Ultrasound guided injection of recalcitrant plantar fasciitis

Abstract

OBJECTIVE—To determine the effect of ultrasound guided injection in recalcitrant idiopathic plantar fasciitis.
METHODS—Four patients with a clinical diagnosis of idiopathic plantar fasciitis, who were unresponsive to palpation guided injection with triamcinolone acetonide and local anaesthetic, underwent ultrasonographic examination of the heel.
RESULTS—The following ultrasonographic features were noted:- (a) increased thickness of plantar fascia in symptomatic heels compared with asymptomatic heels, (b) loss of distinction of the distal plantar fascia borders, (c) reduced echogenicity of the plantar fascia. Ultrasound guided injection of the enlarged, hypoechoic plantar fascia resulted in complete relief in four of five heels(mean duration of follow up=24 months) in three cases. One patient developed a recurrence of symptoms after six months.
CONCLUSION—Ultrasound allows for confirmation of the clinical diagnosis and ultrasound guided injection produces a good clinical response when unguided injection is unsuccessful. The technique is quick, inexpensive, and entails no radiation exposure.

 Keywords: ultrasound guided; corticosteroid injection; plantar fasciitis

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Figure 1  .

A 7.5 Mhz linear array ultrasound transducer is positioned longitudinally in the midline of the left heel and demonstrates normal plantar fascia with regular fibrillar echotexture. On the right heel, the transducer has been positioned longitudinally over the region of maximal thickness of the plantar fascia, which is grossly thickened with reduced echogenicity. There is loss of definition of fibrillar echotexture and of the fascial borders distal to the anterior border of the calcaneus.

Figure 2  .

Under ultrasound guidance a 21 gauge needle has been introduced into the thickened plantar fascia via a posterior approach. An injection of triamcinolone acetonide and xylocaine 2% is distributed evenly into this area and is seen as a hyperechoic solution dispersing around the needle tip.