Treatment outcome of plantar fasciitis with local steroid injection by ultrasound versus palpation technique

Abstract

Introduction: Plantar fasciitis is a degenerative tissue condition that occurs at the site of origin of plantar fascia at the medial tuberosity of calcaneum. Most commonly reported symptom of plantar fasciitis is described as first step pain. Treatment of plantar fasciitis include methods such as heat modalities, patient education, massage, stretching and strengthening exercises, extracorporeal shockwave therapy, non-steroidal anti-inflammatory medications, injections (steroids, local anesthetics, PRP), and surgical interventions (fasciotomy). Objective: The purpose of the study is to prospectively evaluate comparative efficacy of ultrasound guided steroid injection versus palpation technique. Materials and Methods: It is a prospective and interventional randomized comparative study. Eighty cases (40 in each group) in otherwise healthy individuals with the diagnosis of unilateral or bilateral plantar fasciitis attending Outpatient department of PMR of VMMC & Safdarjung hospital were enrolled in this study. The diagnosis of plantar fasciitis was made based on history and clinical examination. Patients who satisfied inclusion and exclusion criteria was randomly assigned by computerized block method to two groups-both groups were treated with injection of 40 mg(1ml) methyl prednisolone, one group with palpation guided (group A) and other with ultrasound guided(group B). All patients underwent pain intensity assessment (VAS), ultrasound examination of foot for plantar fascia thickness and x-ray foot for heel pad thickness at pre injection (0 week), 2 weeks and 8 weeks after steroid injection. Result: Statistically significant improvement in pain (VAS) at the end of 2 weeks (3.25±0.95 vs 2.65±0.83, p=0.003) and 8weeks (2.28±1.24 vs 1.12±1.07, p=0.0005) of intervention in both groups but more in USG guided group. There was decrease in plantar fascia thickness at the end of 2 weeks (0.33±0.02 vs 0.31±0.02, p=0.0005) and 8 weeks (0.30±0.02 vs 0.28±0.02, p=0.0005) of intervention in both groups but more in USG guided group, this was statistically significant. No significant difference in heel pad thickness at the end of 2 weeks (18.08±0.76 vs 18.23±0.80, p=0.356) and 8weeks (18.00±0.75 vs 18.12±0.79, p=0.444) of intervention in both groups. Conclusion: Ultrasound guided injection is better than palpation method as it enhances the accuracy of injection by precisely localizing the lesion and needle placement giving more relief in symptoms and normalization of plantar fascia thickness.