Ultrasound Guided Corticosteroid Injections for Plantar Fasciitis: Randomized Controlled Trial

SLR - July 2013 - Thomas J. Chambers

Reference: McMillan A, Landorf K, Gilheany M, Bird A, Morrow A, Menz H. Ultrasound guided corticosteroid injections for plantar fasciitis: randomized controlled trial. BMJ 2012; 344.

 

Scientific Literature Review

Reviewed by: Thomas J. Chambers, DPM

Residency Program: Southern Arizona VA Health Care System

Podiatric Relevance: Plantar fasciitis accounts for an estimated 1 million office visits per year. Few studies have been performed evaluating the efficacy of corticosteroid injections into the heel. Those that were done have shown positive results in favor of corticosteroids, but more studies are needed. Corticosteroid injections do not always get to the exact anatomic location the physician would like, so this study used ultrasound guided injections to verify injections were at the site of inflammation.
 

Methods: A total of 82 patients were randomly assigned to a control group which received saline injections or an experimental group which received dexamethasone injections. To be included in the trial patients had to have heel pain for longer than eight weeks, pain 20 mm or greater on the 100 mm Visual Analog Scale, plantar heel pain and confirmed ultrasound plantar fascial thickness greater than 4.0 mm. Pain was measured by the foot pain domain of the foot health status questionnaire.

Results:  At four weeks, the dexamethasone group had better results by a 10.9 point margin. At six and eight weeks the pain was not significantly different. The thickness of the plantar fascia was significantly decreased in the dexamethasone at four, six and eight weeks with the thickness measuring -0.35, -0.39 and -0.43. The number needed to treat was reported to be 2.93. No adverse events were reported in the participants.
 

Conclusions:  This study suggests that the use of dexamethasone injections of plantar fasciitis under the guidance of ultrasound is safe and effective for short term relief of plantar fasciitis pain. It was also shown to decrease the swelling of the plantar fascia for several months.