.062), respectively. In six articles that use the color histogram of strain elastography, less stiffness was consistently reported in the diseased plantar fascia compared with healthy controls. Conclusion: This meta-analysis showed that the plantar fasciae were less stiff in the PF group than in asymp-tomatic subjects. The diagnostic performance of US elastography (over B-mode) warrants further investigation.