On Target with Steroid Medication--A Heel of a Deal
The most common cause of heel pain is proximal plantar fasciitis (PPF). PPF involves inflammation in the tissues where the arch connects to the heel bone. Up to 10% of runners have it at some point in their running careers. The pain usually gets better with rest, anti-inflammatory drugs, and ice treatments. When it doesn't, doctors may inject steroid medication into the sore spot under the heel.

These injections are not simple to do because it isn't always easy to feel exactly where to put the injection. This may mean the doctor has to do the injection more than once to get the medicine into the sore spot. Steroid medicine tends to make connective tissue become soft. In the heel, repeated injections can actually cause the tissue to tear. Injections may even hurt the fat pad that sits just under the heel. That's why it is especially important for the medicine to hit the sore spot.

For this study, doctors examined 14 patients with PPF. Their pain and swelling levels were measured before they got a steroid injection. Ultrasound images were used to guide the point of the needle into the heel. The patients' pain and swelling levels were then tested again two weeks later and at three months.

The results show that ultrasound can help the doctor guide the needle into the correct spot on the heel. Every one of the patients in the study had significantly less swelling and pain when they came back in for a recheck. None of them showed any signs of damage to the heel pad.

Ultrasounds are affordable, radiation-free, and easy to use. This study indicates that ultrasound technology helps doctors guide needle placement in patients with PPF. The study also indicated that ultrasound can effectively help track progress in patients with PPF.
Wen-Chung Tsai, et al. Treatment of Proximal Plantar Fasciitis With Ultrasound-Guided Steroid Injection. In Archives of Physical Medicine and Rehabilitation. October 2000. Vol. 81. No. 10. Pp. 1416-1421.