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RE: Fascia measurement

Posted by Mar on 3/03/03 at 10:28 (111574)

Just wondering - when the fascia is measured -- mine is: left 5.6 cm and right 4cm which I know is abnormal, is that the width or thickness? And is it the width or thickness of the whole fascia or just the medial band? And what causes the extra width or thickness -- inflammation? I can't believe after all this time that I'm not sure of this, but I'm not! Thanks - Mar

Re: RE: Fascia measurement

JenL on 3/03/03 at 15:39 (111629)

Mar,
I think the unit of measurement is mm instead of cm. And it's for the thickness of the fascia. The thicker it gets the worse the inflammation. If I recall correctly then 4mm should be considered normal. Since one of my feet is about 4mm as seen by x-ray, the doc. thinks it's not necessary for me to get ESWT at the time. But I'm not sure if there is any ifference in the consideration between male and female. As almost everything in our body differ in size, I think there should be different threshold.
Hope to be corrected by doc. if not right.

Re: RE: Fascia measurement

Mar on 3/03/03 at 17:04 (111639)

My pods said 2.5-3.5 is normal. One pod measured the right one to be 3.5 and another to 4.0, both by ultrasound. Yes mm sounds more reasonable. Perhaps a doc will shed more light on this -- thanks Jen -- Mar

Re: RE: Fascia measurement

Mike P on 3/03/03 at 20:01 (111668)

I just had ESWT done last Thursday by a Dornier EPOS machine. The pod could see my heel spur on the monitor and told me the thickness of my fascia was 5.4. He said around 2.0 is normal and I was a great candidate for ESWT.....

Re: RE: Fascia measurement

BGCPed on 3/04/03 at 07:31 (111685)

Perhaps one of the Doctors on here may speak to the relative sizes. I would think a 90 lb lady with a size 6 foot would have a much smaller one that a 320lb lineman. I am just curious myself

Re: RE: Fascia measurement

JenL on 3/04/03 at 09:05 (111701)

To correct: the thickness of fascia is not by x-ray, mine was done by ultrasound. And I MIR can find it too.

Re: RE: Fascia measurement

Mar on 3/04/03 at 09:15 (111704)

That's a good point - about size of person and size of fascia -- hmmm - Mar

Re: RE: Fascia measurement

Ed Davis, DPM on 3/04/03 at 09:44 (111715)

Mar:

Excellent question! Jen is correct that the measurement is in millimeters and it is the thickness that is being measured.

The two important issues your question brings up are:
1)What is the normal thickness or range of thickness for the plantar fascia?
2)How significant are the measurements in terms of relating such measurements to pathology? This is the million dollar question.

I had a conversation with Dr. Alex Serra, a first class radiologist with significant expertise in imaging of the foot and ankle, about this topic 3 weeks ago. My question to him was, 'When can a radiologist, from both a medical and medicolegal point of view, take a measurement of the fascia and definitively state that it is abnormally thick? At what point would a radiologist be willing to make or support a diagnosis of plantar fasciitis based on MRI (or ultrasound) findings?'

Dr. Serra verified that there is probably not enough data to answer that question with any certainty. He stated that in order to make a potential diagnosis of plantar fasciitis based on radiographic findings ALONE a thickness of at least 6 to 7 mm would need to be seen. On the other hand, if there were confirmed symptoms of PF prior to the imaging exam, then a lessor thickness would be considered.

Keep in mind that such figures are also relative to the size of the individual. One would not use the same standards for a 275 lb. construction worker as for a 110 lb secretary.

Without knowing your size, weight or age, I would view the thicknesses you ahve listed as high normal but not pathologic.
Ed

Re: RE: Fascia measurement

Mar on 3/04/03 at 12:22 (111755)

Dr Ed -

Thanks for the response. I am 115 lb (use to be 110 before PF!!) and 5 ft 2 in. and have been in severe heel pain for 16 months. 5.6 and 4 mm are high normal?? Sure does not feel normal! Mar

Re: RE: Fascia measurement

SteveG on 3/04/03 at 12:59 (111761)

Interesting, Mar. I would have thought that your fascia would be a lot more inflamed, given the amount of pain you have. Does your X-ray show a spur? Perhaps you are right to wonder about the PF diagnosis after all. Have you ever had an MRI?

Re: RE: Fascia measurement

Richard, C.Ped on 3/04/03 at 13:35 (111766)

very intresting (my artie johnson impression). that is a cool thing about this board, you can learn something every day.
Richard

Re: RE: Fascia measurement

Mar on 3/04/03 at 16:37 (111786)

Also -- 51 years old -- Mar

Re: RE: Fascia measurement

Mar on 3/04/03 at 16:41 (111787)

I've had MRI, CT, ultrasound, xray, blood tests, bone scan, nerve conduction tests -- latest ultrasound (on Saturday) showed inflammation in several areas in both feet -- CT last summer showed a small bone spur on the right heel. 3 pods all seem to agree that it is PF -- do not know what else it could be. Any other ideas????? Mar

Re: RE: Fascia measurement

Mar on 3/04/03 at 16:48 (111788)

The more inflammation the higher the fascial measurement? Mar

Re: RE: Fascia measurement

SteveG on 3/04/03 at 20:05 (111816)

That's my impression - the more inflamation, the thicker it is

Re: RE: Fascia measurement

Ed Davis, DPM on 3/05/03 at 13:30 (111885)

Mar:
I have seen patients with as high as 11mm thick plantar fascia and only mild pain. As mentioned previously, the correlation between plantar fascial thickness and exsitence of plantar fascial symptoms is not strong.
Ed

Re: RE: Fascia measurement

Ed Davis, DPM on 3/05/03 at 13:32 (111886)

Mar:
Not necessarily.
Ed

Re: RE: Fascia measurement

Ed Davis, DPM on 3/05/03 at 14:30 (111895)

Steve:

The thickness issue needs a lot more research. There are some recent implications to this issue. Dornier ESWT targets the thickest area of the fascia with diagnostic ultrasound. The problematic Australian study relied on thickness as a criterion.

There must be some reasonable allowance for the size of the individual, age, occupation and perhaps avocation. I have seen some very thick plantar fascia in asymptomatic long distance runners.

I believe that plantar fascial thickness is a function of stresses placed on that tissue. That is true, to an extent of many types of tissue.
The plantar fascia thickens in reponse to chronic, repetetive strain and can thicken with response to chronic inflammation. It is interesting to know those numbers but, for now, I feel that there usefulness from a diagnostic aspect is limited. I would use plantar fascial thickness as a confirmatory criterion. It is also interesting to see if and how much the thickness of the fascia changes several months after ESWT.
Ed

Re: RE: Fascia measurement

Dr Z on 3/05/03 at 17:04 (111917)

Hi

We use the thickness along with physical palpation. If there is pain at the insertion and the ultrasound shows an inflamed plantar fascia then you
have confirmed pf. I have seen many cases where after ESWT with the Dornier

Epos treatment the thickness and swelling goes down with follow- diagnostic ultrasound evaluation

Re: RE: Fascia measurement

Mar on 3/05/03 at 17:06 (111918)

Ed --

Yes - I was wondering about the change in thickness after ESWT also. I was so disappointed to learn that the dornier just recently got a printout system, so there is no record of my measurements before :-( Thanks for the info on thickness vs pain. I'd trade my pain for more thickness anyday!! Mar

Re: RE: Fascia measurement

Mar on 3/05/03 at 17:14 (111919)

Dr Z -

Why is it not standard procedure to do an ultrasound test to confirm PF? What other tests can definitely confirm PF? The one who was the first to put it in writing was the DO who did my first nerve conduction test and eval. Just curious. Mar

Re: RE: Fascia measurement

Ed Davis, DPM on 3/05/03 at 20:45 (111943)

Dr. Z:

It is hard to make a qualitative determination of the fascia with the current state of technology. When looking at thickness how much is fascia, scar tissue, swelling? If there is a fairly rapid decrease in thickness after ESWT, one could attribute that to a decrease in swelling of the fascia. Later changes in thickness could be due to a decrease in scar tissue. I have noted long term changes after ESWT and consider that to be evidence that ESWT effected remodeling of the tissue.

Acute plantar fasciitis would be expected to demonstrate swelling of the fascia but not necessarily thickening. As ultrasound technology improves we may be able to better distinguish between fascia that is swollen vs. fascia that is thickened due to scar tissue. This is one area where MRI does have an edge due to use of the different weighting of images to pick up different tissue characteristics such as fluid.
Ed

Re: RE: Fascia measurement

Dr. Z on 3/06/03 at 08:22 (111977)

Ed,
I agree I have seen ultrasound changes seen over two years post eswt treatment. The duration of plantar fasciitis helps to delineate between acute and chronic fasciitis in most cases.