Sonographic Evaluation of Plantar Hindfoot Pain in Athletes.
6 affiliations
- 1Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA.
- 2Department of Orthopedic Surgery, Division of Sports Medicine, Mayo Clinic, Rochester, MN, USA.
- 3Departments of Orthopedics and Radiology, Essentia Health, Duluth, MN, USA.
- 4Boston Sports & Biologics, Wellesley Hills, MA, USA.
- 5Department of Orthopedics and Rehabilitation, Tufts Medical Center, Boston, MA, USA.
- 6Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, USA. [email protected].
Abstract
Purpose of review
To provide an anatomy-based review of musculoskeletal ultrasound (US) in the evaluation of plantar hindfoot pain in athletes. This review summarizes normal sonographic anatomy, characteristic findings, diagnostic utility, and limitations for plantar fascia, heel fat pad, calcaneal, peripheral nerve, vascular, and foreign-body pathology. It also examines how US findings should be integrated with the history and physical examination in athletes.Recent findings
Recent studies support high-resolution, dynamic US as a useful imaging modality for plantar hindfoot pain. US enables real-time assessment, contralateral comparison, sonopalpation, and evaluation during dynamic maneuvers. Emerging literature has further characterized the layered structure and loading behavior of the heel fat pad, dynamic sonographic findings of fat pad fracture and subluxation, and assessment of peripheral nerve entrapment. Recent studies also demonstrate that plantar fascia, heel fat pad, and other hindfoot abnormalities are prevalent in asymptomatic athletes. Although sonographic abnormalities may be associated with future time-loss injury, their low positive predictive value limits their role as a screening tool. MRI remains important when evaluating suspected calcaneal stress injury, marrow pathology, or complex soft-tissue disease. US is an accessible and valuable modality for the assessment of plantar heel pain in athletes. A structured, symptom-driven examination may improve diagnostic precision and identify alternative or coexisting pathology. Sonographic findings should be correlated with symptom location, physical examination, and sonopalpatory pain, particularly because structural abnormalities are common in asymptomatic athletes.
Related
- Limb Salvage of a Flail Neuropathic Ankle in Congenital Insensitivity to Pain with Anhidrosis Using a Hindfoot Superconstruct.
- Clinical outcomes of hyaluronic acid–sorbitol injection in athletes with patellofemoral pain: Evaluation of the potential influence of body mass index
- Association between patellar tendon-related pain and morphological abnormalities of the patellar tendon visualized using ultrasound imaging in middle school athletes
- Proof-of-Concept Evaluation of a Sock-Based Plantar Strain Sensing System for Diabetic Foot Monitoring.
- Evaluation of a Wearable Hydration Monitor for Estimating Sweat Loss and Hydration Status in Collegiate Athletes: A Pilot Study
BibTeX
@article{swanson2026sonographic,
title = {{Sonographic Evaluation of Plantar Hindfoot Pain in Athletes.}},
author = {Tyra L Swanson and Brennan J Boettcher and Douglas F Hoffman and Walter I Sussman and Ryan C Kruse},
journal = {Current reviews in musculoskeletal medicine},
year = {2026},
month = oct,
doi = {10.1007/s12178-026-10063-6},
url = {https://europepmc.org/article/MED/42905364},
note = {CC BY},
}
RIS
TY - JOUR
TI - Sonographic Evaluation of Plantar Hindfoot Pain in Athletes.
AU - Tyra L Swanson
AU - Brennan J Boettcher
AU - Douglas F Hoffman
AU - Walter I Sussman
AU - Ryan C Kruse
PY - 2026
DA - 2026/10/21
JO - Current reviews in musculoskeletal medicine
DO - 10.1007/s12178-026-10063-6
UR - https://europepmc.org/article/MED/42905364
AB - Purpose of review To provide an anatomy-based review of musculoskeletal ultrasound (US) in the evaluation of plantar hindfoot pain in athletes. This review summarizes normal sonographic anatomy, characteristic findings, diagnostic utility, and limitations for plantar fascia, heel fat pad, calcaneal, peripheral nerve, vascular, and foreign-body pathology. It also examines how US findings should be integrated with the history and physical examination in athletes.Recent findings Recent studies support high-resolution, dynamic US as a useful imaging modality for plantar hindfoot pain. US enables real-time assessment, contralateral comparison, sonopalpation, and evaluation during dynamic maneuvers. Emerging literature has further characterized the layered structure and loading behavior of the heel fat pad, dynamic sonographic findings of fat pad fracture and subluxation, and assessment of peripheral nerve entrapment. Recent studies also demonstrate that plantar fascia, heel fat pad, and other hindfoot abnormalities are prevalent in asymptomatic athletes. Although sonographic abnormalities may be associated with future time-loss injury, their low positive predictive value limits their role as a screening tool. MRI remains important when evaluating suspected calcaneal stress injury, marrow pathology, or complex soft-tissue disease. US is an accessible and valuable modality for the assessment of plantar heel pain in athletes. A structured, symptom-driven examination may improve diagnostic precision and identify alternative or coexisting pathology. Sonographic findings should be correlated with symptom location, physical examination, and sonopalpatory pain, particularly because structural abnormalities are common in asymptomatic athletes.
SN - 1935-973X
SN - 1935-9748
ER -