Sonographic Assessment of Effectiveness of Ultrasound-guided Interventions for Soft-tissue Pain in Foot and Ankle

Abstract Background: Ultrasound (US)-guided interventional procedures are used to relieve soft-tissue pain in the foot and ankle. We evaluated the utility of US (including Doppler and elastography) in the response assessment of patients undergoing interventional procedures for soft-tissue pain in the foot and ankle. We also compared the imaging parameters with clinical scoring systems (Visual Analog Scale [VAS] score [rest pain] and American Orthopedic Foot and Ankle Society [AOFAS] [function] scores). Methods: Consecutive patients with treatable soft-tissue conditions of the foot and ankle underwent US-guided interventional procedures. The patients were followed up at the 1 st , 3 rd , and 6 th months after intervention for VAS (0–10) and AOFAS (0–100) scores and US (B mode, Doppler, and Elastography) parameters. Results: Forty-one patients were screened, of which 24 underwent US-guided procedures for 31 conditions. Group I (tendinopathies/plantar fasciitis) ( n = 20) showed significant short-and long-term improvements after tendon fenestrations (improvements of 45.7%, 56.2%, and 78.9%, respectively, in VAS [ P < 0.001] and 58.6%, 72.8%, and 97%, respectively, in AOFAS [ P < 0.001] at 1, 3, and 6 months follow-up). The volume of the abnormal hypoechoic region showed a significant reduction (48.8% and 77.3% at the 3 rd and 6 th months, respectively, P < 0.001) with an increase of elasticity value by 113%, 174%, and 236% at the 1 st , 3 rd , and 6 th months, respectively. There was a good correlation between changes in VAS and the volume of the hypoechoic area at first ( P = 0.02 and rho = 0.50), third ( P = 0.01 and rho = 0.58), and 6 th months ( P < 0.001 and rho = 0.77) follow-ups. In Group II (bursitis/ganglion) ( n = 7), there was significant improvement of VAS ( P < 0.05) and AOFAS ( P < 0.05) after 1, 3, and 6 months of steroid injection (46.2% and 59.8%, 62.5% and 82.2%, and 77.7% and 109%, respectively). On imaging, the volume of the bursa/ganglion showed a considerable reduction of 50.7% at the 1 st month postintervention ( P < 0.01). Conclusion: US-guided fenestration was effective in treating tendinopathies, while steroid injections were helpful in bursitis/ganglion cysts. US parameters significantly improved and correlated with the clinical response.