BACKGROUND: In the clinic, 25%-35% heel pain is mostly caused by plantar fasciitis. Previous studies mainly focused on plantar fasciitis with heel pain caused by flat foot and the growth of calcaneus bone spur. There are no reports on other reasons for plantar fasciitis in large-sample studies. OBJECTIVE: Using the real-time shear wave elastography, CT scan and X-ray, the anatomic site and thickness of normal two-dimensional ultrasound standard flat plantar aponeurosis were identified to analyze the relationship between plantar elastic characteristics and plantar arch angle from non-weight-bearing to weight-bearing position so as to explore the correlation of plantar fasciitis with plantar elastics and plantar arch angle. METHODS: Fifty healthy volunteers (feet) were selected as the healthy control group. 100 cases of plantar fasciitis (one foot) were selected as the case group. Plantar arch angle from non-weight-bearing to weight-bearing position was obtained using X-ray and CT scan to identify anatomic site of plantar aponeurosis in both groups. Two-dimensional ultrasound and real-time shear wave elastography were utilized to obtain thickness and elastic modulus of plantar aponeurosis. RESULTS AND CONCLUSION: (1) From non-weight-bearing to weight-bearing, arch angle change value was (16.4±4.5)° in the healthy control group and (10.5±3.5)° in the case group. Significant differences in arch angle change were detected between the two groups (P <0.01). (2) Thickness of plantar fascia was obviously smaller in the healthy control group (2.4±0.3) mm than in the case group (3.5±0.9) mm. Elastic modulus of plantar fascia was obviously larger in the healthy control group (30.1±1.3) kPa than in the case group (9.1±1.2) kPa. Thickness of plantar fascia and elastic modulus of plantar fascia were significantly different between the two groups (P < 0.01). (3) In summary, real-time shear wave elastography combined with CT and X-ray images can investigate the morphological and elastic characteristics of the plantar aponeurosis from many aspects. Arch angle change is strongly associated with elastic modulus of plantar fascia. The decreased elastic modulus of plantar fascia is possibly one of the reasons for arch angle change from non-weight-bearing to weight-bearing conditions, and is probably one of reasons for plantar fasciitis with heel pain.%背景:临床25%-35%的跟痛症多为足底腱膜炎所致,过去的研究主要集中于扁平足、跟骨骨刺生长导致的足底腱膜炎性跟痛症,而对于足底腱膜炎的其他原因在大样本的系统研究中未见报道.目的:通过应用实时剪切波弹性成像、CT扫描、X射线等多模态成像技术,确定正常二维超声标准平面足底跖腱膜的解剖部位与厚度,实现对非负重位至负重位状态下足底跖腱膜弹性与足弓角变化的相关性研究,并探讨足底筋膜炎与跖腱膜弹性和足弓角的相关性.方法:选择健康对照组50例(双足),临床足底筋膜炎病例组100例(单足),2组均采用X射线、CT扫描获取非负重位状态至负重位状态下的足弓角,确定足底跖腱膜解剖部位,应用二维超声、实时剪切波弹性成像技术获取足底跖腱膜的厚度及弹性模量值.结果与结论:①健康对照组从非负重位至负重位弓顶角改变值为(16.4±4.5)°,病例组从非负重位至负重位弓顶角改变值为(10.5±3.5)°,2组足弓角变化差异有显著性意义(P < 0.01);②健康对照组足底筋膜厚度(2.4±0.3)mm明显小于病例组足底筋膜厚度(3.5±0.9)mm,健康对照组足底筋膜弹性模量(30.1±1.3)kPa明显大于病例组足底筋膜弹性模量(9.1±1.2)kPa,2组足底筋膜厚度与弹性模量值比较差异有显著性意义(P < 0.01);③综上,实时剪切波弹性成像结合CT成像、X射线等多模态成像技术能够从多个方面实现对足底跖腱膜形态和弹性特征的研究;足弓角变化与足底跖腱膜弹性密切相关,足底跖腱膜弹性减低可能是导致非负重位至负重位状态足弓角改变值减小的原因之一;足底跖腱膜弹性减低可能是导致足底筋膜炎性跟痛症的原因之一.
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