Objectives: To assess the reliability of the sonographic criterion perifascial edema to address the therapy of idiopathic plantar fasciitis with high resolution ultrasonography (HRUS) -guided mini-invasive treatments (steroid injection or extracorporeal shock wave therapy (ESWT)) with a follow-up of 12 weeks.
Methods: Over a period of 24 months, 139 patients with clinical diagnosis of unilateral, recalcitrant idiopathic plantar fasciitis, conservatively treated at least for 8 weeks, were submitted to HRUS. Pain was assessed with a visual analogue scale score. idiopathic plantar fasciitis was verified with HRUS and the presence of perifascial edema was assessed. Patients with sonographic idiopathic plantar fasciitis diagnosis were shared in two groups (1) with and (2) without perifascial edema; and than randomly in (A) ESWT and (B) steroid injection treatment subgroups. Clinical and HRUS follow-up were performed 12 weeks later.
Results: At HRUS idiopathic plantar fasciitis was observed in 86.33% of patients (68 women; mean age 54± 3.1 years) with a perifascial edema in 53.33% of cases. In patients with perifascial edema a clinical-sonographic improvement was observed, respectively, in 32% and 80% of cases of 1A and 1B subgroups, while in those of 2A and 2B subgroups, without perifascial edema, a clinical-sonographic improvement was observed, respectively, in 80% and 36% of cases.
Conclusions: In patients with idiopathic plantar fasciitis, perifascial edema seems to be a useful criterion to address the therapy to the HRUS-guided steroid injections treatment, while in cases without edema treatment could be address to ESWT.