【双语病例】足底筋膜炎MR1例
1.What is the diagnosis?
Plantar fibromatosis 跖部纤维瘤病
Plantar fascia rupture 足底筋膜断裂
Plantar fasciitis 足底筋膜炎
Plantar xanthomatosis 足底黄瘤病
Additional Question
2.What is the upper limit for normal thickness of plantar fascia?
足底筋膜厚度的最大正常值是多少?
2 mm
3 mm
4 mm
5 mm
3.What is the most common site of involvement of the planar fascia with fasciitis?
足底筋膜炎最好累及那个部位?
Proximal plantar fascia 足底筋膜近段
Mid plantar fascia 足底筋膜中段
Distal plantar fascia 足底筋膜远段
选择题答案:
1.Plantar fasciitis Thickened planar fascia proximally near the origin from calcaneus with perifascial edema and edema in calcaneus near the origin of the plantar fascia are characteristic of plantar fasciitis.
足底筋膜靠近跟骨处增厚,伴筋膜周围水肿及骨髓水肿,是足底筋膜炎的典型表现。
2.4 mmNormal plantar fascia thickness is in the range of 2 mm to 4 mm.
正常足底筋膜厚度2-4mm。
3.Proximal plantar fasciaThe proximal plantar fascia near the origin from the calcaneus is the most common site of plantar fasciitis.
足底筋膜炎的好发部位是足底筋膜近端、考虑跟骨附着处。
Findings and Diagnosis
FindingsNear the origin from the calcaneus, the proximal central band of plantar fascia is thickened, measuring 5.5 mm. There is surrounding perifascia edema involving the subcutaneus fat and the flexor digitorum brevis muscle which is just deep to the central band of the plantar fascia. Also seen is subtle marrow edema in the calcaneus near the origin of the plantar fascia.足底筋膜中间部近端、靠近跟骨处增厚,厚度约5.5mm。筋膜周围水肿,包括皮下脂肪和足底筋膜中间部深面的趾短屈肌。足底筋膜跟骨附着也可见轻微骨髓水肿。
Differential Diagnosis
∙Plantar fasciitis 足底筋膜炎
∙Plantar fascial rupture 足底筋膜断裂
∙Plantar fibromatosis 足底纤维瘤病
∙Plantar xanthoma 足底黄瘤
DiagnosisPlantar fasciitis足底筋膜炎
Plantar fasciitis
Plantar fasciitis refers to inflammation of the plantar fascia. It is considered the most common cause of heel pain.足底筋膜炎是指足底部筋膜的炎性病变,是足跟部疼痛的最常见原因。
Clinical PresentationHeel pain that is worse on weight-bearing and passive dorsiflexion of the foot. Also, pain is worse in the morning and improves after some activity.足跟部疼痛,尤其在负重时或被动背屈时较明显。早晨时疼痛明显,运动后加重。
Etiology
∙Physical — secondary to repetitive trauma (prolonged weight bearing especially in obese patients, athletes)物理因素 — 继发于反复创伤(长时间负重,特别是体重较重的患者和运动员)
∙Systemic — secondary to enthesopathy in seronegative spondyloarthropathies.全身系统性因素 — 可继发于血清阴性脊柱关节病的肌腱端炎
∙Degenerative — age-related退变 — 与年龄相关
MR imaging
∙Findings are best seen on sagittal and coronal images.矢状位及冠状位显示最佳。
∙Fusiform thickening of the plantar fascia usually involving the proximal central band extending up to the calcaneal insertion.足底筋膜梭形增厚,常累及足底筋膜近端至跟骨附着点。
∙proliferationEdema in the plantar fascia demonstrated as increased short tau inversion-recovery (STIR)/T2 signal in the fascia, perifascial fat and muscle.足底筋膜水肿表现为STIR/T2WI序列筋膜及周围脂肪、肌肉信号增高。
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