Ultrasound-Guided Cortisone Injections for Plantar Fasciitis

Introduction

Plantar fasciitis is one of the most common causes of heel pain, affecting individuals of all ages, particularly those who engage in prolonged standing, walking, or high-impact activities. It is characterised by inflammation and degeneration of the plantar fascia, a thick band of connective tissue that runs along the bottom of the foot, connecting the heel bone (calcaneus) to the toes.

Plantar fasciitis often presents with sharp pain at the bottom of the heel, especially during the first steps in the morning or after prolonged periods of rest. While conservative treatments such as physiotherapy, orthotics, and stretching exercises are commonly used, some individuals experience persistent pain that affects mobility and quality of life.

For those with ongoing symptoms, ultrasound-guided cortisone injections may be considered to help manage inflammation and discomfort. This blog will explore the anatomy, pathology, causes, symptoms, diagnosis, and management of plantar fasciitis, with a focus on how cortisone injections may help in pain relief.

Anatomy of the Plantar Fascia

The plantar fascia is a thick, fibrous band of connective tissue that extends from the medial tubercle of the calcaneus (heel bone) to the metatarsal heads (ball of the foot). It plays a critical role in:

✔ Maintaining the arch of the foot.
✔ Absorbing shock during walking and running.
✔ Providing stability to the foot during weight-bearing activities.

The plantar fascia consists of three bands:

  1. Medial band — The most commonly affected portion in plantar fasciitis.
  2. Central band — The thickest and strongest part.
  3. Lateral band — The least involved in pathology.

Despite its strength and elasticity, excessive stress can lead to microtears, inflammation, and degeneration, resulting in heel pain and functional limitations.

Pathology of Plantar Fasciitis

Plantar fasciitis is primarily a degenerative condition, rather than a purely inflammatory one. Over time, repetitive stress and strain lead to microscopic damage, resulting in thickening and breakdown of the plantar fascia.

Key pathological changes include:
✔ Collagen disorganisation — The normal structure of the plantar fascia becomes disrupted.
✔ Neovascularisation — Increased formation of small blood vessels in response to tissue damage.
✔ Calcaneal spur formation — Bony outgrowths may develop at the heel due to chronic traction.
✔ Loss of elasticity — The plantar fascia becomes stiff and less flexible, leading to pain.

These changes can contribute to chronic heel pain, making daily activities such as walking, running, and standing difficult.

Causes of Plantar Fasciitis

1. Overuse and Repetitive Stress

  • Common in runners, athletes, and individuals who spend long hours on their feet.
  • Excessive strain can cause small tears in the plantar fascia, leading to pain and stiffness.

2. Poor Foot Biomechanics

  • Flat feet (pes planus) or high arches (pes cavus) can alter foot mechanics, increasing stress on the plantar fascia.
  • Abnormal gait patterns may contribute to uneven pressure distribution.

3. Improper Footwear

  • Wearing unsupportive shoes, such as flip-flops or high heels, can strain the plantar fascia.
  • Lack of proper arch support may lead to excessive pronation (inward rolling of the foot).

4. Tight Calf Muscles (Gastrocnemius Equinus)

  • Limited ankle dorsiflexion due to tight calf muscles increases tension on the plantar fascia.
  • Stiffness in the Achilles tendon can also contribute to excessive foot strain.

5. Increased Body Weight

  • Excess weight places additional stress on the plantar fascia, increasing the risk of chronic heel pain.

6. Age-Related Degeneration

  • Plantar fasciitis is more common in middle-aged and older adults due to reduced tissue elasticity and healing capacity.

Symptoms of Plantar Fasciitis

✔ Sharp, stabbing pain at the bottom of the heel, particularly with the first steps in the morning.
✔ Pain that worsens after long periods of standing, walking, or running.
✔ Tenderness along the medial side of the heel.
✔ Heel stiffness and discomfort after prolonged inactivity.
✔ Pain that improves with movement but worsens again with excessive activity.

Diagnosis of Plantar Fasciitis

Clinical Assessment at Alton Pain Clinic

A clinician will assess the condition through:
✔ History and symptom evaluation — Identifying pain patterns and risk factors.
✔ Physical examination — Palpation of the plantar fascia to locate tenderness.
✔ Windlass test — Stretching the plantar fascia to reproduce symptoms.

Imaging Studies

  1. Ultrasound Scan — Identifies thickening of the plantar fascia, increased vascularity, and structural changes.

Treatment Options for Plantar Fasciitis

Conservative Management

✔ Activity Modification — Reducing prolonged standing or high-impact activities.
✔ Stretching Exercises — Focusing on the plantar fascia and calf muscles.
✔ Orthotics and Supportive Footwear — Arch supports to improve foot biomechanics.
✔ Icing and Pain Relief — Using NSAIDs or cold therapy to manage discomfort.

Ultrasound-Guided Cortisone Injections for Plantar Fasciitis

For individuals with persistent heel pain, ultrasound-guided cortisone injections may be considered to reduce inflammation and discomfort.

Mechanism of Action of Cortisone Injections

Cortisone injections work by:
✔ Suppressing inflammation — Inhibiting pro-inflammatory cytokines to reduce pain.
✔ Decreasing swelling — Reducing tissue irritation in the affected area.
✔ Providing temporary pain relief — Allowing patients to continue rehabilitation.

Why Use Ultrasound Guidance?

At Alton Pain Clinic, ultrasound guidance ensures:
✔ Precise injection placement at the inflamed region of the plantar fascia.
✔ Minimisation of potential complications, such as fat pad atrophy.
✔ Improved accuracy, leading to better symptom management.

Procedure Overview

  1. Preparation — The clinician cleans the foot and applies a local anaesthetic.
  2. Ultrasound Guidance — Ensures accurate injection delivery near the plantar fascia.
  3. Cortisone Injection — The medication is administered under direct imaging.
  4. Post-Injection Care — Patients are advised to avoid excessive activity for a short period.

Why Choose Alton Pain Clinic for Plantar Fasciitis Treatment?

✔ Specialist clinicians experienced in musculoskeletal conditions.
✔ Advanced ultrasound-guided injection techniques for precision treatment.
✔ Personalised care tailored to individual needs.

Conclusion

Plantar fasciitis is a common and often debilitating condition that requires appropriate diagnosis and management to prevent chronic discomfort. Ultrasound-guided cortisone injections may provide pain relief, allowing individuals to engage in rehabilitation and regain mobility.

At Alton Pain Clinic, we offer expert musculoskeletal care to ensure precise and effective treatment for plantar fasciitis.

Comments

Post a Comment

Popular posts from this blog

Ultrasound-Guided Cortisone Injections for Iliopsoas Tendinopathy/Bursitis

Image
  Introduction Iliopsoas tendinopathy and iliopsoas bursitis are common causes of anterior hip pain, particularly in individuals who engage in repetitive hip flexion activities such as running, cycling, or dancing. These conditions can significantly impact mobility, causing discomfort during walking, climbing stairs, or even prolonged sitting. While conservative management often includes rest, physiotherapy, and anti-inflammatory medications, some individuals may experience persistent symptoms requiring targeted interventions.  Ultrasound-guided cortisone injections are an option for managing pain and inflammation associated with iliopsoas-related conditions. This blog explores the anatomy, pathology, symptoms, diagnosis, and treatment options for iliopsoas tendinopathy and bursitis, with a focus on the role of ultrasound-guided cortisone injections. Anatomy of the Iliopsoas Muscle and Bursa The iliopsoas is a deep muscle group consisting of the psoas major, psoas minor, a...
Read more

Ultrasound-Guided Cortisone Injections for Morton's Neuroma

Image
  Introduction Morton’s neuroma is a painful condition affecting the nerves in the forefoot , most commonly between the third and fourth toes. It occurs due to thickening or irritation of the interdigital nerve , leading to symptoms such as burning pain, numbness, and a sensation of walking on a pebble . This condition is often caused by repetitive stress, improper footwear, or biomechanical abnormalities . At Alton Pain Clinic , ultrasound-guided cortisone injections may be considered as a targeted approach for reducing inflammation and pain in Morton’s neuroma. This blog provides a detailed overview of Morton’s neuroma , including anatomy, pathology, causes, symptoms, diagnosis, and treatment options , with a focus on how cortisone injections work and their mechanism of action . Anatomy of the Foot and Morton’s Neuroma The foot is composed of bones, muscles, ligaments, and nerves that work together to provide support and mobility . Key Anatomical Structures Involved in M...
Read more

Ultrasound-Guided Cortisone Injections for Triangular Fibrocartilage Complex (TFCC)

Image
  The Triangular Fibrocartilage Complex (TFCC) plays a critical role in stabilising the wrist and enabling complex movements. Injuries or degeneration of the TFCC can lead to significant discomfort and functional limitations. At Alton Pain Clinic, we specialise in advanced treatments, including ultrasound-guided cortisone injections, to help manage conditions affecting the TFCC. This blog provides a comprehensive overview of TFCC, including its anatomy, pathology, and how cortisone injections may assist in symptom management. Introduction to the TFCC The TFCC is a network of cartilage and ligaments located on the ulnar side of the wrist, providing stability to the distal radioulnar joint (DRUJ) and acting as a cushion between the ulna and carpal bones. Damage to the TFCC, whether from trauma or degenerative changes, is a common cause of wrist pain. Anatomy of the TFCC The TFCC consists of several interconnected components: Articular Disc:  A fibrocartilaginous structure that c...
Read more