Sonoelastographic strain index in the early diagnosis of plantar fasciitis

We read with great interest the recent study published inClinical Imaging that reported the utility of real-time elastography in plantar fasciitis and the comments on this article [1,2]. We would like to share our experience with sonoelastographic strain in early diagnosis of plantar fasciitis (PF). A 36-year-old female patient was admitted with left heel pain. She described a sharp, burning pain that exacerbated in the morning and after rest. She had no symptoms on the right heel. Physical examination revealed positive heel compression test on the left side. Left plantar fascia tenderness was detected on palpation. She had no foot deformities. Her calcaneal X-ray was in normal range without any signs of fascial thickening and calcaneal spur formation (Fig. 1a, b). B-mode ultrasonography (US) revealed normal findings for both right and left plantar fascia with a thickness of 0.8 mm and 2.2 mm, respectively (Fig. 2a, b). Given that her plantar fascia was normal according to B-mode US findings, stretching exercises and modification of daily living activities were recommended. On the follow-up visit 2 weeks later, she reported only 25% relief in her symptoms. Real-time sonoelastography (RTSE) was performed to detect early structural changes in the symptomatic plantar fascia with a high-resolution ultrasound device (Logiq E9; GE Healthcare, Milwaukee, WI, USA) equipped with an elastographycompatible 6–15-MHz matrix linear probe.