Detection of normal plantar fascia thickness in adults via the ultrasonographic method.

BACKGROUND: Heel pain is a prevalent concern in orthopedic clinics, and there are numerous pathologic abnormalities that can cause heel pain. Plantar fasciitis is the most common cause of heel pain, and the plantar fascia thickens in this process. It has been found that thickening to greater than 4 mm in ultrasonographic measurements can be accepted as meaningful in diagnoses. Herein, we aimed to measure normal plantar fascia thickness in adults using ultrasonography. METHODS: We used ultrasonography to measure the plantar fascia thickness of 156 healthy adults in both feet between April 1, 2011, and June 30, 2011. These adults had no previous heel pain. The 156 participants comprised 88 women (56.4%) and 68 men (43.6%) (mean age, 37.9 years; range, 18-65 years). The weight, height, and body mass index of the participants were recorded, and statistical analyses were conducted. RESULTS: The mean ± SD (range) plantar fascia thickness measurements for subgroups of the sample were as follows: 3.284 ± 0.56 mm (2.4-5.1 mm) for male right feet, 3.3 ± 0.55 mm (2.5-5.0 mm) for male left feet, 2.842 ± 0.42 mm (1.8-4.1 mm) for female right feet, and 2.8 ± 0.44 mm (1.8-4.3 mm) for female left feet. The overall mean ± SD (range) thickness for the right foot was 3.035 ± 0.53 mm (1.8-5.1 mm) and for the left foot was 3.053 ± 0.54 mm (1.8-5.0 mm). There was a statistically significant and positive correlation between plantar fascia thickness and participant age, weight, height, and body mass index. CONCLUSIONS: The plantar fascia thickness of adults without heel pain was measured to be less than 4 mm in most participants (~92%). There was no statistically significant difference between the thickness of the right and left foot plantar fascia.

Palpation tests versus impingement tests in Neer stage I and II subacromial impingement syndrome.

PURPOSE: Using sonographic findings to test the diagnostic accuracy of impingement versus tendon palpation tests in Neer stage I and II subacromial impingement syndrome cases and examine their clinical potential. METHODS: Neer and Hawkins impingement tests and rotator cuff tendon palpation tests followed by bilateral shoulder sonography were conducted on 69 patients with a clinical diagnosis of unilateral subacromial impingement. RESULTS: The Neer and Hawkins tests had 74 and 62 % accuracy (sensitivity 80 and 67 %, and specificity 52 and 47 %, respectively) in comparison to 79 and 62 % accuracy rates for supraspinatus and biceps tendon palpation tests (sensitivity 92 and 41 %, and specificity 41 and 48 %, respectively). Overall, the palpation tests scored better than impingement tests in the diagnosis of Neer stage I and II subacromial impingement syndrome. No tendinosis or tear was noted in patients with negative findings in the supraspinatus palpation tests (sensitivity 100 %, specificity 21 %). CONCLUSION: Palpation tests for supraspinatus and biceps tendons have a slightly higher accuracy than the impingement tests, and if tenderness does not exist then supraspinatus tendinopathy can be ruled out. These findings warrant the use of palpation tests in a routine physical examination for tendinopathy. LEVEL OF EVIDENCE: I.