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Diagnosing PF

Posted by Pete R on 7/12/04 at 07:31 (155145)

Discussions on here seem to suggest that an MRI cannot diagnose pf. Is this correct, i.e if the fascia is shown to be swollen then pf is the likely problem ? Is ultrasound better ?

My MRI was normal so surgeon says no pf.Yes or maybe ?

When pressed my foot doesn't hurt at the insertion point...ever. In the morning my foot to the touch is not sore. As the day goes on the pain comes and then my arch feels tight and can be sore to the touch.

If I have pain in the arch, is it pf ? If not what else could it be ?

This is driving me crazy !!!!

Thanks

Re: Diagnosing PF

Pauline on 7/12/04 at 08:37 (155147)

Pete,
I'm not a doctor, but many have posted with similar symptoms and are privlidged to be told they have an atypical case of P.F.

This may be what you have too, but remember I'm not a doctor and I am not
providing you with a diagnosis

Re: Diagnosing PF

Ed Davis, DPM on 7/12/04 at 11:02 (155164)

Pete:
Atypical PF is a reasonable possibility. The clinical exam is still mroe important than imaging since many who read the MRI are unsure of how to diagnose it. Are you seeing a foot specialist.
Ed

Re: Diagnosing PF

Pete R on 7/12/04 at 13:50 (155193)

What would the clinical examination consist of ? I have seen many pod's many of whom seem to discount pf. Their reasons-: no 1st step pain, no pain at the insertion point, negative scans etc

Re: Diagnosing PF

Pauline on 7/12/04 at 17:25 (155215)

Dr. Ed,
I personally think a specialist reading an MRI would error on the side of caution if he was asked to rule out P.F. This would be especially true I think if he saw any thickening of the plantar fascia either focal or diffused.

Usually if there is any doubt they will not confirm one way or the other. They often advise the treating physician that more evaluations by other media should be done. I haven't found them to leave a treating doctor high and dry.

Re: Diagnosing PF

Ed Davis, DPM on 7/12/04 at 17:44 (155222)

Pauline:

I have discussed this issue with a number of radiologists and one problem they have is how and when to make the call. In other words how much thickening is considered to be abnormal? Many are not familiar with Rompe's numbers which are about the best thing se have to date.

I generally will look at the radiologists report but also read the MRI myself in order to be able to use criterion like those developed by Rompe.
Ed

Re: Diagnosing PF

Pauline on 7/12/04 at 17:53 (155225)

Rompe's numbers have been around for some time. If that's what they need to make their call, it would seem that they need the information.

I'm surprised this hasn't been done. I wonder if Dr. Rompe has informed the radiology group (society) how important his numbers are to them producing a correct diagnosis.

They have to get the information somewhere.

Re: Diagnosing PF

Ed Davis, DPM on 7/12/04 at 18:29 (155231)

Pauline:
Yes, it would be their obligation to study the matter. It is likely that they don't get a lot of requests for MRIs for this purpose because the same information can be obtained more cost effectively via sonography. The reason to order an MRI would be not just to look at the plantar fascia but to look for other causes, eg. stress fractures of the calcaneus, tarsal coalitions, tendinopathies of FHL, tibialis posterior, masses in the tarsal tunnel.... all potential alternate sources of heel pain.
Ed

Re: Diagnosing PF : To Dr. Ed

Terry L on 7/12/04 at 18:31 (155232)

Dr. Ed,
So is a bone scan a good way to confirm PF or could it be something else that looks similar?
Terry L

Re: Diagnosing PF : To Dr. Ed

Ed Davis, DPM on 7/12/04 at 18:41 (155235)

Terry:
A bone scan would be valuable primarily to rule out a stress fracture of the calcaneus (heel bone). PF is a soft tissue problem so only MRI and sonography lets you actually look at the fascia. Sonography lets you place a structure in motion, stress it, sometimes conferring an advantage to that modality.
Ed

Re: Diagnosing PF : To Dr. Ed

Terry L on 7/12/04 at 19:11 (155242)

Dr. Ed,
Now I am confused, I had a bone scan and it came back slighly increased bilateral uptake of the bilalatel calcanei without evidence of juxtaposed activity to suggest RSD. More consistent with bilateral PF. I have color and temp changes along with a host of other symptoms. I know this is just on the net and you haven't seen me but can you give me any input on those results. I can say weather changes kill and puts me in a very bad pain cycle.

Terry

Re: Diagnosing PF : To Dr. Ed

Ed Davis, DPM on 7/12/04 at 20:01 (155248)

Terry:

The plantar fascia attaches to the heel bone. There is inflammation at the point at which the fascia attaches to the heel bone. That inflammation will show up on the bone scan as a 'slightly' increased uptake at the area where the plantar fascia attaches to the heel bone. A stress fracture would show significant uptake at an area not necessarily where the fascia is.

RSD is a bit of a tougher call because bone changes may take time to occur, are variable. They may show up as a diffuse (spread around), not focal area of uptake in the heel bone. If you have CLINICAL signs of RSD such as color changes, swelling, temperature changes, pain out of proportion to the severity of the problem -- that is more of an indication of RSD than a bone scan would be. One thing we do know -- if you suspect RSD, it is best to get treatment for it as early as possible.
Ed

Re: Diagnosing PF

Dr. Z on 7/13/04 at 08:08 (155278)

Dr. Ed,

I am familiar with the numbers that go with an ultrasound but not with MRI reading. Would you please explain them to DR. Z. Thanks

Re: Diagnosing PF

Pauline on 7/13/04 at 09:00 (155284)

Dr. Ed,
Numbers are also used for diagnosing and staging various cancers. These numbers have been made know to almost everyone associated with the diagnosing of cancers from radiologist to internists. Everyone is on the same page for the most part especially the Pathologist who must determine the test results.

One would have to think that if Dr. Rompe's numbers are the only way that a Radiologist can determine and render a P.F. diagnosis surely they would have to know about them. They wouldn't be left in the dark. After giving this a lot more thought I believe that a Radiologist is able to diagnosis P.F. from reading a MRI is the results for that finding exhibit themselves numbers or no numbers.

Re: Diagnosing PF

Ed Davis, DPM on 7/13/04 at 11:44 (155307)

Dr. Z:
I would expect that thickness measurements of the plantar fascia would be similar for MRI than for ultrasound.
Ed