Douglas D. Robertson, Abstract Co-Author: Nothing to Disclose

Amitesh Prasad MD, Presenter: Nothing to Disclose

Lance Silverman MD, Abstract Co-Author: Nothing to Disclose

Stephen F. Conti MD, Abstract Co-Author: Nothing to Disclose

Chronic recalcitrant fasciitis is a common disorder defined by nonoperative treatment failure after a minimum of six months. This disorder results from inadequate healing of repetitive micro-tears. The purpose of this investigation was to evaluate the role of MRI in 1) detailing the preoperative characteristics and 2) guiding the management of plantar fasciitis.

Seventy-five patients with the clinical diagnosis of chronic recalcitrant fasciitis where identified from a two year period. Their MR imaging studies were evaluated by a musculoskeletal radiologist who had not previously seen the studies. Patients with surgical interventions prior to MRI or tarsal tunnel syndrome were excluded. MRIs were graded for perifascial edema, plantar fascia thickness, and percentage of fascial origin involved. Additional foot pathology was also recorded. Following MRI, primary partial plantar fasciectomy and release of the nerve to the abductor digiti minimi were performed. All patients had at least a one year post-operative follow-up and pre and post-operative functional scores.

Pre-operative MRI documented degenerative scarring and thickening of the plantar fascia. Edema was seen within and at the fat and muscle facial surfaces and within the calcaneus. The MRI gradings of edema, thickness, and percent involvement did not correlate with the length of symptoms preoperatively or the degree of post-operative improvement (p>0.2). Co-existent foot pathology, excluding tarsal tunnel, included subtalar arthrosis, fracture, and plantar fibroma.

MRI confirmed the clinical diagnosis, detailed the extent of disease, and detected unsuspected foot pathology. Severity of the MRI findings did not correlate with preoperative symptoms or the degree of post-operative improvement. In summary, MRI has an important role in confirming the diagnosis and in uncovering additional clinically-unsuspected foot pathology.

Robertson, D, Prasad, A, Silverman, L, Conti, S, MRI of Recalcitrant Plantar Fasciitis.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4417340.html