Exploring plantar aponeurosis disorders: beyond the classics

Plantar aponeurosis (PA) disorders are a common cause of heel pain and functional impairment, with plantar fasciitis representing the most prevalent pathology. Although often attributed to chronic mechanical overload, the PA may also be affected by inflammatory, metabolic, and neoplastic conditions. A thorough understanding of the anatomy, histology, and biomechanics of the PA are auxiliary instruments for accurate diagnosis and differentiation of these entities. Imaging plays a central role in evaluation, with ultrasound offering a cost-effective method for initial assessment and MRI providing superior soft-tissue contrast for characterization of disease extent, complications, and postoperative changes. This is a comprehensive literature review that discusses the full spectrum of PA disorders, including mechanical overload, inflammatory enthesitis, fibromatosis, and rare entities such as xanthomas and tumoral calcinosis, with emphasis on their radiologic features and diagnostic pitfalls. In postoperative evaluation, the recognition of typical imaging patterns is essential for guiding treatment and avoiding misinterpretation of expected postsurgical findings.