The plantar fascia is a thick,
ligamentous connective tissue that runs from the calcaneus to the ball of the foot.
This tight tissue helps to maintain the arch of the foot and transmits weight across the foot as person walks or runs.
That's why tremendous stress is placed on the plantar fascia.(6)
Heel pain is a very common complaint in adults especially in females.
It is estimated that more than one million patients seek treatment annually for this condition.
The Plantar fasciitis is thought to be the most common cause & is mainly due to biomechanical overuse ,
thus creating microtears at the calcaneal enthesis.(7)
Some experts have deemed this condition “plantar fasciosis,” implying that its etiology is a more chronic degenerative process versus acute inflammation.(8)
Far and away the most common cause of plantar fascia pain is faulty biomechanics of the foot or leg.
Faulty biomechanics causes the foot to sustain increased or prolonged stresses over and above those of routine ground contacts.(9)
High-heeled shoes can limit proprioception where the heel hits the ground first followed by the toe .It has been shown that high heeled stiff shoes restrict the inversion/eversion of the foot,
which can lead to an increase in rearfoot pronation ,
therefore showing that the stiffer the shoe,
the more the natural foot motion is restricted.(10)
Not only is the normal foot motion restricted by shoes,
it has also been shown that wearing high heeled shoes restricts other biomechanics aspects of the foot.(10)
Forefoot to rearfoot eversion/inversion and abduction/adduction were restricted by shoes,
as well as forefoot spreading,
which is important for comfort as well as natural gait,
and forefoot pronation during push-off.
(11)
Plantar fasciosis can be confused with a condition called tarsal tunnel syndrome.
In tarsal tunnel syndrome,
the tibial nerve is trapped and pinched as it passes through the tarsal tunnel.
This may cause symptoms similar to the pain of a Plantar fasciosis/fasciitis ,
in this study ,
the suspected cases to have tarsal tunnel syndrome were investigated with nerve conduction study & were all free.(12)
In all our patients suspected of having plantar fasciitis,high signal intensity consistent with edema in the perifascial soft tissue was appreciated on T2-weighted images & STIR images as well .
Our findings are in agreement with those of a previous studies,
in which the perifascial edema was considered the most common manifestation of plantar fasciitis.(13) In our patients with plantar fasciitis,
soft-tissue edema superficial and deep to the PA was the dominant abnormal imaging finding in 90% of cases ,
that frequency for edema superficial to the PA was reported previously .
The second most common MR imaging finding of plantar fasciitis,
seen in 66% of our patient ,
was mild thickening of the PA,
corresponding to the presence of granulation tissue.
This finding was more common in our study than was previously reported .(13)
Then,
the following MR imaging finding of plantar fasciitis,
observed in 23 % of our cases,
was increased signal intensity within the involved plantar fascia on T2-weighted and STIR images; this finding was consistent with edema ,
this findings did not match with the other studies ,
we believe that the difference may be contributed to the different number of patient & the plenty of exclusion criteria .(13)
In patients with a clinical diagnosis of partial rupture of the PA,
MR imaging allowed diagnosis of the case ,exact localization,
and determination of severity of the lesion with regard to the thickness of the affected PA.
In the examined volunteers with age matching not wearing high heels ,
onecase for mild edema & plantar fasciitis was seen only among the group ,
raising the consideration to the effect of high heel on the PA.
As we preceded ,
the causes of plantaris fascia pain were lots & we tried to exclude some causes both by clinical examination & laboratory investigations ,
so that we come to a conclusion that a relation is present between the presence of plantar fascial pathology & high heel in absence of other obvious causes of heel pain .
In conclusion ,
MRI was helpful in diagnosis of pathology of the plantar fascia In our patients with a clinical diagnosis of rupture of the PA,
MR imaging allowed demonstration,
exact localization,
and determination of severity of the lesion with regard to the thickness of the affected PA.
Depicting the relation between the complain ,
physical examination & the presence of high heel in absence of any other cause for the presence of either PA rupture or fasciitis/fasciosis,
& drawing a line correlating the high heel & plantar fascial pathology.
We recognize that although the patients show the similar symptoms & similar imaging findings ,
yet the implication of this examination over a larger population may help support our conclusion