How To Detect Chronic Heel Pain With Musculoskeletal Ultrasound
- Volume 19 - Issue 11 - November 2006
- 13547 reads
- 0 comments
Documentation of an ultrasound of the heel can be in a separate report or as a subset of the objective part of one’s notes. Either way, photos should accompany the written report. The assessment should include the measurements of all three bands of the symptomatic fascia and, in a unilateral case, the asymptomatic heel as a comparison. Along with the quantitative assessment, one should include a qualitative description as well and utilize proper terminology. Here are some of the more common terms:
• Hyperechoic: increased echo or brightness on the screen
• Hypoechoic: decreased echo or gray to dark on the screen
• Anechoic: lack of echo or black on the screen
• Fibrillar pattern: normal fiber pattern of tendon or ligament
• Echotexture: general term referring to the internal architecture of the structure and the echo pattern seen
Musculoskeletal ultrasound is a powerful diagnostic tool. In a relatively short clinical time, one can obtain vital information to better diagnose and subsequently treat patients. What is paramount, however, is the need for proper education and training in its use. In addition to understanding the anatomy, one must also understand the physics, the artifacts inherent with imaging and the machine itself.
As we have seen, musculoskeletal ultrasound provides strong identification of the fascia but can also enable the clinician to assess soft tissue masses, tendinopathy and ligament injuries just as well. One may also utilize the ultrasound for guided injections and directed biopsies.
Dr. Tassone is an Assistant Professor and Course Director for Medical Imaging at the Arizona Podiatric Medical Program at Midwestern University. He is a Diplomate of the American Board of Podiatric Orthopedics and Primary Podiatric Medicine, and a Diplomate of the American Board of Multiple Specialties in Podiatry. Dr. Tassone has a private practice in Glendale, Ariz.
1. Barrett SL, Day SV, Pignetti TT, Egly BR. Endoscopic heel anatomy: analysis of 200 fresh frozen specimens. J Foot Ankle Surg 1995 Jan-Feb; 34(1):51-56.
2. Wong SM, Griffeth J, Tang A, Hui A. The role of Ultrasonography in the Diagnoses and Management of Idiopathic Plantar Fasciitis, Rheumatology 2002: 41: 835-836.
3. Sabir N, Demirlenk S, Cubkeu S, Yagci B. Clinical Utility of Sonography in Diagnosing Plantar Fasciitis, J Ultrasound Med 1998: 24: 1041-1048.
4. Muglia V, Cooperberg P. “Artifacts,” www.rad.pulmonary.ubc.ca/USartifacts.
5. Dondelinger RF, Marcelis S, Daenen B, Ferrara M. Peripheral Musculoskeletal Ultrasound Atlas, New York, Thieme Medical Publishers: 1996. 6. Zagzebiski J. Essentials of Ultrasound Physics, St. Louis, Missouri, Mosby: 1996.