Orthopedics Book

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Local Corticosteroid Injection of Plantar Fascia

Aka: Local Corticosteroid Injection of Plantar Fascia, Plantar Fascia Injection
  1. Indications
    1. Avoid if possible (See Complications below)
    2. Plantar Fasciitis refractory to other measures
  2. Preparation
    1. Foot Xray prior to injection (rule-out tumor)
    2. Needle
      1. Gauge: 25-27
      2. Length: 1.5 inches
    3. Syringe: 5 ml
    4. Corticosteroid options
      1. Betamethasone (Celestone) 1 ml of 6 mg/ml
      2. Methylprednisolone (Depo-Medrol): 1 ml of 40 mg/ml
    5. Anesthetic
      1. Lidocaine 1%: 2 ml or
      2. Bupivacaine 0.25% or 0.5%: 2 ml
  3. Technique
    1. Patient position
      1. Lateral decubitus position with affected foot down
    2. Landmarks
      1. Distal longitudinal crease at medial sole
        1. Proximal base of longitudinal arch
      2. Level of medial process of calcaneal tuberosity
        1. Soft tissue slightly distal to Calcaneus
      3. Identify point of maximal tenderness and swelling
    3. Mark needle insertion site based on landmarks
    4. Sterilize local skin with Betadine or Hibiclens
    5. Insert needle at medial foot landmark
      1. Important: See precautions below
      2. Needle inserted perpendicular to skin
      3. Insert needle past midline of foot
      4. Inject preparation into middle third of foot width
    6. Patient lies supine for several minutes after procedure
      1. Distribute with passive foot range of motion
  4. Precautions
    1. Do not inject into fat pad at foot base
    2. Do not inject via base of foot
    3. Do not inject into tibial nerve
  5. Complications
    1. Fat pad atrophy
    2. Plantar fascia rupture (10% risk in one studies)
      1. Sellman (1994) Foot Ankle Int 15:376-81 [PubMed]
  6. Efficacy
    1. Improvement in >70% of cases (Ultrasound-guided)
      1. Kane (1998) Ann Rheum Dis 57:383-4 [PubMed]
  7. Follow-up Instructions
    1. No stress to foot for 2 weeks after injection
      1. Minimum time to strenuous activity: 48 hours
    2. Examine again in 3 weeks post-injection
    3. Consider Ultrasound guidance in refractory cases
      1. Kane (1998) Ann Rheum Dis 57:383-4 [PubMed]
  8. References
    1. Greene (2001) Musculoskeletal Care, AAOS, p. 491-2
    2. Tallia (2003) Am Fam Physician 68(7):1356-62 [PubMed]
    3. Young (2001) Am Fam Physician 63(3):467-78 [PubMed]

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