Outcome of Local Corticosteroid Injection by Ultrasound- versus Palpation-Guided Technique in Plantar Fasciitis

Background: Plantar fasciitis is a common cause of heel pain. Conservative treatment is often effective, but in many cases, invasive procedures may be required. Local corticosteroid injection is the most frequently used invasive technique and can be given under ultrasound (USG) or palpation guidance. We sought to compare the outcome of local corticosteroid injection by USG and palpation guidance in plantar fasciitis. Methods: This was a prospective randomized study of patients who presented with heel pain between July 2015 and November 2016 and were screened for plantar fasciitis by USG. Patients with confirmed plantar fasciitis were managed conservatively for 4 weeks. The 60 consecutive patients not responding to the conservative treatment were randomized into two groups. Group A (n = 30) received a corticosteroid injection under USG guidance. Group B (n = 30) received a corticosteroid injection under palpation guidance. Patients were followed up at 3 and 6 weeks. We compared the visual analog scale score, plantar fascia thickness, and heel pad thickness in both groups. Results: There was significant pain relief in both groups after 3 and 6 weeks of local corticosteroid injection, with greater relief noted in the USG-guided group. There was a significant decrement in plantar fascia thickness in both groups after 3 and 6 weeks; however, a greater decrement was observed in the USG-guided group. Neither group showed a significant difference in heel pad thickness after 3 and 6 weeks. Conclusions: Ultrasound-guided injection provided better pain relief and a greater reduction in plantar fascia thickness than palpation-guided injection.