Diagnostic Imaging and Treatment of Plantar Fasciitis

Diagnostic Imaging

• Ultrasonography is reasonable and inexpensive for recalcitrant cases (pain persisting beyond 3 months despite treatment), showing plantar fascia thickness >4mm and abnormal tissue signal, with ultrasound elastography demonstrating superior diagnostic accuracy (95% sensitivity, 100% specificity) compared to standard ultrasound 1
• MRI is the most sensitive imaging modality but typically unnecessary unless ruling out other heel pathology such as stress fractures or tears, according to the American College of Radiology 2

Treatment

• The American College of Radiology recommends ultrasonography-guided focal extracorporeal shock wave therapy (ESWT) for chronic plantar fasciitis unresponsive to conservative treatment, with a success rate supported by evidence from the medical community 1