Ultrasound-Guided Plantar Fascia (Perifascial) Injection Technique

MATERIALS 21- to 30-gauge 1.5- to 2-inch needle for local anesthesia and injectate 12- to 18-MHz linear array transducer Local anesthetic, steroid, and/or other injectate Sterile ultrasound probe cover Sterile ultrasound gel Sterile gloves Chlorhexidine or other skin antiseptic 4 × 4 gauze Adhesive bandage PATIENT POSITIONING The patient is placed in a lateral recumbent position with the affected leg on the table, extended, with the foot in a neutral position and the medial surface facing upward. The unaffected leg remains flexed and out of the procedural field. With ergonomic considerations in mind, the provider is positioned inferior to the patient and the ultrasound screen should be in direct view across from the provider and in direct line with the clinician’s eye line. PROBE POSITIONING The ultrasound transducer is placed in the transverse plane providing a short-axis image of the plantar fascia. The ideal transducer position, and most common, is at the confluence of the plantar fascia insertion and the medial tubercule of the calcaneus. However, the clinician is to focus probe position on the region directly overlying area of fascial pathology. NEEDLE TECHNIQUE The needle is introduced and progressed using an in-plane, medial-to-lateral approach. The needle is introduced at a depth parallel to the calcaneal-fascial interface and is progressed toward the target of the peri-fascial hypoechoic space; located between the calcaneus and plantar fascia. PEARS AND PITFALLS Pathology generally affects the medial band of the plantar fascia, as such approaching from the lateral foot is ill-advised. In order to minimize the risk of heel fat pad atrophy, care is taken to avoid placing steroid injectate superficial to the plantar fascia. Additionally, avoid risk of fascial rupture care is taken to avoid placing steroid injectate within the plantar fascia proper. Video Legends Ultrasound-Guided Injection Video Series: Plantar Fascia Perifascial, https://links.lww.com/PHM/C604