Preliminary Diagnosis: Plantar Fasciitis
I. What imaging technique is first-line for this diagnosis?
MRI of the foot without contrast
II. Describe the advantages and disadvantages of this technique for diagnosing plantar fasciitis.
Advantages
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Diagnostic modality to evaluate the anatomy of the plantar fascia, including the medial, central, and lateral cords.
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Diagnostic modality to evaluate for fascial tears, perifascial muscle/soft tissue edema, or osseous edema at the calcaneal enthesal attachment.
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Does not use ionizing radiation.
Disadvantages
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Expensive.
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Time consuming.
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Requires significant patient cooperation to minimize motion artifact.
III. What are the contraindications for the first-line imaging technique?
Contraindications include a non-MR compatible hardware.
IV. What alternative imaging techniques are available?
An alternative is ultrasound of the plantar fascia using a high frequency linear transducer with Color Doppler interrogation.
V. Describe the advantages and disadvantages of the alternative techniques for diagnosing plantar fasciitis.
Ultrasound of the plantar fascia using a high frequency linear transducer with Color Doppler interrogation
Advantages
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Inexpensive.
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Provides a dynamic assessment.
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Can compare both lower extremities.
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Can use color doppler to evaluate for hyperemia.
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Provides a quick evaluation.
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Highly portable.
Disadvantages
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Operator dependent (need a skilled sonographer).
VI. What are the contraindications for the alternative imaging techniques?
There are no significant contraindications for ultrasound of the plantar fascia using a high frequency linear transducer with Color Doppler interrogation.
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