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Calcaneal bone marrow lesions and plantar fascia imaging biomarkers are associated with chronic plantar heel pain: a case-control study

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posted on 2023-08-07, 04:43 authored by Jason Rogers, Graeme Jones, Jillianne CookJillianne Cook, Kathryn Squibb, Andrew Halliday, Karen Wills, Aroub Lahham, Tania Winzenberg
Objective: To determine associations between chronic plantar heel pain (CPHP) and imaging biomarkers derived from magnetic resonance imaging (MRI) and ultrasonography. Methods: We compared 218 participants with CPHP with 100 age- and sex-matched population controls. We assessed imaging biomarkers on MRI (calcaneal bone marrow lesions [BMLs], plantar fascia [PF] signal and thickness, spurs, and fat pad signal) and B-mode/power Doppler ultrasound (PF thickness, echogenicity, and vascularity). Covariate data collected included demographic characteristics, disease history, clinical measures, and physical activity by accelerometry. Data were analyzed using multivariable conditional logistic regression. Results: Plantar calcaneal BML size (mm2, odds ratio [OR] 1.03 [95% confidence interval (95% CI) 1.02–1.05]), larger plantar spurs (OR for spurs >5 mm 2.15 [95% CI 1.13–4.10]), PF signal (OR for signal penetrating >50% of the dorsoplantar width 12.12 [95% CI 5.36–27.42]), PF thickness (mm, OR for MRI 3.23 [95% CI 2.36–4.43] and ultrasound OR 3.78 [95% CI 2.69–5.32]), and echogenicity (diffusely hypoechoic OR 7.89 [95% CI 4.02–15.48] and focally hypoechoic OR 24.92 [95% CI 9.60–64.69]) were independently associated with CPHP. PF vascularity was uncommon, occurring exclusively in cases (cases with signal n = 47 [22%]). Combining imaging biomarkers into 1 model, plantar BMLs and PF imaging biomarkers, but not fat pad signal or heel spurs, were independently associated with CPHP. Conclusion: Calcaneal BMLs and PF imaging biomarkers are associated with CPHP. Further research is required to understand whether these different markers represent distinct phenotypes of heel pain, and if so, whether there are specific treatment implications.


Supported by the Royal Hobart Hospital Research Foundation (grant 17-203), the Physiotherapy Research Foundation (seeding grant S14-025), the Rebecca L. Cooper Medical Research Foundation, Arthritis Australia (grant-in-aid 2015), the Halifax Foundation, Tasmania (philanthropic grant), and Allcare Physiotherapy Tasmania (professional development funds).


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Arthritis Care and Research






10p. (p. 911-920)





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© 2022 The Authors. Arthritis Care & Research published by Wiley Periodicals LLC on behalf of American College of Rheumatology. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.