Ultrasonographic examination of plantar fasciitis: a comparison of patient positions during examination

Abstract

Background: Musculoskeletal ultrasound is a non-invasive and low-cost modality for real-time visualisation of the plantar fascia. Ultrasound examination for plantar fasciitis is generally performed with the patient in a prone position, although the rational for using a prone position has not been validated. The aim of the study was to investigate if ultrasound examination in a supine position, which is more comfortable than the prone position, is valid.

Methods: We conducted a prospective study of 30 participants with plantar fasciitis, 8 men (27 %) and 22 women (73 %), with a mean age of 53.9 ± 12.6 (range, 32 to 77) years, and an equal distribution of left and right feet. The plantar heel was divided into three portions for ultrasound examination: medial, central and lateral. Two measurements of plantar fascia thickness were obtained for each portion, with participants in 2 positions (supine and prone) and for 2 ankle postures (neutral and 15° of plantarflexion). Mean measurements of plantar fascia thickness were compared between the two positions (Wilcoxon signed rank tests for non-normally distributed data and paired t-tests for normally distributed data). Participants were asked to report their preferred position for examination, supine or prone.

Results: The measured thickness was comparable for both supine and prone positions, for both ankle postures, neutral and 15° of plantarflexion (p > 0.05). A specific self-reported preferred position was not identified.

Conclusions: Ultrasound examination of plantar fasciitis can be performed in the supine position without any significant difference in measurement compared to examination in the conventional prone position.

Trial registration: The Catholic Medical Center Office of Human Research Protection Program (CMC-OHRP)/Institutional Review Board approved the current study (Approval No. KC12DISI0338), and all participants provided their written informed consent for participation and publication.

Keywords: Plantar fasciitis; Prone position; Supine position; Ultrasound.

Fig. 1

The vertical thickness of the plantar fascia was measured at a standard reference point (white arrow) where the fascia crosses the anterior most aspect of the inferior border of the calcaneus

Fig. 2

Comparison of measurements of plantar fascia thickness obtained in supine and in prone positions for a representative 54-year-old woman, with the ankle in a neutral posture. A thickness of 7.0 mm was obtained in the supine position (a); compared to 7.1 mm in the prone position (b)