One structure, one landmark, one number. The plantar fascia measured where it leaves the medial calcaneal tubercle — with every moment timestamped, the preset, depth and frequency read off the device screen, and the whole recording transcribed.
Sobre a Dra. Mariz
I am Dr. Fernando Mariz, a gynecology and pelvic surgery physician practicing in New York City. Before my medical career, I served in the U.S. Marine Corps, where I developed the discipline, focus, and steadiness that continue to shape the way I care for patients today. At Maiden Lane Medical, my work covers women’s health, preventive care, sonography, pelvic pain, abnormal uterine bleeding, and minimally invasive gynecologic procedures.
Sobre o Dr. Avila
I am Dr. Jailyn Avila, an emergency medicine physician, educator, and digital health innovator based in Southern California. My clinical work is rooted in emergency care, while my teaching focuses on point-of-care ultrasound, residency education, and practical training for physicians. Through my roles with Emergent Medical Associates, UHS SoCal MEC Emergency Medicine Residency, Core Ultrasound, and FemInEM, I work at the intersection of patient care, medical education, and accessible digital learning.
Resposta rápida
A normal plantar fascia measures roughly 3.5 to 4.0 mm where it leaves the medial calcaneal tubercle; thicker than 4.0 mm, with the bright striped pattern replaced by a dark heterogeneous band, is plantar fasciitis. Put a linear probe in long axis on the spot the patient points to, find the bright calcaneal cortex, pick the fascia up off it, freeze, and drop two calipers — superficial border to deep border. That is the entire exam, and it takes about a minute. The evidence behind the cut-off is strong in both directions: pooled across 23 imaging studies, a fascia over 4.0 mm carried an odds ratio of 105 for chronic plantar heel pain, and a hypoechoic proximal fascia carried an odds ratio of 204. I read those two findings together rather than trusting the millimetres alone, because thickness drifts with body size and hypoechogenicity does not. Start at 0:31 for the rule and the settings, at 2:08 for the scan itself.
Looking for a device rather than the exam? The sports medicine hub covers the models used for foot, ankle and tendon work, and the Página do produto D3Ultra carries the full specification and current price.
One number
Four millimetres, and why the answer is rarely close to it
This exam produces a single measurement and compares it to a single line. What makes it easy in practice is that real feet do not cluster around the line — they sit well below it or well above it. Click the amber marker to jump the video to the moment the caliper reads.
Plantar fascia thickness at the medial calcaneal tubercle, in millimetres
4.0 mmThe published threshold. Above it, with the fibrillar pattern lost, is plantar fasciitis.
2.80 mmWhat the caliper reads on camera at 2:39. A normal fascia, on the hardest foot he could find.
012345678
0 to 4.0 mm: normalabove 4.0 mm: thickened
The presenter’s own rule of thumb, stated at 0:31: a normal fascia measures two or three millimetres and an abnormal one five or six, so a result sitting on the threshold itself is rare. That is the useful part — this measurement usually lands nowhere near the line you are comparing it to.
3.5–4.0mmNormal fascia at the calcaneal insertion, long axisManske 20254.0mmMean maximal thickness of the central bundle in healthy feetDraghi 2017+2.16mmHow much thicker the fascia is in chronic plantar heel pain, pooledMcMillan 2009
Plantar fibromatosisWell-demarcated nodular thickenings inside the fascia, iso- to hypoechoic. A thick reading that sits in a lump rather than along the band.Draghi 2017A fascial tearPartial or complete interruption of the fibres, often with fluid around them. Thickening plus a discontinuity is a different diagnosis.Draghi 2017Tibialis posterior tendinopathyThe tendon runs behind the medial malleolus, a probe-width away from where you are already standing. Check it before you call the fascia normal.Named in the recording at 1:32Plantar myofascial trigger pointsA focal hypoechoic nodule inside the plantar muscle rather than in the fascia. Echogenicity was long disputed and is now measured.Named at 1:32; Chen 2024
0:00The rule, the settings and the differential2:08The fascia scanned and measured on camera3:16Fechar
the rule, the settings and the differentialthe fascia scanned and measuredclose
The foot scanned here is normal, and that was the point of choosing it: Brandon Ramakko says at 1:48 that this model has the thinnest, most awkwardly placed fascia he has had to scan, so if the measurement works on her it works on anyone. The consequence is that this recording contains no thickened fascia acquired on camera. Two heels above the threshold do appear on screen at 0:22 as labelled reference pictures with no stated provenance; they are not acquisitions from this session, and their numbers are not repeated here.
Timestamped
Key moments, with the settings
The third column is the part normally missing from a scan video: the preset, depth, transmit frequency and gain showing on the device at that moment. The interesting entry is the frequency. This linear array offers 7.5 and 10 MHz, and the fascia is shallow enough that 10 would resolve it better — but the heel pad is thick skin that eats signal, so the scan runs at 7.5.
| Tempo | What is on screen | Preset, depth, frequency, gain |
|---|---|---|
| 0:31 | The threshold, and getting through the heel padbefore the probe goes downPresenter to camera, foot in the frame | Stated, not yet on screen: 7.5 MHz for this scan, with 5 MHz on the curvilinear side as the fallback |
| 1:13 | Positioning: anything that gives you access to the footbefore the probe goes downPresenter to camera, demonstrating a dangling foot | No device panel on screen |
| 1:32 | What else produces the same heel painbefore the probe goes downPresenter to camera | No device panel on screen |
| 1:48 | A deliberately difficult fascia, and an atypical tuberclebefore the probe goes downPresenter to camera, palpating the medial heel | No device panel on screen |
| 2:08 | Gel on, probe down, first lookProbe placed on the medial heel, live image appears | MSK preset · D 40 mm · F 7.5 MHz · GN 105 dB · Compound ON |
| 2:22 | Calcaneal cortex first, then the fascia above itLive long-axis image: the bright cortex, then the fascial band | MSK preset · D 40 mm · F 7.5 MHz · DR 80 · ENH 0 · MI 0.7 · TIS 0.1 |
| 2:39 | The measurement: 2.8 mmFrozen frame, LENGTH tool, calipers on the superficial and deep borders | FREEZE · Meas → LENGTH · reads 2.80 mm · cine 99/100 |
| 2:50 | What else to check while you are therePresenter to camera | No device panel on screen |
Settings transcribed from the device interface visible in the recording. The preset name and software version are legible in the title bar throughout: MSK, V 3.6.78, probe header SX-6CT. The first four rows are argued to camera with the software window covered by the presenter’s own title card, so no panel is readable for them; the frequency shown against row one is what he says aloud at 1:05, not what is on screen.
Reading the images
What this scan shows
Three layers, in order, from the skin down. Heel pad first — thick fibro-fatty tissue, mottled and grey, and the reason this window is harder than it looks. Then the plantar fascia: a tight band of parallel collagen that draws as a bright striped ribbon with crisp upper and lower edges. Then the calcaneus, which stops the sound dead and draws as a brilliant white line with pure black shadow under it. Find the bone first. It is unmissable, it tells you the fascia is the ribbon sitting directly on top of it, and it anchors the measurement.
The measurement goes in one place: long axis, immediately distal to the origin on the medial calcaneal tubercle, where the fascia is at its thickest before it tapers forward. Angle the probe slightly medially so the beam strikes the fibres square, because a fascia sampled off-axis reads darker and thicker than it is. Then look at the band itself and not only at the number. A diseased fascia loses its stripes, turns hypoechoic and heterogeneous, and gives up the sharp deep edge that normally sits against the bone.
What I want you to take from a normal study like this one is calibration. You cannot recognise a swollen, dark, edgeless fascia until you have watched a thin bright one glide over the calcaneal cortex a dozen times, and this recording is that reference at the difficult end — a thin fascia, an atypically placed tubercle, and a heel pad that fights the beam.
Verbatim
Full transcript
Transcript — 3:33, 9 passages
Transcribed from the recording and edited for readability; square brackets mark an editorial clarification. Every timestamp jumps the video, and any timestamp before 0:31 opens it at 0:31, where the clinical content starts.
The whole test, in two sentences
0:00Today we’re going to use a Suresult D3Ultra to evaluate the plantar fascia for plantar fasciitis or fasciosis. Now, the evaluation itself is very, very, very simple. You look at the medial tubercle, which is typically where the patient says their pain is, and if the plantar fascia is larger than 4 millimetres, they have plantar fasciitis or fasciosis. If it’s less than 4 millimetres, then they’re probably fine. And normal is around like two or three, and abnormal is like five or six, so it’s very rare that you’ll find someone around that 4 millimetre mark.
Getting penetration through the heel
0:39Now, the plantar surface itself can be a little tricky to scan through, because it’s hard to get penetration sometimes through that thick skin. So you may have to increase power or decrease frequency in order to see anything. In fact, I’ve even had to go down to like 5 megahertz with the curvilinear side just to get the penetration to measure the plantar fascia. But in theory the structure is quite shallow, so higher frequency should be better for higher resolution. I think I’m going to use 7.5 megahertz for this today.
Patient positioning
1:13Now, our sample patient here — this is a possible patient positioning, but you can pretty much have almost any patient position that gives you access to the foot. If you have a taller table where they’re sitting and their foot is dangling — just a dangling foot, and just place it underneath and check.
What else could be causing the heel pain
1:32Some other structures you should keep in mind: sometimes it’s actually a problem, for example, with the tibialis posterior tendon instead of the plantar fascia, or it could be myofascial trigger points at the bottom of the foot instead of the plantar fascia. So those are other things to consider.
A deliberately hard case
1:48I’ve already scanned her before, and in particular she has probably the most difficult plantar fascia I’ve ever had to scan. It’s very thin, and the medial tubercle — you expect it sort of around here, but it’s actually a little bit further on her. So if I can use this to evaluate her plantar fascia, then I can probably evaluate anyone’s plantar fascia.
Acquisition
2:08We’ll get some gel on here. We’ll turn it on, and let’s go like this.
Reading the image
2:22So we’re seeing the calcaneus as the cortex there. And there’s the plantar fascia. That wasn’t so bad — that was pretty easy. So here’s that surface, and here’s the bottom of it, and that’s the thickness we need to measure.
The measurement
2:39So I can grab the measurement tool — we need a length — and grab that. And it’s 2.8 millimetres. Pretty easy.
What else to look for while you are there
2:50Now, you can of course scan over the entire plantar fascia looking for other pathologies. And as I mentioned, you could look for myofascial trigger points, either through palpation or with the ultrasound unit. Remember, muscle that looks unusually hypoechoic — darker than usual — could indicate a myofascial trigger point. And again, I do recommend checking the tibialis posterior tendon for tendinopathy there. Anyways, I hope you found this useful. Cheers.
[Sponsor segment omitted, 3:16–3:33]
Hardware
Device and settings
The left column is the published specification; the right column is what the device interface actually showed while this exam was running, and the right column is the one I would copy. Note what is not maximised. Gain is at the ceiling and frequency is one step below it — the deliberate trade for a window where the obstacle is attenuation in the heel pad rather than the depth of the target. If almost all of your week is superficial tendon and nerve work at 12 MHz and above, a three-geometry head like this is not a good fit: its linear side stops at 10 MHz and a dedicated high-frequency linear probe will out-resolve it every time.
Published specification
Suresult D3Ultra
Three geometries, one head — $2,976
- Linear7.5 / 10 MHz · 20 / 40 / 60 / 100 mm · 40 mm
- Convexo3.2 / 5.0 MHz · 90–300 mm · 45°
- Faseado3.2 / 5.0 MHz · 90–300 mm · 60°
- Signal path192 elements · 64 channels · 256 grey levels
- Gain range30–105 dB · dynamic range 40–110
- DopplerColour, Power and PW, alongside B and M
- Handpiece156 × 65 × 20 mm · 263 g · 2 h scanning
- Connects toiOS, Android, Windows · dual-band Wi-Fi
Read off the screen in this recording
- PresetMSK · software V 3.6.78 · probe header SX-6CT
- ArrayLinear · unchanged for the whole scan
- ProfundidadeD 40 mm · generous for a structure a centimetre down
- FrequênciaF 7.5 MHz · one step below this array’s 10 MHz ceiling
- GanhoGN 105 dB · the top of the published range
- Dynamic rangeDR 80 · ENH 0 · Compound ON
- OutputMI 0.7 · TIS 0.1
- MediçãoB mode, freeze, Meas → LENGTH · reads 2.80 mm
Same probe, other windows
Related scans
3:57Tibialis posterior tendon, behind the medial malleolusThe differential named in this recording at 1:32, scanned properly. It is the tendon that explains the heel that hurts with a normal fascia.Watch in the Library →
5:32Achilles tendon in long and short axisThe other end of the same calcaneus. Posterior heel pain and plantar heel pain arrive at the same clinic appointment and are two different scans.Watch in the Library →
5:27Median nerve at the carpal tunnelThe same discipline on a different structure: find the thickest point, freeze, take one number, and read it against a published cut-off.Read the walkthrough →All the clinical clips, filterable by anatomy and probe, are in the Scan Library.
Asked on this search
Heel pain questions
Can plantar fasciitis be seen on ultrasound?
Yes, and it is the first-line imaging test for it. The plantar fascia is a superficial band a few millimetres thick, so a linear probe resolves it easily where it leaves the medial calcaneal tubercle. Two findings carry the diagnosis: the band is thicker than 4.0 mm, and its normally bright fibrillar pattern turns dark and heterogeneous. In a pooled analysis of 23 imaging studies, people with chronic plantar heel pain were far more likely than controls to show both — an odds ratio of 105.11 for thickness above 4.0 mm and 204.12 for hypoechogenicity of the proximal fascia. I read the two together and never the thickness alone.
Source: McMillan AM, Landorf KB, Barrett JT, Menz HB, Bird AR. Diagnostic imaging for chronic plantar heel pain: a systematic review and meta-analysis. Journal of Foot and Ankle Research 2009;2:32. Accessed September 10, 2026.
How thick is a normal plantar fascia on ultrasound?
About 3.5 to 4.0 mm at the calcaneal insertion, tapering as it runs forward; the mean maximal thickness of the central bundle in healthy feet is reported at 4.0 mm, against 2.3 mm for the lateral bundle and 0.6 mm for the medial one. A measurement above 4.0 mm at the insertion is treated as pathological. The fascia scanned in this recording measures 2.80 mm, which is a normal result on a foot the presenter picked because it is unusually thin and unusually hard to scan.
Source: Manske RC, Wolfe C, Page P, Voight M. Diagnostic Musculoskeletal Ultrasound in the Evaluation of the Plantar Fascia. International Journal of Sports Physical Therapy 2025;20(7):1091–1096. Accessed September 10, 2026.
Where exactly do you measure the plantar fascia?
In long axis, at the thickest part of the fascia next to the calcaneus, just distal to its origin on the medial calcaneal tubercle, with the probe angled slightly medially so the beam meets the fibres square. Put one caliper on the superficial border and one on the deep border and read the distance between them. The textbook position is prone with the ankle over a bolster; in this recording the model sits with the knee bent and the sole presented, which is the position I would use in a clinic room where the patient is already sitting.
Source: Manske RC, Wolfe C, Page P, Voight M. Diagnostic Musculoskeletal Ultrasound in the Evaluation of the Plantar Fascia. International Journal of Sports Physical Therapy 2025;20(7):1091–1096. Accessed September 10, 2026.
What does plantar fasciitis look like on ultrasound?
A healthy fascia is a tight, bright, striped band with sharp borders sitting directly on the bright line of the calcaneal cortex. In plantar fasciitis that band swells past 4.0 mm, the stripes blur into a dark heterogeneous block, and the deep border next to the bone loses its edge. Fluid around the fascia, calcification inside it and increased flow on Doppler can all appear alongside. The recording on this page shows a normal fascia, so it teaches the baseline rather than the abnormality.
Source: Draghi F, Gitto S, Bortolotto C, Draghi AG, Ori Belometti G. Imaging of plantar fascia disorders: findings on plain radiography, ultrasound and magnetic resonance imaging. Insights into Imaging 2017;8(1):69–78. Accessed September 10, 2026.
What frequency should you use to scan the plantar fascia?
High enough to resolve a 3 mm band, low enough to get through the heel pad. The fascia sits roughly a centimetre down, so resolution matters more than penetration and the top of a linear array is the usual answer. The skin over the plantar surface is thick, though, and it eats signal: the presenter runs this scan at 7.5 MHz rather than the 10 MHz his linear array also offers, and says he has dropped to 5 MHz on the curvilinear side on other feet to see anything at all. Start high, and trade frequency for power only when the image gives you nothing.
Source: POCUS for Plantar Fasciitis — Suresult channel, 13 October 2025. Accessed September 10, 2026.
Provenance
Fontes
- Manske RC, Wolfe C, Page P, Voight M. Diagnostic Musculoskeletal Ultrasound in the Evaluation of the Plantar Fascia. International Journal of Sports Physical Therapy 2025;20(7):1091–1096Technique reference for this exam: long axis with slight medial obliquity along the thickest part of the fascia near the calcaneus, patient prone with the ankle on a bolster; a normal fascia is a thick hyperechoic fibrillar band of approximately 3.5 to 4.0 mm that tapers anteriorly, with a thickness exceeding 4.0 mm suggestive of pathology, and the fibrillar pattern turning hypoechoic and heterogeneous in disease. Accessed September 10, 2026.
- McMillan AM, Landorf KB, Barrett JT, Menz HB, Bird AR. Diagnostic imaging for chronic plantar heel pain: a systematic review and meta-analysis. Journal of Foot and Ankle Research 2009;2:32Twenty-three studies pooled. The plantar fascia of participants with chronic plantar heel pain was 2.16 mm thicker than controls (95% CI 1.60 to 2.71, P below 0.001); they were more likely to measure above 4.0 mm (OR 105.11, 95% CI 3.09 to 3577.28) and more than 200 times more likely to show hypoechogenicity of the proximal fascia (OR 204.12, 95% CI 52.00 to 801.28, four studies, 209 cases and 146 controls, heterogeneity 0%). The wide interval on the thickness estimate is the study’s own. Accessed September 10, 2026.
- Draghi F, Gitto S, Bortolotto C, Draghi AG, Ori Belometti G. Imaging of plantar fascia disorders: findings on plain radiography, ultrasound and magnetic resonance imaging. Insights into Imaging 2017;8(1):69–78Anatomy and the differential. The fascia arises from the medial tubercle of the calcaneus; mean maximal thickness is 4.0 mm in the central bundle, 2.3 mm laterally and 0.6 mm medially. Sonographic features of plantar fasciitis are loss of fibrillar structure, thickness over 4 mm, perifascial collections, calcification and hyperaemia on Doppler. Plantar fibromatosis appears as well-demarcated iso- to hypoechoic nodular thickenings, and tears as partial or complete fibre interruption. Accessed September 10, 2026.
- Chen H-Y, Hsu C-H, Chen K-H, et al. Assessment of the Performance of Ultrasonography for Detecting Myofascial Trigger Points. Sensors 2024;24(3):718Whether trigger points read as hyperechoic or hypoechoic had been disputed. Using spontaneous endplate noise on needle EMG as the reference standard in an animal model, trigger points were hypoechoic on B-mode with 100% sensitivity, and detection accuracy and precision were 89.9% and 89.2%. The authors state that human studies are the next step. Accessed September 10, 2026.
- ACEP Sonoguide — Musculoskeletal UltrasoundBaseline sonoanatomy for this window: fascia draws as thin hyperechoic lines, muscle as striated hypoechoic slabs between them, and a bone cortex as a bright surface with no echoes deep to it — which is why the calcaneus is the landmark you find first. Accessed September 10, 2026.
- Página do produto Suresult D3UltraManufacturer figures for the three-geometry head this scan was run on: array geometries, frequency steps, depth range, gain and dynamic range. The price shown in the card above is rendered live from this page. Accessed September 10, 2026.
- POCUS for Plantar Fasciitis — Suresult channel, 13 October 2025The recording transcribed on this page. Presented by Brandon Ramakko, DC. Accessed September 10, 2026.
Which probe does your foot and ankle work actually need?
A fascia measurement wants resolution and almost no depth; a heel pad that will not let signal through wants the opposite. A three-geometry head covers both from one device, and a dedicated high-frequency linear probe covers the first one better. Tell us the setting and the case mix and you will get a direct recommendation in one conversation — one probe, two, or neither.
