EVALUATION OF THE ELASTICITY AND THICKNESS OF THE HEEL FAT PAD WITH ULTRASOUND IN PLANTAR FASCIITIS

Year 2022, Volume: 29 Issue: 3, 422 - 428, 30.09.2022

Ahmet Çağdaş Biçen Utku Mahir Yıldırım Meric Unal

https://doi.org/10.17343/sdutfd.1121418

Abstract

Objective
The aim of this study was to evaluate thickness and
elasticity of heel fat pad in patients with unilateral
plantar fasciitis and to investigate the effects of age,
sex, body mass index (BMI), and functional scores on
plantar fasciitis.
Material and Method
70 patients who had been suffering from unilateral
plantar fasciitis longer than 6 months were enrolled
in the study. The thickness and elasticity of fat pad
were compared between the painful and healthy feet
of the patients with ultrasound. For measurement of
elasticity, shear wave elastography (SWE) was used.
Comparative analysis was performed for thickness
and elasticity variables between the painful and
healthy feet with Mann–Whitney U and independent
samples t-test.
Results
Average of age of the patients was 44±11.66. The
average thickness of the heel fat pad was 17.9±3.1
mm on the affected side and 18.3±3.3 mm on the
healthy side. The mean SWE value of the painful side
was 23.9 m/s (range 9.3-32) and was 24.7 m/s (range
10.8-34) on the healthy side. Heel fat pad thickness
was greater in the healthy feet than in the painful feet,
but there was no statistical significance (p=0.448).
The painful feet were stiffer, but the difference was
statistically similar (p=0.347). BMI had a statistically
significant impact on thickness of heel fat pad.
Conclusion
The results showed that a decrease in the heel fat pad
thickness was a supporting finding of plantar fasciitis
in patients with normal BMI but not in patients with
BMI>25.

Keywords

Plantar fasciitis, fat pad, elasticity, shear wave elastography

PLANTAR FASİİTTE TOPUK FAT PAD ELASTİKİYETİNİN VE KALINLIĞININ ULTRASON İLE DEĞERLENDİRİLMESİ

Abstract

Amaç
Bu çalışmanın amacı, tek taraflı plantar fasiitli hastalarda
topuk yağ yastığının kalınlığını ve elastikiyetini
değerlendirmek ve yaş, cinsiyet, vücut kitle indeksi
(VKİ) ve fonksiyonel skorların plantar fasiit üzerindeki
etkilerini araştırmaktır.
Gereç ve Yöntem
Çalışmaya 6 aydan uzun süredir tek taraflı plantar fasiiti
olan toplam 70 hasta dahil edildi. Hastaların ağrılı
ve sağlıklı ayakları arasında ultrason ile yağ yastığının
kalınlığı ve elastikiyeti karşılaştırıldı. Elastisite ölçümü
için Shear Wave Elastografi (SWE) kullanıldı.
Fonksiyonel değerlendirme American Orthopaedic
Foot and Ankle Society Skoru (AOFAS) ile yapıldı. Ağrılı
ve sağlıklı taraflar arasında kalınlık ve elastikiyet
değişkenleri, bağımsız grup t-testi ve Mann-Whitney
U testi kullanılarak karşılaştırıldı.
Bulgular
Hastaların yaş ortalaması 44±11.66 idi. Topuk yağ
yastığının ortalama kalınlığı etkilenen tarafta 17.9±3.1
mm ve sağlıklı tarafta 18.3±3.3 mm idi. Ağrılı tarafta
ortalama SWE değeri 23.9 m/s (9.3-32), sağlıklı tarafta
24.7 m/s (10.8-34) idi. Hastaların ortalama AOFAS
skoru 70 (62-78) idi. Topuk yağ yastığı kalınlığı, sağlıklı
ayaklarda ağrılı ayaklara göre daha fazlaydı, ancak
bu fark istatistiksel olarak anlamlı değildi (p=0,448).
Ağrılı ayaklar daha sertti, ancak fark istatistiksel olarak
benzerdi (p=0,347). Ağrılı ve sağlıklı ayaklar arasındaki
elastikiyet ve kalınlık değerleri cinsiyetten etkilenmemiştir.
VKİ, ağrılı ve sağlıklı ayaklar arasındaki
topuk yağ yastığı kalınlığı üzerinde istatistiksel olarak
anlamlı bir etkiye sahiptir.
Sonuç
Topuk yağ yastığı kalınlığındaki azalma plantar fasiit
için, VKİ normal olan hastalarda destekleyici bir
bulgudur ancak VKİ>25 olan hastalarda destekleyici
değildir.

Keywords

Plantar fasiit, fat pad, shear wave elastografi, elastisite

References

• 1- Schwartz EN, Su J. Plantar fasciitis: a concise review. Perm J. 2014;18:105-107.
• 2- Lareau CR, Sawyer GA, Wang JH, DiGiovanni CW. Plantar and medial heel pain: diagnosis and management. J Am Acad Orthop Surg. 2014; 22:372-380.
• 3- Ersen Ö, Koca K, Akpancar S, Seven MM, Akyıldız F, Yıldız Y, Özkan H. A randomized-controlled trial of prolotherapy injections in the treatment of plantar fasciitis. Turk J Phys Med Rehabil. 2017; 64:59-65.
• 4- Lopez-Lopez D, Becerro-de-Bengoa-Vallejo R, Losa-Iglesias ME, Soriano-Medrano A, Palomo-Lopez P, Morales-Ponce A, Rodriguez-Sanz D, Calvo-Lobo C. Relationship Between Decreased Subcalcaneal Fat Pad Thickness and Plantar Heel Pain. A Case Control Study. Pain Physician. 2019; 22:109-116.
• 5-Wearing SC, Smeathers JE, Yates B, Urry SR, Dubois P. Bulk compressive properties of the heel fat pad during walking: A pilot investigation in plantar heel pain. Clin Biomech. 2009; 24:397-402.
• 6-Ozdemir H, Söyüncü Y, Ozgörgen M, Dabak K. Effects of changes in heel fat pad thickness and elasticity on heel pain. J Am Podiatr Med Assoc. 2004; 94:47-52.
• 7-Belhan O, Kaya M, Gurger M. The thickness of heel fat-pad in patients with plantar fasciitis. Acta Orthop Traumatol Turc. 2019; 53:463-467.
• 8-Nakale NT, Strydom A, Saragas NP, Ferrao PNF. Association Between Plantar Fasciitis and Isolated Gastrocnemius Tightness. Foot Ankle Int. 2018;39:271-277.
• 9-Thompson JV, Saini SS, Reb CW, Daniel JN. Diagnosis and management of plantar fasciitis. J Am Osteopath Assoc. 2014; 114:900-906.
• 10- Gatz M, Bejder L, Quack V, Schrading S, Dirrichs T, Tingart M, Kuhl C, Betsch M. Shear Wave Elastography (SWE) for the Evaluation of Patients with Plantar Fasciitis. Acad Radiol. 2020; 27:363-370.
• 11-Aggarwal P, Jirankali V, Garg SK. Evaluation of plantar fascia using high-resolution ultrasonography in clinically diagnosed cases of plantar fasciitis. Pol J Radiol. 2020; 85:375-380.
• 12- Goff JD, Crawford R. Diagnosis and treatment of plantar fasciitis. Am Fam Physician. 2011; 84:676-682.
• 13- Zhou JP, Yu JF, Feng YN, Liu CL, Su P, Shen SH, Zhang ZJ. Modulation in the elastic properties of gastrocnemius muscle heads in individuals with plantar fasciitis and its relationship with pain. Sci Rep. 2020; 10:2770.
• 14- Turgut A, Göktürk E, Köse N, Seber S, Hazer B, Günal I. The relationship of heel pad elasticity and plantar heel pain. Clin Orthop Relat Res. 1999; 360:191-196.
• 15-Hsu TC, Wang CL, Tsai WC, Kuo JK, Tang FT. Comparison of the mechanical properties of the heel pad between young and elderly adults. Arch Phys Med Rehabil. 1998; 79:1101-1104.
• 16- Kanatli U, Yetkin H, Simsek A, Besli K, Ozturk A. The relationship of the heel pad compressibility and plantar pressure distribution. Foot Ankle Int. 2001; 22:662-665.
• 17- Sconfienza LM, Silvestri E, Orlandi D, Fabbro E, Ferrero G, Martini C, Sardanelli F, Cimmino MA. Real-time sonoelastography of the plantar fascia: comparison between patients with plantar fasciitis and healthy control subjects. Radiology. 2013; 267:195-200.
• 18- Lin CY, Lin CC, Chou YC, Chen PY, Wang CL. Heel Pad Stiffness in Plantar Heel Pain by Shear Wave Elastography. Ultrasound Med Biol. 2015; 41:2890-2898.
• 19- Prichasuk S, Mulpruek P, Siriwongpairat P. The heel-pad compressibility. Clin Orthop Relat Res. 1994; 300:197-200.
• 20- Ozdemir H, Urgüden M, Ozgörgen M, Gür S. The relationship between the thickness and elasticity of the heel pad and heel pain. Acta Orthop Traumatol Turc 2002;36(5):423-8.
• 21- Ermutlu C, Aksakal M, Gümüştaş A, Özkaya G, Kovalak E, Özkan Y. Thickness of plantar fascia is not predictive of functional outcome in plantar fasciitis treatment. Acta Orthop Traumatol Turc. 2018; 52:442-446.
• 22- Lai TW, Ma HL, Lee MS, Chen PM, Ku MC. Ultrasonography and clinical outcome comparison of extracorporeal shock wave therapy and corticosteroid injections for chronic plantar fasciitis: A randomized controlled trial. J Musculoskelet Neuronal Interact. 2018; 18:47-54.