Learning objectives
1) In this pictorial essay,
we explore causes of heel and hind foot pain.
Thesecan be broadly divided as follows:
Plantar fascia
Muscular,
tendinous and ligamentous
Neurogenic
Osseous
Bursal
Tarsal tunnel
Soft tissue lesions: benign andmalignant
2) Revise anatomy of the heel and hind foot.
3) Review image modalities used to assess heel and hind foot.
4) Understand thepathologies that cause heel and hind foot pain.
5) Understand important imaging features that aid in correct diagnosis of the given pathology.
Background
Heel/hindfoot pain is a common presenting symptomthat can have a significant impact on the quality and activity of daily living.
Upto 1 in 5 people in a given population have been found to have foot pain,
which increases with age,
female sex and obesity.
There are multitude of pathologies of the hindfoot that can cause pain.
It is oftendifficult to obtain a firm diagnosis on clinical examination alone,
with imaging becoming increasingly relevant and integral part of the diagnostic process.
Multimodality imaging is used for...
Imaging findings OR Procedure Details
PLANTAR FASCIA:
Anatomy:
Multilayered,
fibrous aponeurosis with medial,
central,
and lateral components.
In the midsole,
it splits into five bands,
one for each toe,
that insert on the proximal phalanges.
The normal fascia appears as a thin (2–4-mm) band with low signal intensityon all pulse sequences
1) Plantar fasciitis
Classically present as heel pain,
which is worse when weight bearing after a prolonged rest and eases with walking.Exacerbated by passive dorsiflextion.
Low grade inflammatory process involving the plantar aponeurosis caused by:
Degenerative
Mechanical: repetitive injury...
Conclusion
Heel/hindfoot pain is a non-specific symptom that can be produced by wide range of pathology,
which makes it challenging for both clinicians and radiologists to come to a firm diagnosis.
Musculoskeletal radiologists must therefore be aware of the differential diagnosesa simple heel pain may represent.
Majority of patients with heel pain can be successfully treated conservatively,
but in cases that require surgery,
MRI is especially useful in planning and assessing for the soft tissue involvement in order to confirm the exact location and lesion extent.
References
Hill CL,
Gill TK,
Menz HB,
Taylor AW.
Prevalence and correlates of foot pain in a population-based study: the North West Adelaide health study.
J Foot Ankle Res.
2008; 28(1):2.
Navarez JA,
Navarez J,
Ortega R et al.
Painful Heel: MR Imaging Findings.
Radiographics.
2000; 20(2):333-352.
Berkowitz JF,
Kier R,
Rudicel S.
Plantar fasciitis: MR imaging.
Radiology 1991; 179:665-667.
Roger B,
Grenier P.
MRI of plantar fasciitis.
Eur Radiol 1997; 7:1430-1435.
Theodorou DJ,
Theodorou SJ,
Kakitsubata Y et al.
Plantar fasciitis and fascial rupture: MR...
Personal Information
S.B.Gagrani,Department of Radiology ,Heart of England NHS Foundation Trust,Birmingham Heartlands Hospital,
Bordesley Green East,
Birmingham B9 5SS,
R.Bhatt,Department of Radiology ,University Hospitals of Leicester ,Leicester General Hospital,Gwendolen Road,
Leicester LE5 4PW,
S.Lee,Department of Radiology ,University Hospitals of Leicester,Infirmary Square,Leicester,LE1 5WW.