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Monday, March 31, 2014

Monday's Images of the Week: MRI views of normal and injured plantar fascia

These are some of the MRI images I look at when evaluating the plantar fascia for injuries. I wanted to show mainly the coronal images which typically show the injury the best. 

On this first view we see the sensor is just under the medial slip of the plantar fascia which is healthy when dark black as in this case. The "itis" of plantar fasciitis is seen by the white under the darker plantar fascia.

These next views follow the medial slip of the plantar fascia about 3 inches in front of the heel towards the arch. So, this image is closer to the arch than the first one I showed.

Check as normal plantar fascia gets closer to the arch it will thin out, but remain dark black. The area under and around the sensor is the normal fat pad of your heel. The heel bone is dark black above the plantar fascia. 

As we go further out into the arch, the wonderful arch muscles and veins and tendons all come into view. 

Here is the final coronal view of the plantar fascia. We have traced it from under the heel forward into the arch. You can appreciate all the incredible structure in the arch.

Same patient but now we are looking form the side. See how the plantar fascia starts under the heel and goes into the arch. It should look solid, consistent, and one thickness. 

Unfortunately this is on the opposite side. See the plantar fascia above the sensor is very dark on the bottom and irregular/gray on the top. This is an old plantar fascia partial tear which has somewhat healed.

This is the same patient from above with the old plantar fascial tear. Compare this side view with the image 2 above. See in this image the plantar fascia is thinner by the heel, then gets thick, then thins out as you go into the arch. This thinner area by the heel is the first hint something is wrong. We know by looking at other images that that area was injured and attempting to heal.

Here is another patient with an acute (just happened) plantar fascial tear. The plantar fascia has just exploded from the heel. 

Same patient from above. Missing plantar fascial medial slip due to recent tear. We will now follow this forward into the arch. See how the plantar fascia starts to show normalcy as we move forward. 

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