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目的：探讨MRI在足底筋膜病的诊断及其伴发征中的应用价值。方法：回顾性分析2019年1月-2024年12月因足底疼痛就诊、并经临床随访证实的50例足底筋膜病患者（研究组）的临床及MRI资料，并与同期因其他原因行足踝MRI检查的50例患者（对照组）进行对比，总结足底筋膜病的MRI影像学表现特征。所有研究组患者均符合足底筋膜病的临床诊断标准，包括长时间或长程运动史、足跟内侧结节处压痛，以及MRI显示足底筋膜增厚（厚度>4.0 mm）。结果：研究组足底筋膜跟骨附着处不同程度增厚，界限欠清，局部信号增高，足底脂肪垫结构紊乱，可见水肿及渗出信号影；对照组足底筋膜走行自然，界清，信号均匀。研究组的足底筋膜厚度平均为（4.52±0.35）mm，显著高于对照组的（2.84±0.23）mm(P<0.001)。研究组中跟骨骨髓水肿、足跟底骨刺、附着点跟腱病及足底筋膜周围软组织肿胀的发生率分别为70%、54%、62%和90%，均显著高于对照组（P<0.001）。结论：MRI能够清晰显示足底筋膜病的特征性表现，包括足底筋膜增厚及其伴发征象，是诊断足底筋膜病的最佳影像学方法。
Abstract：Objective: To explore the diagnostic value of magnetic resonance imaging(MRI) in plantar fasciopathy and its accompanying signs. Methods: We retrospectively analyzed 50 patients with plantar fasciopathy(study group) and 50 patients who underwent ankle MRI for other reasons(control group)from January 2019 to December 2024. All patients in the study group met the clinical diagnostic criteria for plantar pasciopathy, including a history of prolonged activity, tenderness at the medial calcaneal tubercle, and MRI evidence of plantar fascia thickening(>4.0 mm). Results: In the study group, the plantar fascia attachment to the calcaneus was thickened to varying degrees, the boundary was unclear and the local signal was increased, the structure of plantar fat pad was disordered, and edema and effusion could be seen. In the control group, the plantar fascia had a natural alignment, clear boundary, and homogeneous signal. The average thickness of the plantar fascia in the study group was(4.52±0.35) mm, significantly higher than that in the control group [(2.84±0.23) mm], with P<0.001. The incidence of calcaneal bone marrow edema, plantar bone spurs, insertional Achilles tendinopathy, and soft tissue swelling around the plantar fascia in the study group was 70%, 54%, 62%, and 90%, respectively, all significantly higher than in the control group(P<0.001). Conclusion: MRI can clearly display the characteristic manifestations of plantar fasciopathy, including plantar fascia thickening and accompanying signs, and is the optimal imaging method for diagnosing plantar fasciopathy.
[1] Chang A H, Rasmussen S Z, Jensen A E, et al. What do we actually know about a common cause of plantar heel pain? A scoping review of heel fat pad syndrome[J]. J Foot Ankle Res, 2022, 15(1):60.
[2] Kim D H, Choi J H, Park C H, et al. The diagnostic significance of ultrasonographic measurement of the achilles tendon thickness for the Insertional Achilles Tendinopathy in patients with heel pain[J]. J Clin Med, 2021, 10(10):2165.
[3] Colberg R E, Kenneth-Nwosa K O, Juradovélez J A, et al.Clinical and imaging outcomes of plantar fasciotomy using microdebrider coblation wand[J]. Foot Ankle Orthop,2022, 7(2):24730114221091797.
[4] Al-Siyabi Z, Karam M, Al-Hajri E, et al. Extracorporeal shockwave therapy versus ultrasound therapy for plantar fasciitis:a systematic review and meta-analysis[J]. Cureus, 2022, 14(1):e20871.
[5] Rhim H C, Kwon J, Park J, et al. A systematic review of systematic reviews on the epidemiology, evaluation, and treatment of plantar fasciitis[J]. Life(Basel), 2021, 11(12):1287.
[6] Weaver J S, Omar I M, Mar W A, et al. Magnetic resonance imaging of musculoskeletal infections[J]. Pol J Radiol, 2022, 87:e141-e162.
[7] Jiang L, Liu T, Li Z, et al. Clinical study of a four-step program for the treatment of plantar fasciitis with bone spurs[J]. Orthop Surg, 2024, 16(6):1374-1380.
[8] Chang C D, Wu J S. MR imaging findings in heel pain[J]. Magn Reson Imaging Clin N Am, 2017, 25(1):79-93.
[9] Noriega D C, Cristoá, León A, et al. Plantar fasciitis in soccer players-a systemic review[J]. Int J Environ Res Public Health, 2022, 19(21):14426.
[10] Draghi F, Gitto S, Bortolotto C, et al. Imaging of plantar fascia disorders:findings on plain radiography, ultrasound and magnetic resonance imaging[J]. Insights Imaging,2017, 8(1):69-78.
[11] Lee W, Metgud N, Moore M. Association of obesity and plantar fasciitis in patients with plantar heel spurs[J].Foot Ankle Orthop, 2023, 8(4):24730114231213625.
[12] Zhou B, Zhou Y, Tao X, et al. Classification of calcaneal spurs and their relationship with plantar fasciitis[J]. J Foot Ankle Surg, 2015, 54(4):594-600.
[13] Finkenstaedt T, Siriwanarangsun P, Statum S, et al. The calcaneal crescent in patients with and without plantar fasciitis:an ankle MRI study[J]. AJR Am J Roentgenol,2018, 211(5):1075-1082.
[14]张伟,王崧铭,白荣杰,等.跖筋膜炎的X线、CT及MRI表现[J].实用放射学杂志, 2022, 38(12):2035-2038.
[15] Zhang L, Cai M, Gan Y, et al. Anatomical features of plantar fasciitis in various age cohorts:based on Magnetic Resonance Imaging[J]. J Orthop Surg(Hong Kong),2023, 31(1):10225536231161181.
[16] Chen T L, Wong D W, Wang Y, et al. Foot arch deformation and plantar fascia loading during running with rearfoot strike and forefoot strike:a dynamic finite element analysis[J]. J Biomech, 2019, 83:260-272.
[17]杨洋,王熙,傅维杰,等.着鞋和触地方式对慢跑时足部受力特征的影响[J].医用生物力学, 2017, 32(2):154-160.
[18]牛森,霍洪峰,赵焕彬.新兵足底筋膜炎患者足底压力分布与步态特征[J].中国运动医学杂志, 2019, 38(4):257-262.
[19] Ermutlu C, Aksakal M, Gümü?ta?A, et al. Thickness of plantar fascia is not predictive of functional outcome in plantar fasciitis treatment[J]. Acta Orthop Traumatol Turc, 2018, 52(6):442-446.
[20] Gamba C, Sala-Pujals A, Perez-Prieto D, et al. Relationship of plantar fascia thickness and preoperative pain,function, and quality of life in recalcitrant plantar fasciitis[J]. Foot Ankle Int, 2018, 39(8):930-934.
[21] Maki M, Ikoma K, Kido M, et al. Magnetic Resonance Imaging findings of chronic plantar fasciitis before and after extracorporeal shock wave therapy[J]. Foot(Edinb),2017, 33:25-28.
[22] Drake C, Whittaker G A, Kaminski M R, et al. Medical imaging for plantar heel pain:a systematic review and meta-analysis[J]. J Foot Ankle Res, 2022, 15(1):4.
[23]余雪玲,张立,杨燕华,等.足底筋膜炎的彩超成像与MRI成像特点的对比分析[J].黑龙江医药, 2019, 32(3):528-530.
[24]杨燕华.超声与MRI辅助诊断足底筋膜炎的价值分析[J].现代医院, 2018, 18(11):1708-1710.
[25]韦骏,王树庆.足底筋膜炎的磁共振表现[J].广东医学, 2016, 37(22):3429-3431.
[26] Wu J, Zhang Y Z, Gao Y, et al. Assessment the reliability of ultrasonography in the imaging of the plantar fascia:a comparative study[J]. BMC Med Imaging, 2019, 19(1):62.
[27]栗平,王东海,郭芳芳,等.多模态成像技术对足底筋膜炎性跟痛症发病机制的研究[J].中国医药导报,2018, 15(18):112-115.
[28] Kothari U, Shah S, Pancholi D, et al. Efficacy and safety of platelet-rich plasma injection for chronic plantar fasciitis:a prospective study on functional restoration and pain relief[J]. Cureus, 2024, 16(1):e52414.
[29] Latt L D, Jaffe D E, Tang Y, et al. Evaluation and treatment of chronic plantar fasciitis[J]. Foot Ankle Orthop,2020, 5(1):2473011419896763.
[30] Alrashidi Y, Alsaygh E F, Khoshhal M S, et al. Prevalence of plantar heel pain among school teachers in medina region, Saudi Arabia:a cross-sectional study[J]. Cureus, 2022, 14(11):e31821.
[31]朱廷敏,王松,李志歧,等.足底筋膜损伤的MRI诊断[J].中国医学创新, 2011, 8(34):85-86.
[32] Gitto S, Draghi F. Spontaneous distal rupture of the plantar fascia[J]. J Clin Ultrasound, 2018, 46(6):419-420.
[33] Teo F, Mohamed Shah M T, Wong B S S. Clinics in diagnostic imaging(195). Plantar fibromatosis[J]. Singapore Med J, 2019, 60(5):230-235.
[34] Lepoff A, Makarov V, Williams M. Angioleiomyoma of the plantar foot[J]. J Am Podiatr Med Assoc, 2018, 108(3):262-266.
基本信息:
DOI：
中图分类号:R686.3;R445.2
引用信息:
[1]代兰兰,丁长青,孙惠芳,等.足底筋膜病的MRI诊断价值[J].影像技术,2025,37(06):21-26+37.
基金信息:
2023年度徐州市推动科技创新专项资金——社会发展基金项目（KC23330）