Abstract
Introduction
We compared ultrasound guided methylprednizolone-lidacaine infiltrations around inflammatory area of plantar aponeurosis with systematic use of NSAID'S. Also, we investigated the reliability of the sonographic criteria (a. swelling of aponeurosis more than 20% in comparison to the healthy foot, b. effusion around aponeurosis, c. calcium deposits) most used to identify plantar fasciitis in clinically suspicious patients.
Methods
A prospective randomised controlled clinical trial, including 28 patients (mean age: 47 years, range: 36–65 years, 85% females) with typical clinical symptoms of plantar fasciitis. All of these patients undertook a soft tissue ultrasonography of the plantar aponeurosis, without Doppler. Then, we randomly divided our sample in 2 groups, group A (14 patients) and group B (14 patients). In group A patients we performed an ultrasound guided injection –in transverse view- around the swollen part of aponeurosis, while we managed group B patients with per os NSAID's treatment (meloxicam 15 mg, once per day) for 2 weeks.
Results
From the 28 suspicious patients we found 20 (71.4%) matching at least in one of our sonographic criteria. Swelling in comparison to the contralateral foot was the most usual found on these patients (14/20: 70% of the -ultrasound positive- patients). In group A patients the mean visual analogue scale (VAS) 100/100 after 1 month reduced –from 69/100 prior to injection- to 34/100, while 6 patients (42.85%) declared free of symptoms and 4 had poor or no improvement. In group B patients, the mean VAS decline was 21/100 (from 66/100 prior to injection, to 45/100 1 month later), but only 1 patient reported pain free.
Conclusion
High frequency ultrasound of the foot is a good standing -but not excellent- diagnostic tool for plantar aponeurositis. Ultrasound guided methylprednisolone injections seems to have better short-term results than per os anti-inflammatory treatment on these patients.
