Treatment of proximal plantar fasciitis with ultrasound-guided steroid injection.
OBJECTIVE
To investigate the efficacy of ultrasound-guided steroid injection for the treatment of proximal plantar fasciitis and to evaluate mechanical properties of the heel pad after steroid injection.


METHODS
Proximal plantar fascia and heel pad were assessed with a 10-MHz linear array ultrasound transducer. Pain intensity was quantified with a tenderness threshold (TT) and visual analog scale (VAS). The transducer was incorporated into a specially designed device to measure mechanical properties of the heel pad. Evaluations were performed before injection and at 2 weeks and 3 months after injection.


METHODS
An outpatient clinic of a tertiary care center.


METHODS
Fourteen consecutive patients with unilateral proximal plantar fasciitis.


METHODS
Ultrasound-guided injection of 7 mg betamethasone and 0.5 mL of 1% lidocaine into the inflamed proximal plantar fascia.


METHODS
VAS, TT, heel pad and plantar fascia thickness, and echogenicity of the proximal plantar fascia on sonogram were assessed. Mechanical properties included unloaded heel pad thickness, compressibility index, and energy dissipation ratio.


RESULTS
Both VAS score +/- standard deviation (SD; 5.43 +/- 2.03, 1.39 +/- 2.19, 0.57 +/- 1.40 at the 3 measurements, respectively) and TT +/- SD (5.05 +/- 1.42, 9.34 +/- 1.84, 9.93 +/- 1.98 kg/cm2 at the 3 measurements, respectively) improved significantly (p < .001) after steroid injection. The mean thickness of the plantar fascia was greater in the symptomatic side than in the asymptomatic side before treatment (0.58 +/- 0.13 cm vs 0.40 +/- 0.11 cm, p < .001). The thickness had decreased significantly 3 months after injection (0.46 +/- 0.12 cm at 2 weeks, 0.42 +/- 0.10 cm at 3 months, p < .001). The hypoechogenicity at the proximal plantar fascia disappeared after steroid injection (p < .001). Mechanical properties of the heel pad did not change 3 months after steroid injection (p > .05).


CONCLUSIONS
Ultrasound offers an objective measurement of the therapeutic effect on proximal plantar fasciitis. Accurate steroid injection under ultrasound guidance can effectively treat proximal plantar fasciitis without significant deterioration of the mechanical properties of the heel pads.
Tsai
W C
WC
Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Gueishan, Taoyuan Hsien, Taiwan.
Wang
C L
CL
Tang
F T
FT
Hsu
T C
TC
Hsu
K H
KH
Wong
M K
MK
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001623:Betamethasone / Q000627:therapeutic use*; D005208:Fasciitis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000534:rehabilitation; D005260:Female; D005534:Foot Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000534:rehabilitation; D005938:Glucocorticoids / Q000627:therapeutic use*; D006365:Heel; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy / Q000209:etiology; D014463:Ultrasonography / Q000295:instrumentation / Q000379:methods*
D005938:Glucocorticoids; D001623:Betamethasone