Plantar fasciitis treated with local steroid injection: comparison between sonographic and palpation guidance.
OBJECTIVE
To compare the effectiveness of sonographically guided and palpation-guided steroid injection for the treatment of proximal plantar fasciitis.


METHODS
Twenty-five consecutive patients with unilateral proximal plantar fasciitis were recruited and randomly divided into a sonographically guided group (n = 12) and palpation-guided group (n = 13). Proximal plantar fascia was assessed with a 5- to 12-MHz linear-array transducer. Pain intensity was quantified using a "tenderness threshold" (TT) and a visual analog scale (VAS). Injection of 7 mg (1 ml) of betamethasone and 0.5 ml of 1% lidocaine into the inflamed proximal plantar fascia was performed under the guidance of sonography or palpation. Patients were evaluated clinically and sonographically before injection and at 2 weeks, 2 months, and 1 year after injection. VAS- and TT-measured pain intensity, thickness, and echogenicity of the proximal plantar fascia, as well as the recurrence of heel pain, were assessed.


RESULTS
Both VAS- and TT-measured levels of pain improved significantly after steroid injection in both groups (p < 0.001). Also, the thickness decreased significantly after injection (p < 0.01 in the palpation-guided group; p < 0.001 in the sonographically guided group). The number of patients with hypoechogenicity at the proximal plantar fascia decreased after steroid injection in both groups (p < 0.01 for both groups). The recurrence rate of plantar fasciitis in patients of the palpation-guided group (6/13) was significantly higher than that of the sonographically guided group (1/12) (p < 0.05).


CONCLUSIONS
Steroid injection can be an effective way to treat plantar fasciitis, and injection under sonographic guidance is associated with lower recurrence of heel pain.
Tsai
Wen-Chung
WC
Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, 5, Fu-Shin Street, Kweishan, Taoyuan 333, Taiwan.
Hsu
Chih-Chin
CC
Chen
Carl P C
CP
Chen
Max J L
MJ
Yu
Tung-Yang
TY
Chen
Ying-Jen
YJ
D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D003907:Dexamethasone / Q000008:administration & dosage; D036981:Fasciitis, Plantar / Q000000981:diagnostic imaging / Q000188:drug therapy*; D005260:Female; D006801:Humans; D015552:Injections, Intralesional / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010808:Physical Examination; D018084:Ultrasonography, Interventional
D000893:Anti-Inflammatory Agents; D003907:Dexamethasone