Plantar fasciitis, reportedly the most common cause of pain in the inferior heel, is estimated to account for 11 to 15 percent of all foot symptoms requiring professional care among adults. Plantar fasciitis has been reported to account for about 10 percent of injuries that occur in connection with running and is common among military personnel. The incidence reportedly peaks in people between the ages of 40 and 60 years in the general population and in younger people among runners. The condition is bilateral in up to a third of cases.
Plantar fasciitis can be an important cause of chronic foot pain. Plantar fascia injection under ultrasound cases can provide good pain relief in some patients with plantar fasciitis. Dry needling and PRP therapy can also be beneficial in these patients. However it is important to note that in some cases injection treatment may not provide the desired results or the pain relief may not be sustained. At Pain Spa Dr Krishna is very experienced in interventional treatments. Dr Krishna always performs plantar fascia injections under ultrasound guidance for greater accuracy and improved safety. Ultrasound gives the added advantage of targeting the surrounding tendons and muscles, which can be contributory to pain.
At Pain Spa Dr Krishna is very experienced in interventional treatments. Dr Krishna always performs plantar fascia injections under ultrasound guidance for greater accuracy and improved safety. Ultrasound gives the added advantage of targeting the surrounding tendons and muscles, which can be contributory to pain.
The site of abnormality is typically near the site of origin of the plantar fascia at the medial tuberosity of the calcaneus. Histologic examination of biopsy specimens from patients undergoing plantar fascia–release surgery has shown degenerative changes in the plantar fascia, with or without fibroblastic proliferation and chronic inflammatory changes.
The diagnosis of plantar fasciitis can be made with reasonable certainty on the basis of clinical assessment alone. Patients typically report a gradual onset of pain in the inferior heel that is usually worse with their first steps in the morning or after a period of inactivity. Patients may describe limping with the heel off the ground. The pain tends to lessen with gradually increased activity but worsens toward the end of the day with increased duration of weight-bearing activity. Associated paresthesias are uncommon. Patients may report that before the onset of their symptoms, they increased the amount or intensity of their regular walking or running regimen, changed footwear, or exercised on a different surface. There is often a localized area of maximal tenderness over the anteromedial aspect of the inferior heel. Limitation of ankle dorsiflexion due to tightness of the achilles tendon may be present.
Injection of local anaesthetic and steroid is generally reserved for patients who do not improve with conservative treatment. One concern is that corticosteroid injections may be associated with an increased risk of rupture of the plantar fascia, although data to support this association are limited and inconclusive.
Platelet-rich plasma (PRP) is a concentrate of platelets derived from the patient’s own blood and is known to contain a high content of growth factors that have the potential to enhance the healing process of the tendon. A blood sample is taken and centrifuged to extract the plasma content, and the blood is then re-injected around the plantar fascia. Please note that there is a great variation in the way that different commercial systems prepare and activate the PRP, and hence it is difficult to draw clear conclusions on the efficacy of PRP.
Injections are generally avoided in patients with systemic infection or skin infection over puncture site, bleeding disorders or coagulopathy, allergy to local anaesthetics or any of the medications to be administered.
The procedure is usually done on an outpatient basis. The procedure is performed under ultrasound guidance to ensure accuracy of needle placement. Patients need to be aware that the outcome of the procedure is variable and they may not receive the desired benefits. Similarly, they must be aware of the transient nature of the therapeutic benefits and that there may need repeated injections.
Generally a mixture of local anaesthetic and steroid is injected. The local anaesthetic agent within the injectate may act on the nociceptive fibres , whereas corticosteroids may reduce inflammation. The anaesthetic is probably responsible for immediate pain relief, whereas steroids are believed to be responsible for pain relief 2–6 days after their administration.
Complications are rare, particularly if the injections are performed using a precise needle-positioning technique. Possible complications include bruising, infection, hematoma, nerve injury and reaction to the injectates. Infection can be avoided with appropriate aseptic precautions. Severe allergic reactions to local anaesthetics are uncommon. Steroid injections may produce local reactions, occurring most often immediately after injection. These local reactions last for 24 to 48 hours, and are relieved by application of ice packs. Post-procedural pain flare-up may occasionally occur, and may be treated with pain killers. Neurological complications including paraesthesias and numbness have been described but are extremely rare.
In addition corticosteroids have been associated with local skin atrophy, depigmentation and muscle wasting. Heel pad atrophy is a know complication of steroid injection in the vicinity of plantar fascia.