Sonographically Guided Intratendinous Injections of Hyperosmolar Dextrose/Lidocaine: A Pilot Study for the Treatment of Chronic Plantar Fasciitis

Michael B Ryan ^1*, Anthony Wong ², Jean Gillies ³, Julia Wong ⁴ and Jack Taunton ⁵

¹ Experimental Medicine Program, University of British Columbia, Canada
² Department of Radiology, St. Paul's Hospital, Canada
³ Department of Rheumatology, St. Paul's Hospital, Canada
⁴ Department of Medicine, University of British Columbia, Canada
⁵ Division of Sports Medicine, Faculty of Medicine and School of Human Kinetics, Canada

^* To whom correspondence should be addressed. E-mail: mryan76{at}gmail.com.

Accepted 30 September 2008

Abstract

Objective: To report on the effectiveness of sonographically guided injections of hyperosmolar dextrose at reducing the pain associated with chronic plantar fasciitis.

Design: Case series.

Setting: Ultrasound division of St Paul's Hospital.

Patients: Twenty referrals (3 men, 17 women; age 51 "b 13 years) from local sports medicine primary care practitioners who had failed previous conservative treatments.

Interventions: A 27-gauge needle administered a 25% dextrose/Lidocaine solution under sonographic guidance at 6-week intervals returning for a median of three consultations.

Main Outcome Measures: Visual analog scale (VAS) items for pain levels at rest (VAS1), activities of daily living (VAS2), and during or after physical activity (VAS3) were recorded at baseline and at the final treatment consultation (post-test). A telephone interview conducted an average of 11.8 months after the post-test provided a measure of long-term follow-up.

Results: Sixteen patients reported a good to excellent outcome, while the symptoms in four patients were unchanged. There was a significant decrease in all mean VAS items from pre-test to post-test: VAS1 (36.8 ± 25.6 - 10.3 ± 10.9), VAS2 (74.7 ± 20.8 - 25.0 ± 27.7) and VAS3 (91.6 ± 9.2 - 38.7 ± 35.1) and there were no apparent changes after the follow-up interview.

Conclusions: Sonographically guided dextrose injections showed a good clinical response in patients with chronic plantar fasciitis insofar as reducing pain during rest and activity. Further studies including a control group are needed to validate these outcomes.