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. 2025 Jul 23;17(7):e88609.
doi: 10.7759/cureus.88609. eCollection 2025 Jul.

Ultrasound Imaging of Plantar Fascia in Apparently Healthy Individuals, Diabetics and Patients With Plantar Fasciitis: A Case-Control Study

Soumya Chincholikar  1 , Anil K Sakalecha  1 , Guruyogendra Muthyal  1 , Suprith Shankar  1 , Sneha D N  1 , Sri Madhurima Puttagunta  2 , Richik Sarkar  3
Affiliations

Ultrasound Imaging of Plantar Fascia in Apparently Healthy Individuals, Diabetics and Patients With Plantar Fasciitis: A Case-Control Study

Soumya Chincholikar et al. Cureus. .

Abstract

Introduction: The plantar fascia (PF) is a critical load-bearing structure of the foot, contributing to arch support and gait mechanics. Diabetes mellitus (DM) and plantar fasciitis (PFis) are two distinct conditions that affect the structure and function of the PF. While PFis is typically linked to mechanical overload and localized degeneration, diabetes may lead to more widespread changes in connective tissue consistency and thickness. Although both conditions impact PF morphology, no meta-analysis to date has systematically distinguished the ultrasound features of diabetic fascial thickening versus plantar fasciitis, highlighting a critical gap that this study addresses.

Methods: This case-control ultrasound study included 90 participants aged 30-60 years (30 per group): (1) healthy controls, (2) patients with type 2 DM (duration five or more years, no heel pain), and (3) non-diabetic individuals with clinically diagnosed unilateral PFis. High-resolution ultrasound was performed to assess PF thickness was measured 1 cm distal to the calcaneal insertion (a standardized site with good reproducibility), echogenicity (normal vs. reduced), and power Doppler vascularity. The examiner was blinded to group assignment. Group comparisons were conducted using ANOVA and chi-square tests.

Results: PF thickness was significantly increased in both diabetic (3.4 ± 0.6 mm) and PFis (5.6 ± 1.1 mm) groups compared to controls (2.6 ± 0.5 mm, p<0.001). Hypoechogenicity was observed in 90% of PFis subjects but only 7% of individuals with diabetes and none of the controls (p<0.001). Doppler vascularity was absent in controls and nearly all diabetics (3%) but present in 33% of PFis cases (p < 0.01), typically indicating neovascularization.

Conclusion: Ultrasound effectively distinguishes PF changes in diabetes and PFis. While both conditions show PF thickening, PFis is characterised by hypoechoic hypervascular fascia, reflecting localised degeneration. Diabetic PF changes are diffuse and subclinical, without significant echo-textural disruption or inflammation. These findings underscore the diagnostic utility of ultrasound in evaluating heel pain and in the early detection of diabetic foot tissue remodelling.

Keywords: diabetes mellitus; doppler vascularity; healthy; neovascularization; plantar fascia.

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Conflict of interest statement

Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. Sri Devaraj Urs Academy of Higher Education and Research Central Ethics Committee issued approval SDUAHER/R&D/CEC/SDUMC-PG/63/NF/2025-26. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

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