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Kane et al reported four cases of ultrasound guided injection in recalcitrant idiopathic plantar fasciitis.1 We would like to report a different experience using a similar method.
Two patients with a clinical diagnosis of idiopathic plantar fasciitis, unresponsive to an initial palpation guided injection with 10 mg of triamcinolone acetonide, underwent ultrasound examination of the heel. Increased thickness of the plantar fascia near the calcaneal insertion was noted with both plantar fasciae measuring 7.5 mm in depth. Under real time ultrasound guidance, using a medial approach, the tip of a 21 gauge needle was positioned in the centre of the plantar fascia. However, on both occasions, considerable resistance was experienced on attempting to inject triamcinolone and lidocaine mixture into the centre of the plantar fascia. Injection was possible only by withdrawing the needle, under ultrasound guidance, to the edge of the plantar fascia where the injected solution was seen to disperse around the edge of the plantar fascia as shown in figs 1A and B. Both patients responded well to this treatment, being symptom free on review one month later.
Kane et al described injection directly into the substance of the plantar fascia with dispersal of the injection mixture into the substance of the fascia. Our experience suggests that it is difficult to inject into the substance of the plantar fascia. Rather, one may inject at the edge of the plantarfasciawith perifascial dispersal of steroid. This still appears to result in satisfactory alleviation of symptoms.
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