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154040 - Association of Calcaneal Bone Marrow.pdf (864.16 kB)

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 2023-05-21, 14:36 authored by Jason RogersJason Rogers, Graeme JonesGraeme Jones, Cook, JL, Kathryn Squibb, Halliday, A, Karen WillsKaren Wills, Lahham, A, Tania WinzenbergTania Winzenberg

Objective: To determine associations between chronic plantar heel pain (CPHP) and MRI- and US-derived imaging biomarkers.

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 signal and thickness, spurs and fat pad signal) and B-mode/ power Doppler US (plantar fascia thickness, echogenicity and vascularity). Covariate data collected included demographics, disease history, clinical measures and physical activity by accelerometry. Data were analysed using multivariable conditional logistic regression.

Results: Plantar calcaneal BML size (mm2, OR 1.03 (95% CI 1.02 to 1.05)), larger plantar spurs (>5mm, OR 2.15 (95% CI 1.13 to 4.10)), plantar fascia signal (penetrating > 50% of dorsoplantar width, OR 12.12 (95% CI 5.36 to 27.42)), plantar fascia thickness (mm, (MRI) OR 3.23 (95% CI 2.36 to 4.43), (US) OR 3.78 ( 95% CI 2.69 to 5.32) and echogenicity (diffusely hypoechoic OR 7.89 (95% CI 4.02 to 15.48), focally hypoechoic OR 24.92 (95% CI 9.60 to 64.69)) were independently associated with CPHP. Plantar fascia vascularity was uncommon, occurring exclusively in cases (cases with signal n=47(22%)) Combining imaging biomarkers into one model, plantar BMLs and plantar fascia imaging biomarkers, but not fat pad signal or heel spurs, were independently associated with CPHP.

Conclusion: Calcaneal BMLs and plantar fascia 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.


Publication title

Arthritis Care & Research






Menzies Institute for Medical Research


John Wiley & Sons

Place of publication

United States

Rights statement

© 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-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) 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.

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Diagnosis of human diseases and conditions

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