Plantar fasciitis treated with local steroid injection: comparison between sonographic and palpation guidance

Abstract

Abstract Purpose To compare the effectiveness of sonographically guided and palpation‐guided steroid injection for the treatment of proximal plantar fasciitis. Patients and 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. © 2006 Wiley Periodicals, Inc. J Clin Ultrasound 34 :12–16, 2006