Retrospective Review Evaluating the Relationship Between Radiographic Calcaneal Fat Pad Thickness and Plantar Fasciitis

Chronic degeneration of the plantar fascia at its insertion on the plantar calcaneus, known as plantar fasciitis (PF), is the most common cause of heel pain in adults. The calcaneal fat pad (CFP) is a structure superficial to the plantar fascia and calcaneus, serving a critical purpose in shock absorption at heel strike during gait. To our knowledge, the radiographic relationship between the thickness of the CFP and PF has never been evaluated. The purpose of this study was to determine if there is a relationship between the thickness of the CFP, as measured on weightbearing lateral radiographs, and the incidence of PF.

This was a comparative retrospective analysis between a study cohort and a control group performed at our facility. The study cohort consisted of patients diagnosed with PF, whereas the control group consisted of patients who had no known history of PF. All patients involved in this study had weightbearing lateral foot radiographs taken and met study inclusion and exclusion criteria. The CFP thickness of the study participants was measured using the ruler tool in the AccuVueCloud radiography software.

The study cohort consisted of ten patients and the average of the radiographic measurements obtained was 0.808 cm, whereas the control group consisted of ten patients and the average of the radiographic measurements obtained was 1.091 cm. A t test was then conducted to determine if there was a significant difference between the means of the two groups, and the results produced a P value of 0.0045.

When diagnosing PF, radiographs are typically the first imaging modality used, but prior to our study, they lacked diagnostic practicality. Our study suggests that there is a relationship between CFP thickness and the incidence of PF that can be examined using weightbearing lateral radiographs.