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Study: Medial gastrocnemius stiffness linked to plantar fasciitis with elastography

PainSci » bibliography » Zhou et al 2020
Tags: etiology, diagnosis, plantar fasciitis, neat, pro, foot, leg, limbs, pain problems, overuse injury, injury, tendinosis

One article on PainSci cites Zhou 2020: Complete Guide to Plantar Fasciitis

PainSci commentary on Zhou 2020: ?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

This is a somewhat fancy study of calf tightness using “shear wave elastography” (SWE), which is a clever way of using ultrasound to measure rigidity of soft substances like flesh. (For instance, if you had a soft brick of tofu stacked on a brick of firm tofu, SWE would show a stark contrast in the two substances even though they are nearly identical visually.) Using this method is arguably much more reliable than the manual method used by Nakale et al (Silfverskiöld test).

SWE ultrasound also had the distinct advantage of allowing them to compare the two big halves of the gastrocnemius muscle — just like two slabs of tofu. Good stuff. It can also detect stiffness differences even when the ankle is in a relaxed position.

On the other hand, they only studied (forty) people with plantar fasciitis: no comparison to healthy people, or other kinds of foot problems, a limitation Nakale et al specifically set out to overcome.

Some other data was gathered along the way — plantar fasciitis thickness and current pain levels — looking for other links.

They found that the medial gastroc muscle was stiff (hard tofu!) in these patients, but not the lateral gastroc (soft tofu!). Also, stiffness of the medial muscle correlated with pain levels. That’s all well worth knowing. Thanks, Zhou et al.

They also found no correlation between plantar fascia thickness and pain.

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

The objectives of this study were (1) to investigate the passive stiffness of the medial gastrocnemius (MG) and lateral gastrocnemius (LG) in patients with and without plantar fasciitis (PF), (2) to explore the correlation between gastrocnemius stiffness and plantar fascia thickness (PFT) as well as the intensity of pain in patients with PF, (3) to detect optimal cut-off points for stiffness of the MG and LG for identifying patients with PF. Forty patients (mean age = 51.1 years ± 12.9) participated in this study. The elastic properties of the MG and LG were quantified using shear wave elastography ultrasound. The thickness of the plantar fascia was measured by B-mode imaging. The intensity of pain was assessed using a visual analogue scale. The results showed that when the ankle was in the relaxed position, patients with PF had increased passive stiffness in the MG (P < 0.05) but not in the LG. Significant correlations were found between pain and the stiffness of the MG (middle, distal; all P-values < 0.05) and no correlation was observed between pain and PFT (P = 0.416). The initial cut-off point for the stiffness of the MG was 29.08 kPa when the ankle was in the relaxed position. The findings from the present study show that an increase in muscle stiffness is not the same in the individual muscles of the gastrocnemius muscle. Traditional treatment of the whole gastrocnemius muscle might not be targeted at the tight muscle.

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