Plantar Fascial Tearing with Intense Inflammation MRI Images

The Plantar Fascia on the bottom of the foot should be as dark as the Achilles Tendon shown here.

The Plantar Fascia should be uniform thickness and density. Here it is seen rising up and with gray holes. 

The slice through the bottom of the foot under the heel bone showing a bursae sac of intense inflammation. 

This is the section that is at a right angle to the raised part of the plantar fascia seen above. The fascia above my arrow should be a solid dark fiber like the Achilles. In this image, it is showing 90% torn with the gray signifying fluid and scar tissue. 

The image just in front of the last view looking more solid, although some irregularity and less density.

This is the initial image again in our series showing a section of plantar fascia separated from the bone. 

A defect in the plantar fascia more to the outside of the foot. The arrow denotes the defect and is surrounded by intense inflammation probably a bursal sac. 

Only slight irregularity noted in the plantar at this section, but see the inflammation is so intense it distorts the normal fat pad below the arrow. 

This is really the best image of the problem. The patient's image shows the split partial horizontal tear of the plantar fascia seen as is there was a layer of Oreo cookie in the fascia. How do we know it is injured, the intense inflammation under the tear where the swelling is pulled downward by gravity. I would not want to walk on that heal. 

This is the same image of the plantar fascia 1/8th inch further under the heel bone. It looks totally fine, so the tear is the 1/2 inch in front of its attachement into the heel. The swelling from infracalcaneal bursitis will travel all under the heel and the reason patients can not walk well. The plantar fascial tear protocol should be started. Plantar bursitis will take some work off-weighting the heel to transfer the weight into the arch. 

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. 

Plantar Fascial Tear on MRI image

MRI Images of Plantar Fascia with and without Tear

I just sent this to a patient with significant pain in the bottom of her heel (lower right). The MRI on the lower right clearly shows the gap in the plantar fascia not seen in the MRI seen on the lower left (Thanks Cheryl). The arrow on the lower right shows the gap with the dark plantar fascia seen to the right and left of the arrow. The initial treatment is casting in the removable boot and an EvenUp on the opposite side placed on the patient's shoe (upper left). The sunset from June 2009 minutes after my son Steve married Clare in Hawaii (upper right).