Plantar fasciitis-MRI

Clinical details: 45 yr old male with pain undersurface of foot  , more so, after resting (in the morning after overnight resting) and  exacerbated pain on passive dorsiflexion of toes   shows on MRI, enlarged and heterogeneous edema of  plantar fascia with  involvement of soft tissues in the vicinity with no discontinuity or subcalcaneal spur, consistent with  degenerative  variety of Plantar fasciitis.

Teaching points by Dr MGK Murthy

1.     Plantar fascia is thick aponeurosis (connective tissue ) from medial calcaneal tuberosity to the proximal phalanges with three components : medial,  central(largest) (referred  to as aponeurosis)  and lateral. It bears approximate 14%load of foot  apart from supporting the arch and acting to keep "windlass mechanism "of foot in conjunction with Tendoachilles

2.      Fasciitis is  low-grade inflammatory process involving the plantar aponeurosis with or without involvement of the perifascial structures. It can be  repetitive micro trauma(most common) or degenerative or enthesopathy varieties. 

3.      MR extremely sensitive with delineation of fascial and perifascial edema , apart from  thickening (proximal  more than distal)  and edema of the adjacent fat and  soft tissues, marrow edema  medial calcaneal tuberosity. Treatment is conservative/Steroidal injections/molded foot wear etc

4.     Lack of edema  differentiates fibromatosis (non malignant thickening of fascia) and xanthoma shows typical T1 hyperintensity.