Ultrasound Imaging and Guidance for Plantar Fascia Lesions
EURO-MUSCULUS/USPRM Approach
Corresponding Author
Pelin Analay MD
Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
Address correspondence to Pelin Analay, Hacettepe Üniversitesi Tıp Fakültesi Hastaneleri, Zemin Kat, FTR AD, Sıhhıye Ankara, Turkey.
E-mail: [email protected]
Search for more papers by this authorMurat Kara MD
Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
Search for more papers by this authorAhmad J. Abdulsalam MD
Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
Department of Physical Medicine and Rehabilitation, Mubarak Alkabeer Hospital, Jabriya, Kuwait
Search for more papers by this authorBerkay Yalçınkaya MD
Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
Search for more papers by this authorVincenzo Ricci MD
Department of Physical and Rehabilitation Medicine, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
Search for more papers by this authorGiulio Cocco MD, PhD
Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d'Annunzio University of Chieti and Pescara, Chieti, Italy
Search for more papers by this authorOndřej Naňka MD, PhD
Institute of Anatomy, First Faculty of Medicine, Charles University, Prague, Czech Republic
Search for more papers by this authorLevent Özçakar MD
Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
Search for more papers by this authorCorresponding Author
Pelin Analay MD
Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
Address correspondence to Pelin Analay, Hacettepe Üniversitesi Tıp Fakültesi Hastaneleri, Zemin Kat, FTR AD, Sıhhıye Ankara, Turkey.
E-mail: [email protected]
Search for more papers by this authorMurat Kara MD
Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
Search for more papers by this authorAhmad J. Abdulsalam MD
Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
Department of Physical Medicine and Rehabilitation, Mubarak Alkabeer Hospital, Jabriya, Kuwait
Search for more papers by this authorBerkay Yalçınkaya MD
Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
Search for more papers by this authorVincenzo Ricci MD
Department of Physical and Rehabilitation Medicine, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
Search for more papers by this authorGiulio Cocco MD, PhD
Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d'Annunzio University of Chieti and Pescara, Chieti, Italy
Search for more papers by this authorOndřej Naňka MD, PhD
Institute of Anatomy, First Faculty of Medicine, Charles University, Prague, Czech Republic
Search for more papers by this authorLevent Özçakar MD
Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
Search for more papers by this authorThe pictures of the anatomic specimens were elaborated using donated bodies with the approval of the Institute of Anatomy, First Faculty of Medicine, Charles University, Prague. The fetal microscopic specimen is a part of the Doskočil's collection belonging to the same institution. These fetal models were prepared between the 1960s and 1970s in compliance with respective effective norms. The authors sincerely thank those who donated their bodies to science so that anatomical research could be performed. Results from such research can potentially increase mankind's overall knowledge that would improve patient care. Therefore, these donors and their families deserve our highest gratitude. Informed consent was obtained from the patients included in the photographs. All of the authors of this article have reported no disclosers.
Abstract
Plantar fascia (PF) lesions, such as plantar fasciitis, PF tear, and plantar fibromatosis (Ledderhose disease), are among the common causes of heel pain. The management of these lesions includes conservative treatments, minimally invasive treatments, and surgical interventions. When conservative treatments fail, minimally invasive injection therapies have been proposed as alternatives for managing PF lesions. Despite the availability of various injectable options, where and how to perform the injection is still controversial in the pertinent literature. In this article, considering the paramount role of ultrasound imaging in the diagnosis, interventions, and follow-up for PF pathologies, we demonstrated our sonographic approach to PF lesions for sonographers/physicians in daily clinical practice.
Open Research
Data Availability Statement
Data sharing not applicable to this article as no datasets were generated or analysed during the current study.
Supporting Information
| Filename | Description |
|---|---|
| jum16694-sup-0001-Video1.mp4MPEG-4 video, 1.2 MB | Supplemental Video S1 Focal injury involving the deep fibers of the plantar fascia (longitudinal view). |
| jum16694-sup-0002-Video2.mp4MPEG-4 video, 261.8 KB | Supplemental Video S2 In some cases, the hypoechoic thickening and hypervascularization may selectively involve the superficial fibers of the plantar fascia. |
| jum16694-sup-0003-Video3.mp4MPEG-4 video, 4.8 MB | Supplemental Video S3 During the in-plane medial to lateral approach, the injectate (arrow) is being given deep to the plantar fascia (dashed lines) under short-axis ultrasound imaging. HFP: heel fat pad, FDB: flexor digitorum brevis muscle, Cal: calcaneus; arrowhead, needle. |
| jum16694-sup-0004-Video4.mp4MPEG-4 video, 6.3 MB | Supplemental Video S4 Real-time ultrasound guidance during injection into the nodule. Plantar fibromatosis (dashed lines), injection material (arrow). The needle (arrowhead) is inserted using the direct in-plane technique. HFP: heel fat pad, FDB: flexor digitorum brevis muscle, Cal: calcaneus. |
| jum16694-sup-0005-Video5.mp4MPEG-4 video, 5.3 MB | Supplemental Video S5 During the in-plane medial to lateral approach, the injectate (arrow) is being given into the fascia under short-axis ultrasound imaging. Cal: calcaneus; dashed lines, plantar fascia; arrowhead, needle. |
| jum16694-sup-0006-Video6.mp4MPEG-4 video, 14.1 MB | Supplemental Video S6 During the in-plane proximal to distal approach, the injectate (arrows) is being given along the fascia under long-axis ultrasound imaging. Cal: calcaneus; arrowhead, needle. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
References
- 1Latt LD, Jaffe DE, Tang Y, Taljanovic MS. Evaluation and treatment of chronic plantar fasciitis. Foot Ankle Orthop 2020; 5:2473011419896763.
10.1177/2473011419896763 Google Scholar
- 2Gurcay E, Kara M, Karaahmet OZ, Ata AM, Onat ŞŞ, Özçakar L. Shall we inject superficial or deep to the plantar fascia? An ultrasound study of the treatment of chronic plantar fasciitis. J Foot Ankle Surg 2017; 56: 783–787.
- 3Meyers AL, Marquart MJ. Plantar fibromatosis. StatPearls. Treasure Island, FL: StatPearls Publishing; 2024.
- 4Özçakar L, Onat ŞŞ, Gürçay E, Kara M. Are blind injections ethical or historical?: Think twice with ultrasound. Am J Phys Med Rehabil 2016; 95: 158–160.
- 5Tsai WC, Hsu CC, Chen CP, Chen MJ, Yu TY, Chen YJ. Plantar fasciitis treated with local steroid injection: comparison between sonographic and palpation guidance. J Clin Ultrasound 2006; 34: 12–16.
- 6Standring S. Gray's Anatomy: The Anatomical Basis of Clinical Practice. 42nd ed. Amsterdam: Elsevier Health Sciences; 2020.
- 7Abreu MR, Chung CB, Mendes L, Mohana-Borges A, Trudell D, Resnick D. Plantar calcaneal enthesophytes: new observations regarding sites of origin based on radiographic, MR imaging, anatomic, and paleopathologic analysis. Skeletal Radiol 2003; 32: 13–21.
- 8Lui E. Systemic causes of heel pain. Clin Podiatr Med Surg 2010; 27: 431–441.
- 9Orchard J. Plantar fasciitis. BMJ 2012; 345:e6603.
- 10Özçakar L, Kara M, Chang KV, et al. EURO-MUSCULUS/USPRM. Basic scanning protocols for ankle and foot. Eur J Phys Rehabil Med 2015; 51: 647–653.
- 11 L Özçakar (ed). Plantar fascia-lower limb. Sonographic Atlas for Common Musculoskeletal Pathologies. Milan: Edi.Ermes; 2017: 426-441.
- 12McNally EG, Shetty S. Plantar fascia: imaging diagnosis and guided treatment. Semin Musculoskelet Radiol 2010; 14: 334–343.
- 13Guirao L. Periarticular and soft tissue injections – lower limb. In: L Özçakar (ed). Ultrasound Imaging and Guidance for Musculoskeletal Interventions in Physical and Rehabilitation Medicine. Milan: Edi.Ermes; 2020: 207-232.
- 14Williams R, Cleland T, Enriquez R, et al. Ultrasound-guided plantar fascia (perifascial) injection technique. Am J Phys Med Rehabil 2024; 103:e187.
- 15Ruiz Santiago F, Moraleda Cabrera B, Láinez Ramos-Bossini AJ. Ultrasound guided injections in ankle and foot. J Ultrasound 2024; 27: 153–159.
- 16Cortés-Pérez I, Moreno-Montilla L, Ibáñez-Vera AJ, Díaz-Fernández Á, Obrero-Gaitán E, Lomas-Vega R. Efficacy of extracorporeal shockwave therapy, compared to corticosteroid injections, on pain, plantar fascia thickness and foot function in patients with plantar fasciitis: a systematic review and meta-analysis. Clin Rehabil 2024; 38: 1023–1043.
- 17Freire V, Bureau NJ. Injectable corticosteroids: take precautions and use caution. Semin Musculoskelet Radiol 2016; 20: 401–408.
- 18Wong MW, Tang YN, Fu SC, Lee KM, Chan KM. Triamcinolone suppresses human tenocyte cellular activity and collagen synthesis. Clin Orthop Relat Res 2004; 421: 277–281.
- 19Zuo A, Gao C, Jia Q, et al. Platelet-rich plasma versus corticosteroids in the treatment of plantar fasciitis: a systematic review and meta-analysis. Am J Phys Med Rehabil 2025 (in press). https://doi.org/10.1097/PHM.0000000000002677.
- 20Tsikopoulos K, Tsikopoulos A, Natsis K. Autologous whole blood or corticosteroid injections for the treatment of epicondylopathy and plantar fasciopathy? A systematic review and meta-analysis of randomized controlled trials. Phys Ther Sport 2016; 22: 114–122.
- 21Bildik C, Kaya O. Platelet-rich plasma vs autologous blood injection to treat plantar fasciitis: a prospective randomized, double-blinded, controlled trial. Foot Ankle Int 2022; 43: 1211–1218.
- 22Karakılıç GD, Aras M, Büyük F, Bakırcı EŞ. Prolotherapy versus phonophoresis and corticosteroid injections for the treatment of plantar fasciitis: a randomized, double-blind clinical trial. J Foot Ankle Surg 2023; 62: 922–927.
- 23Chutumstid T, Susantitaphong P, Koonalinthip N. Effectiveness of dextrose prolotherapy for the treatment of chronic plantar fasciitis: a systematic review and meta-analysis of randomized controlled trials. PM R 2023; 15: 380–391.
- 24Wei P, Bao R. Intra-articular mesenchymal stem cell injection for knee osteoarthritis: mechanisms and clinical evidence. Int J Mol Sci 2022; 24: 59.
- 25Acosta-Olivo C, Simental-Mendía LE, Vilchez-Cavazos F, Peña-Martínez VM, Elizondo-Rodíguez J, Simental-Mendía M. Clinical efficacy of botulinum toxin in the treatment of plantar fasciitis: a systematic review and meta-analysis of randomized controlled trials. Arch Phys Med Rehabil 2022; 103: 364–371.e2.
- 26Wearing SC, Smeathers JE, Urry SR, Hennig EM, Hills AP. The pathomechanics of plantar fasciitis. Sports Med 2006; 36: 585–611.
- 27Kaymak B, Kara M, Yağiz On A, Soylu AR, Özçakar L. Innervation zone targeted botulinum toxin injections. Eur J Phys Rehabil Med 2018; 54: 100–109.
- 28Kaymak B, Kara M, Abdulsalam AJ, Ricci V, Özçakar L. Optimizing botulinum toxin injections by minding the muscle architecture and its innervation zone: the “seeding” technique. Can J Neurol Sci 2025; 1–3 (in press). https://doi.org/10.1017/cjn.2024.336.
- 29Raeissadat SA, Nouri F, Darvish M, Esmaily H, Ghazihosseini P. Ultrasound-guided injection of high molecular weight hyaluronic acid versus corticosteroid in management of plantar fasciitis: a 24-week randomized clinical trial. J Pain Res 2020; 13: 109–121.
- 30Kumai T, Samoto N, Hasegawa A, et al. Short-term efficacy and safety of hyaluronic acid injection for plantar fasciopathy. Knee Surg Sports Traumatol Arthrosc 2018; 26: 903–911.
Citing Literature
