1.What is the diagnosis?
Plantar fibromatosis 跖部纤维瘤病
Plantar fascia rupture 足底筋膜断裂
Plantar fasciitis 足底筋膜炎
Plantar xanthomatosis 足底黄色瘤病
Additional Question
2.What is the upper limit for normal thickness of plantar fascia?
足底筋膜厚度的最大正常值是多少？
2 mm
3 mm
4 mm
5 mm
3.What is the most common site of involvement of the planar fascia with fasciitis?
足底筋膜炎最好累及那个部位？
Proximal plantar fascia 足底筋膜近段
Mid plantar fascia 足底筋膜中段
Distal plantar fascia 足底筋膜远段
选择题答案：
- Plantar fasciitis Thickened planar fascia proximally near the origin from calcaneus with perifascial edema and edema in calcaneus near the origin of the plantar fascia are characteristic of plantar fasciitis.
足底筋膜靠近跟骨处增厚，伴筋膜周围水肿及骨髓水肿，是足底筋膜炎的典型表现。
- 4 mmNormal plantar fascia thickness is in the range of 2 mm to 4 mm.
正常足底筋膜厚度2-4mm。
- Proximal plantar fasciaThe proximal plantar fascia near the origin from the calcaneus is the most common site of plantar fasciitis.
足底筋膜炎的好发部位是足底筋膜近端、考虑跟骨附着处。
Findings and Diagnosis
- Plantar fasciitis 足底筋膜炎
- Plantar fascial rupture 足底筋膜断裂
- Plantar fibromatosis 足底纤维瘤病
- Plantar xanthoma 足底黄色瘤
Plantar fasciitis
- Physical — secondary to repetitive trauma (prolonged weight bearing especially in obese patients, athletes)物理因素 — 继发于反复创伤（长时间负重，特别是体重较重的患者和运动员）
- Systemic — secondary to enthesopathy in seronegative spondyloarthropathies.全身系统性因素 — 可继发于血清阴性脊柱关节病的肌腱端炎
- Degenerative — age-related退变 — 与年龄相关
- Findings are best seen on sagittal and coronal images.矢状位及冠状位显示最佳。
- Fusiform thickening of the plantar fascia usually involving the proximal central band extending up to the calcaneal insertion.足底筋膜梭形增厚，常累及足底筋膜近端至跟骨附着点。
- Edema in the plantar fascia demonstrated as increased short tau inversion-recovery (STIR)/T2 signal in the fascia, perifascial fat and muscle.足底筋膜水肿表现为STIR/T2WI序列筋膜及周围脂肪、肌肉信号增高。
- Marrow edema in the calcaneus near the origin of the plantar fascia.足底筋膜的跟骨附着处骨髓水肿。
Differential Diagnosis
- Plantar fascial rupture: This usually occurs as an acute sports injury. There is sudden-onset heel pain with clicking and snapping sensation and a palpable tender mass at the site of injury following a traumatic event. On MRI, there is partial or complete interruption of the fascia with large areas of markedly increased signal intensity on T2-weighted and STIR images. This may be associated with tears in the underlying flexor digitorum brevis muscle. Conservative treatment, consisting of rest, shoe arch supports, and orthoses, and physical therapy are sufficient in most cases.足底筋膜断裂：通常发生于急性运动损伤，表现为外伤后足跟部突发疼痛、弹响、损伤处可触及包块。MRI上，足底筋膜部分或完全断裂表现为T2WI和STIR序列大范围明显高信号。足底筋膜断裂可合并趾短屈肌损伤。通常采取保守治疗的方法，如休息、鞋拱支持、矫形器。大部分情况下，物理治疗有效。
- Plantar fibromatosis: Benign but locally invasive fibrous proliferation originating from the plantar fascia. It involves the medial and central portions of the fascia more commonly and can be palpated as nodules in the sole of the foot that may or may not be painful. It is diagnosed based on MRI demonstrating one or multiple T1 and T2 dark nodules associated with plantar fascia. Treatment is conservative, but surgery is performed in patients with deep infiltrating lesions. Postsurgical radiation and chemotherapy with methotrexate are used to prevent recurrence.足底纤维瘤病：起源于足底筋膜的纤维增生性病变，为良性病变，但有局部侵袭性。多累及足底筋膜中部，体检可触及足底部结节，可伴有或不伴有疼痛。MRI示足底筋膜可见一个或多个T1WI、T2WI低信号结节。患者通常采取保守治疗的方法，对于深部浸润的患者可采取手术治疗。术后放疗及甲氨蝶呤化疗可防止复发。
- Plantar xanthoma: Associated with hyperlipidemia and more commonly involves the tendons, skin, and subcutaneous tissue. Occasionally, can involve the plantar fascia. It is usually asymptomatic but can cause vague pain. MRI demonstrates fusiform enlargement with speckled appearance on T1- and T2-weighted images. Lowering serum cholesterol can decrease the size of the aponeurosis. Surgical excision provides long-term relief.足底黄色瘤：多合并高脂血症，通常累及肌腱、皮肤、皮下组织，偶尔可发生于足底筋膜。通常无明显症状，也可伴有疼痛。MRI表现为足底筋膜梭形增大，伴T1WI、T2WI斑点状异常信号。降低血清胆固醇可使腱膜体积缩小，手术切除可长期缓解症状。