II. Indications
- Avoid if possible (See Complications below)
- Plantar Fasciitis refractory to other measures
III. Preparation
- Foot Xray prior to injection (rule-out tumor)
- Needle
- Gauge: 25-27
- Length: 1.5 inches
- Syringe: 5 ml
-
Corticosteroid options
- Betamethasone (Celestone) 1 ml of 6 mg/ml
- Methylprednisolone (Depo-Medrol): 1 ml of 40 mg/ml
-
Anesthetic
- Lidocaine 1%: 2 ml or
- Bupivacaine 0.25% or 0.5%: 2 ml
IV. Technique
- Patient position
- Lateral decubitus position with affected foot down
- Landmarks
- Distal longitudinal crease at medial sole
- Proximal base of longitudinal arch
- Level of medial process of calcaneal tuberosity
- Soft tissue slightly distal to Calcaneus
- Identify point of maximal tenderness and swelling
- Distal longitudinal crease at medial sole
- Mark needle insertion site based on landmarks
- Sterilize local skin with Betadine or Hibiclens
- Insert needle at medial foot landmark
- Important: See precautions below
- Needle inserted perpendicular to skin
- Insert needle past midline of foot
- Inject preparation into middle third of foot width
- Patient lies supine for several minutes after procedure
- Distribute with passive foot range of motion
V. Precautions
- Do not inject into fat pad at foot base
- Do not inject via base of foot
- Do not inject into tibial nerve
VI. Complications
- Fat pad atrophy
- Plantar fascia rupture (10% risk in one studies)
VII. Efficacy
- Improvement in >70% of cases (Ultrasound-guided)
VIII. Follow-up Instructions
- No stress to foot for 2 weeks after injection
- Minimum time to strenuous activity: 48 hours
- Examine again in 3 weeks post-injection
- Consider Ultrasound guidance in refractory cases
IX. References
- Greene (2001) Musculoskeletal Care, AAOS, p. 491-2
- Tallia (2003) Am Fam Physician 68(7):1356-62 [PubMed]
- Young (2001) Am Fam Physician 63(3):467-78 [PubMed]