The role of ultrasonography in the diagnosis and management of idiopathic plantar fasciitis

Objective. To compare ultrasonography with bone scintigraphy in the diagnos is of plantar fasciitis and to compare ultrasound-guided injection with pal pation-guided injection in the management of idiopathic plantar fasciitis. Methods. Twenty-three patients with a clinical diagnosis of idiopathic plan tar fasciitis in 28 heels underwent ultrasonography and bone scintigraphy o f both heels at baseline. The patients were randomized to ultrasound- or pa lpation-guided injection of triamcinolone hexacetonide and xylocaine into t he plantar fascia. The 100 mm visual analogue scale (VAS) of pain, the heel tenderness index (HTI), and ultrasonography were performed at baseline and follow-up (mean=13.4 weeks). Results. The mean thickness (+/- standard error of the mean) of the plantar fascia, measured by ultrasonography, was 5.7 +/-0.3 mm in symptomatic heel s as compared with 3.8 +/-0.2 mm in asymptomatic heels (P <0.001). Ultrason ography findings correlated with bone scintigraphic findings in the diagnos is of plantar fasciitis (P <0.001). Fourteen heels were randomized to ultra sound-guided injection, 10 heels were randomized to palpation-guided inject ion and four heels were not injected. Ultrasound- and palpation-guided inje ction resulted in significant mean improvements in VAS [39.6 +/-9.2 (ultras ound) vs 41.5 +/-8 (palpation)] and HTI [1.35 +/-0.2 (ultrasound) vs 1.3 +/ -0.4 (palpation)]. There was no significant difference in the response rate following corticosteroid injection by either modality (ultrasound=13/14, p alpation=8/10). Following injection, the mean thickness of the plantar fasc ia decreased from 5.7 +/-0.3 mm to 4.65 +/-0.4 mm (P <0.01). Conclusion. Ultrasonography and bone scintigraphy are equally effective in the diagnosis of plantar fasciitis. Ultrasound-guided injection is effectiv e in the management of plantar fasciitis but is not more effective than pal pation-guided injection. Ultrasonography may be used as an objective measur e of response to treatment in plantar fasciitis.