ORIGINAL RESEARCH n MUSCULOSKELETAL IMAGING Radiology: Volume 267: Number 1—April 2013 n radiology.rsna.org 195 Real-time Sonoelastography of the Plantar Fascia: Comparison between Patients with Plantar Fasciitis and Healthy Control Subjects 1 Luca Maria Sconﬁenza, MD, PhD Enzo Silvestri, MD Davide Orlandi, MD Emanuele Fabbro, MD Giulio Ferrero, MD Chiara Martini, MD Francesco Sardanelli, MD Marco Amedeo Cimmino, MD Purpose: To evaluate the use of axial-strain real-time sonoelastogra- phy in patients with plantar fasciitis compared with that in healthy control subjects. Materials and Methods: Institutional review board approval and patients’ consent were obtained. Eighty feet of 80 patients (43 men, 37 women; mean age 6 standard deviation, 46.3 years 6 8.7) with plantar fasciitis and 50 feet of 50 asymptomatic volunteers (27 men, 23 women; mean age, 44.3 years 6 8.0) were prospectively evaluated. Individuals graded heel pain with a visual analogue scale and underwent B-mode ultrasonography (US) and real-time sonoelastography. Maximum fascial thickness was measured, and two longi- tudinal images were recorded with both modalities. Two radiologists who were blinded to clinical symptoms inde- pendently reviewed images for hypoechoic echotexture and fascial-border blurring at B-mode US and semiquanti- tative elasticity score at real-time sonoelastography (blue, 1; green, 2; red, 3), with the fascia divided into proximal, intermediate, and distal sections. Results: No differences were found for sex (P = .999) or age distribution (P = .144) between groups. Fascial thicken- ing, hypoechoic echotexture, and fascial-border blurring at B-mode US were increased in patients versus control subjects (P , .001), and fascial thickening and hypoechoic echotexture correlated with heel pain score (r . .475, P , .001). Plantar fasciae of patients (median score, 11; interquartile interval, 10–12) were less elastic than those of control subjects (median score, 7; interquartile inter- val, 6–7.25) (P , .001). Image interpretation yielded high interobserver reproducibility (k  .80). Pain and real- time sonoelastographic scores correlated signiﬁcantly (r = 0.851, P , .001). Pain was associated with older age (t = 3.7, P , .001), fascial thickening (t = 7.3 [multiple stepwise regression model], P , .001), and total real- time sonoelastographic score (t = 10.2, P , .001) but not with sex, fascial-border blurring, or hypoechoic echotex- ture. Accuracy increased from 90.0% with B-mode US to 95.4% with real-time sonoelastography (P = .016). Conclusion: Real-time sonoelastography can show plantar fasciitis, in- crease diagnostic performance of B-mode US, and assist in cases of inconclusive B-mode US ﬁndings. q RSNA, 2013 1 From the Department of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy (L.M.S., F.S.); Di- partimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Piazza Malan 2, San Donato Milanese 20097, Milan, Italy (L.M.S., F.S.); Department of Radiology, Ospedale Evangelico Internazionale, Genoa, Italy (E.S.); and Scuola di Specializzazione in Radiodiagnostica (D.O., E.F., G.F., C.M.) and Rheumatology Unit, Department of Internal Medicine (M.A.C.), Università degli Studi di Genova, Genoa, Italy. Received May 9, 2012; revision requested June 18; revision received September 6; accepted September 12; ﬁnal version accepted September 18. Address correspon- dence to L.M.S. (e-mail: io@lucasconﬁenza.it). q RSNA, 2013 Note: This copy is for your personal non-commercial use only. To order presentation-ready copies for distribution to your colleagues or clients, contact us at www.rsna.org/rsnarights.