Plantar Fascia Injection

Acute fasciitis

Causes and findings:
• Idiopathic, overuse, poor footwear
• Pain on medial aspect of heel pad on putting foot to ground in the morning
• Tender area over medial edge of origin of fascia from calcaneus

Equipment:
Syringe - 1ml
Needle - 21G 1.5-2 inches (40-50mm) green
Kenalog 40 - 20 mg
Lidocaine - 1.5 ml 2%
Total volume - 2 ml

Anatomy:
The plantar fascia, or long plantar ligament, arises from the medial and lateral tubercles on the inferior surface of the calcaneus. The lesion is always found
at the medial head and the area of irritation can be palpated by deep pressure with the thumb.

Technique:
• Patient lies prone with foot supported in dorsiflexion
• Identify tender area on heel
• Insert needle perpendicularly into medial side of soft part of sole just distal to heel pad. Advance at 45 ° towards calcaneus until it touches bone
• Pepper solution in two rows into fascia at its medial bony origin

Aftercare:
A heel support is used for at least 1 week after the injection, followed by intrinsic muscle exercise and stretching of the fascia. Standing on a golf ball to apply
deep friction can be helpful and orthotics can be applied. Taping can also be used.

Comments:
Although this would appear to be an extremely painful injection, this approach is much kinder than inserting the needle straight through the heel pad, and patients tolerate it well.