Is the percutaneous ultrasound (US) guided approach effective in the treatment of painful plantar fasciitis?

Purpose: Plantar fasciitis is an annoying and widespread pathology. So far, no therapy has been indicated as a standard of reference for such affection. Therefore, the purpose of our work is to describe a clinical and technical approach to US-guided percutaneous treatment of painful plantar fasciitis.

Methods and materials: Thirty-one patients with clinical and US diagnosis of plantar fasciitis unresponsive to medical therapy were treated. The procedure is performed by two expert radiologists. After the injection of a small amount of local anaesthetic, we perform a dry-needling on its insertional portion and on periostium to produce local phenomena of hyperaemia. Then the needle is retracted to reach the perifascial soft tissues and a small amount of steroid (1ml of Triamcinolone acetonide 40mg/ml) is injected. After the treatment, a orthotic soft arch support to relieve the hind part of the foot is suggested. All the patients were followed-up clinically after the treatment for 4–6 months.

Results: In 89% of patients we have observed a complete disappearance of symptoms after 2–3 weeks from the treatment. In 8% of patients we have observed a relative worsening of symptoms in the first days after the treatment, followed by a progressive reduction and a disappearance of symptoms in about three weeks. In 3% of patients we have observed no significant response to the therapy; in these patients, MR showed a remarkable calcaneal bone edema at the fascial insertion.

Conclusion: US-guided treatment of plantar fasciitis is a non invasive and successful technique that allows to be more precise when injecting the steroid, avoiding the fascia. The dry-needling performed on plantar fascia and on periostium produces a local hyperemia that can be compared to a surgical debridement.