Plantar heel fascia injection is used to treat inflammation at the insertion of the long plantar ligament at the anterior aspect of the calcaneus, secondary to chronic overuse disorder or spondyloarthritides.
After informed consent is obtained, the patient is placed in the prone position with the feet extending over the end of the examination table. The plantar aspect of the heel is palpated in the area of the attachment of the plantar fascia to the calcaneus to determine the point of maximal tenderness. The patient is prepared in a standard aseptic fashion over an area large enough to allow palpation of landmarks, and sterile technique is used throughout the procedure. A 1½-in. (4-cm), 23- to 25-gauge needle is inserted at the point of maximum tenderness on the plantar surface of the heel, perpendicular to the skin. The needle is gently advanced until the tip touches the underlying bone and then is withdrawn 2 mm. After negative aspiration, a 2-mL mixture of 20 to 10 mg of triamcinolone acetonide (or equivalent) and local anesthetic is injected. If proper palpation of the point of maximal tenderness is difficult, one half of the mixture of local anesthetic and corticosteroid should be injected into the region of maximal tenderness and the remainder injected in a fanwise manner around the plantar fascia attachment (Fig. 67-58A).
FIGURE 67-58. Foot injections. A: Approach for plantar fasciitis or calcaneal bursitis injection. B: Approach for aspiration and injection of metatarsophalangeal joint.
This is a significantly painful procedure with or without cutaneous anesthesia. After injection, the patient is discouraged from excessive walking until the local anesthetic wears off and is encouraged to wear a heel cushion inside the shoe.
Serious complications are uncommon with appropriate needle placement.