Plantar fasciitis

Rupture of the plantar fascia induced by glucocorticoids has usually been reported in athletes. However, a case of spontaneous degenerative rupture has been reported in a 72-year-old man who had received four glucocorticoid injections over 1 year for plantar fasciitis (SEDA-21, 418) (277). 

Zelen CM, Poka A, Andrews J. Prospective randomized, blinded, comparative study of injectable micronized dehydrated amniotic/chorionic membrane allograft for plantar fasciitis a feasibility study. Foot Ankle Int 2013 34 1332-9. 

Hanselman A, Tidwell J, Santrock R. Cryopreserved human amniotic membrane injection for plantar fasciitis a randomized, controlled, double-blind pilot study. Foot Ankle Int 2015 34 151-8. 

The number needed to treat with dexamethasone for one successful outcome for pain at 4 weeks was 2.93. There were no reported adverse events associated with the intervention. It could, therefore, be concluded that a single, ultrasoxmd-guided dexamethasone injection is a safe and effective short-term treatment for plantar fasciitis. It provides greater pain relief than placebo at 4 weeks and reduces abnormal swelling of the plantar fascia for up to 3 months. However, clinicians offering this treatment should also note that significant pain relief did not continue beyond 4 weeks. 

A new case of a plantar fascia calcification as sequela of CS injection in the treatment of a plantar fasciitis has been published [34 ]. A 72-year-old woman with severe plantar fasciitis who received a therapeutic CS injection developed a small calcified lump under the skin which subsequently caused ulceration and infection. 

Fox TP, Oliver G, Wek C, Hester T. Plantar fascia calcification a sequelae of corticosteroid injection in the treatment of recalcitrant plantar fasciitis. BMJ Case Rep 2013 2013. http //dx.doi.org/10.1136/bcr-2013-200303. pii bcr2013200303. 

US has a definite role in the management of plantar fasciitis by guiding local injection of steroids (Kane et al. 1998 Tsai et al. 2000b, 2006), extracorporeal shock-wave therapy (Hyer et al. 2005b), or needle fasciotomy (Folman et al. 2005). For steroid injection, both posterior and anterior approaches can be used to direct the needle tip inside the thickened portion of the fascia. Similar to other authors, we prefer to select a posterior approach to inject the plantar fascia (Kane et al. 1998 Tsai et al. 2000). The patient lies prone with the affected foot resting on a triangular pillow to... 

Plantar fascia tears are located at the posterior insertion of the fascia. This condition is most often observed in sportsmen who have sustained forceful plantar flexions. The US appearance of plantar fascia rupture is similar to that of plantar fasciitis and the diagnosis relies mainly on clinical and US findings, including focal nodular swelling and a hypoechoic appearance of the fascia (Fig. 17.33e,f). Surgical fasciotomy exhibits similar characteristics (Yu et al. 1999 Yu 2000). The fascia remains markedly thickened with indistinct superficial and deep margins, probably representing perifascial fibrosis (Fig. 17.35). 

Fig. 17.34a-c. Plantar fasciitis and calcaneal enthesophytes. a Long-axis 12-5 MHz US image over the posterior insertion of the plantar fascia with b lateral radiographic and c schematic drawing correlation in a patient with chronic heel pain shows signs of preinsertional fasciitis (open arrow) associated with a prominent enthesophyte (arrowheads) arising from the inferior aspect of the medial tubercle (asterisk). The hyperechoic cortical line (thin arrows) of the calcaneus is typically interrupted and discontinuous due to the anterior projection of the spur... 

Dyck DD Jr, Boyajian-O Neill LA (2004) Plantar fasciitis. Clin J Sport Med 5 305-309... 

Hyer CF, Dawson JM, Philbin TM et al (2005a) The peroneal tubercle description, classification, and relevance to peroneus longus tendon pathology. Foot Ankle Int 26 947-950 Hyer CF, Vancourt R, Block A (2005b) Evaluation of ultrasound-guided extracorporeal shock wave therapy (ESWT) in the treatment of chronic plantar fasciitis. J Foot Ankle Surg 44 137-143... 

Kamel M, Kotob H (2000) High-frequency ultrasonographic findings in plantar fasciitis and assessment of local steroid injection. J Rheumatol 27 2139-2141 Kane D, Greaney T, Bresnihan B et al (1998) Ultrasound guided... 

J Am Podiatr Med Assoc 89 331-338 Rozbruch SR, Chang V, Bohne WH et al (1998) Ganglion cysts of the lower extremity an analysis of 54 cases and review of the literature. Orthopedics 21 141-148 Sabir N, Demirlenk S, Yagci B et al (2005) Clinical utility of sonography in diagnosing plantar fasciitis. J Ultrasound Med 24 1041-1048... 

Tsai WC, Chiu MF, Wang CL (2000a) Ultrasound evaluation of plantar fasciitis. Scand J Rheumatol 29 255-259... 

Tsai WC, Wang CL, Tang FT et al (2000b) Treatment of proximal plantar fasciitis with ultrasound-guided steroid injection. Arch Phys Med Rehabil 81 1416-1421... 

Tsai WC, Hsu CC, Chen CP et al (2006) Plantar fasciitis treated with local steroid injection comparison between sonographic and palpation guidance. J Clin Ultrasound 34 12-16... 

Wall JR, Harkness MA, Crawford A (1993) Ultrasound diagnosis of plantar fasciitis. Eoot Ankle 14 465-470... 

Walther M, Radke S, Kirschner S et al (2004) Power Doppler findings in plantar fasciitis. Ultrasound Med Biol 30 435-440... 

Wong SM, Griffith JF, Tang A et al (2002) The role of ultrasonography in the diagnosis and management of idiopathic plantar fasciitis. Rheumatology 41 835-836... 

Injection of steroids in patients with painful plantar fasciitis is performed with the foot hanging over the examination bed. The transducer is placed in a sagittal plane just caudal to the attachment of the fascia to the calcaneus. Then, a 21 gauge needle is inserted from the posterior edge of the probe and directed toward the thickened origin of the fascia. The needle should traverse the fascia, as it leaves its origin from the calcaneus, to inject on its deep surface. 

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