Realtime elastography in plantar fasciitis: comparison with ultrasonography and MRIx

Background Plantar fasciitis is a common cause of heel pain in adults, and the diagnosis is based on clinical history and examination. Ultrasound and MRI have so far been used to substantiate the clinical diagnosis. Elastography is a new emerging modality to evaluate the changes in the tissue elasticity of the plantar fascia. Hence, this study was designed to evaluate its role in the evaluation of plantar fasciitis and to compare it with ultrasound and MRI. Methods Twenty-five patients with bilateral heel pain were assessed using ultrasound, elastography and MRI, and the findings were graded according to the severity of disease and compared with each other. Sensitivity, specificity and overall accuracy were determined followed by two-way analysis of variance (ANOVA) to assess the statistical significance between the differences observed, with MRI being considered the gold standard for diagnosis. Results Elastography showed a 95% sensitivity and 100% specificity in the diagnosis of plantar fasciitis while ultrasound was 65.8% sensitive and 75% specific with the differences being statistically significant (P = 0.009). Elastography was shown to detect early stages I and II plantar fasciitis in 10 of 12 and in 15 of 16 patients, respectively, while ultrasound only detected four of 12 patients with stage I disease (P = 0.001). Conclusions The combination of elastography with ultrasound improves the accuracy from 68% to 96% and also stages the extent of disease, with the results being comparable to MRI.