Semin Musculoskelet Radiol 2023; 27(03): 351-366
DOI: 10.1055/s-0043-1766095
Review Article

Ultrasonography-guided Intervention in the Achilles Tendon and Plantar Fascia

Silvia Martin
1   Department of Radiology, Clínica Rotger, Palma de Mallorca, Spain
,
Javier Gomez Moriñigo
1   Department of Radiology, Clínica Rotger, Palma de Mallorca, Spain
› Author Affiliations

Abstract

Tendinopathy is very common in the foot and ankle. Achilles tendinopathy is a painful overuse injury that often occurs in athletes, especially those who participate in running and jumping sports. Plantar fasciitis is the most frequent cause of plantar pain in the adult heel. Initial treatment of these conditions is conservative. However, in some cases symptoms only improve slowly, and many cases are intractable. When conservative management fails, ultrasonography guided injections are indicated. We discuss the main interventions performed in the foot and ankle for Achilles tendinopathy, retrocalcaneal bursitis, and plantar fasciitis. We describe the different agents that can be used and the various ultrasonography-guided procedures that offer technical and practical information to improve daily clinical practice.



Publication History

Article published online:
25 May 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Silbernagel KG, Hanlon S, Sprague A. Current clinical concepts: conservative management of Achilles tendinopathy. J Athl Train 2020; 55 (05) 438-447
  • 2 Maffulli N, Khan KM, Puddu G. Overuse tendon conditions: time to change a confusing terminology. Arthroscopy 1998; 14 (08) 840-843
  • 3 Guillén Abellán JF. Terminologíay clasificación de las tendinopatías. Accessed February 28, 2023 at: http://femede.es/documentos/Terminol_Clasificacion_tendinopatias_XXJJTrauma.pdf
  • 4 Martinez S, Álvarez G, Álvarez I. Experto en ecografía musculoesquelética módulo 5 | Ecografía Del Miembro Inferior (II)
  • 5 de Vos RJ, van der Vlist AC, Zwerver J. et al. Dutch multidisciplinary guideline on Achilles tendinopathy. Br J Sports Med 2021; 55 (20) 1125-1134
  • 6 Alfredson H, Cook J. A treatment algorithm for managing Achilles tendinopathy: new treatment options. Br J Sports Med 2007; 41 (04) 211-216
  • 7 Rhim HC, Kim MS, Choi S, Tenforde AS. Comparative efficacy and tolerability of nonsurgical therapies for the treatment of midportion Achilles tendinopathy: a systematic review with network meta-analysis. Orthop J Sports Med 2020; 8 (07) 2325967120930567
  • 8 Sconfienza LM, Adriaensen M, Albano D. et al. Clinical indications for image-guided interventional procedures in the musculoskeletal system: a Delphi-based consensus paper from the European Society of Musculoskeletal Radiology (ESSR)—part VI, foot and ankle. Eur Radiol 2022; 32 (02) 1384-1394
  • 9 Boesen AP, Hansen R, Boesen MI, Malliaras P, Langberg H. Effect of high-volume injection, platelet-rich plasma, and sham treatment in chronic midportion achilles tendinopathy: a randomized double-blinded prospective study. Am J Sports Med 2017; 45 (09) 2034-2043
  • 10 Barker-Davies RM, Nicol A, McCurdie I. et al. Study protocol: a double blind randomised control trial of high volume image guided injections in Achilles and patellar tendinopathy in a young active population. BMC Musculoskelet Disord 2017; 18 (01) 204
  • 11 Humphrey J, Chan O, Crisp T. et al. The short-term effects of high volume image guided injections in resistant non-insertional Achilles tendinopathy. J Sci Med Sport 2010; 13 (03) 295-298
  • 12 Chan O, O'Dowd D, Padhiar N. et al. High volume image guided injections in chronic Achilles tendinopathy. Disabil Rehabil 2008; 30 (20–22): 1697-1708
  • 13 Housner JA, Jacobson JA, Misko R. Sonographically guided percutaneous needle tenotomy for the treatment of chronic tendinosis. J Ultrasound Med 2009; 28 (09) 1187-1192
  • 14 Lee KS, Wilson JJ, Rabago DP, Baer GS, Jacobson JA, Borrero CG. Musculoskeletal applications of platelet-rich plasma: fad or future?. AJR Am J Roentgenol 2011; 196 (03) 628-636
  • 15 Rha DW, Park GY, Kim YK, Kim MT, Lee SC. Comparison of the therapeutic effects of ultrasound-guided platelet-rich plasma injection and dry needling in rotator cuff disease: a randomized controlled trial. Clin Rehabil 2013; 27 (02) 113-122
  • 16 Wesner M, Defreitas T, Bredy H. et al. A pilot study evaluating the effectiveness of platelet-rich plasma therapy for treating degenerative tendinopathies: a randomized control trial with synchronous observational cohort. PLoS One 2016; 11 (02) e0147842
  • 17 Dohan Ehrenfest DM, Bielecki T, Mishra A. et al. Terminology in the field of platelet concentrates for surgical use. 2017; 13 (07) 1131-1137
  • 18 Mishra AK, Skrepnik NV, Edwards SG. et al. Efficacy of platelet-rich plasma for chronic tennis elbow: a double-blind, prospective, multicenter, randomized controlled trial of 230 patients. Am J Sports Med 2014; 42 (02) 463-471
  • 19 De La Mata J. Platelet rich plasma. A new treatment tool for the rheumatologist?. Reumatol Clin 2013; 9 (03) 166-171
  • 20 Scarpone M, Rabago D, Snell E. et al. Effectiveness of platelet-rich plasma injection for rotator cuff tendinopathy: a prospective open-label study. Glob Adv Health Med 2013; 2 (02) 26-31
  • 21 Doss A. Neotendon infilling of a full thickness rotator cuff foot print tear following ultrasound guided liquid platelet rich plasma injection and percutaneous tenotomy: favourable outcome up to one year. F1000 Res 2013; 2: 23
  • 22 Mautner K, Colberg RE, Malanga G. et al. Outcomes after ultrasound-guided platelet-rich plasma injections for chronic tendinopathy: a multicenter, retrospective review. PM R 2013; 5 (03) 169-175
  • 23 Tahririan MA, Moezi M, Motififard M, Nemati M, Nemati A. Ultrasound guided platelet-rich plasma injection for the treatment of rotator cuff tendinopathy. Adv Biomed Res 2016; 5 (01) 200
  • 24 Cai YU, Sun Z, Liao B, Song Z, Xiao T, Zhu P. Sodium hyaluronate and platelet-rich plasma for partial-thickness rotator cuff tears. Med Sci Sports Exerc 2019; 51 (02) 227-233
  • 25 Berná-Mestre JD, Fernández C, Carbonell G. et al. Influence of acromial morphologic characteristics and acromioclavicular arthrosis on the effect of platelet-rich plasma on partial tears of the supraspinatus tendon. AJR Am J Roentgenol 2020; 215 (04) 954-962
  • 26 de Vos RJ, Weir A, van Schie HTM. et al. Platelet-rich plasma injection for chronic Achilles tendinopathy: a randomized controlled trial. JAMA 2010; 303 (02) 144-149
  • 27 Srivastava P, Aggarwal A. Ultrasound-guided retro-calcaneal bursa corticosteroid injection for refractory Achilles tendinitis in patients with seronegative spondyloarthropathy: efficacy and follow-up study. Rheumatol Int 2016; 36 (06) 875-880
  • 28 Coombes BK, Bisset L, Vicenzino B. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Lancet 2010; 376 (9754): 1751-1767
  • 29 Drakonaki EE, Allen GM, Watura R. Ultrasound-guided intervention in the ankle and foot. Br J Radiol 2016; 89 (1057): 20150577
  • 30 Li Z, Xia C, Yu A, Qi B. Ultrasound- versus palpation-guided injection of corticosteroid for plantar fasciitis: a meta-analysis. PLoS One 2014; 9 (03) e92671
  • 31 Sirisena D. Ultrasound Guided Musculoskeletal Procedures in Sports Medicine. A Practical Atlas. Philadelphia, PA: Elsevier; 2021
  • 32 Harris CA, Peduto AJ. Achilles tendon imaging. Australas Radiol 2006; 50 (06) 513-525
  • 33 Szaro P, Nilsson-Helander K, Carmont M. MRI of the Achilles tendon—a comprehensive pictorial review. Part one. Eur J Radiol Open 2021; 8: 100342
  • 34 Messina C, Sconfienza LM. Ultrasound-guided percutaneous irrigation of calcific tendinopathy. Semin Musculoskelet Radiol 2016; 20 (05) 409-413
  • 35 Chaudhry FA. Effectiveness of dry needling and high-volume image-guided injection in the management of chronic mid-portion Achilles tendinopathy in adult population: a literature review. Eur J Orthop Surg Traumatol 2017; 27 (04) 441-448
  • 36 El Miedany Y. ed. Musculoskeletal Ultrasound-Guided Regenerative Medicine. Cham, Switzerland: Springer; 2022
  • 37 Wheeler PC, Mahadevan D, Bhatt R, Bhatia M. A comparison of two different high-volume image-guided injection procedures for patients with chronic noninsertional Achilles tendinopathy: a pragmatic retrospective cohort study. J Foot Ankle Surg 2016; 55 (05) 976-979
  • 38 McCormack HM, Horne Dde L, Sheather S. Clinical applications of visual analogue scales: a critical review. Psychol Med 1988; 18 (04) 1007-1019
  • 39 Robinson JM, Cook JL, Purdam C. et al; Victorian Institute Of Sport Tendon Study Group. The VISA-A questionnaire: a valid and reliable index of the clinical severity of Achilles tendinopathy. Br J Sports Med 2001; 35 (05) 335-341
  • 40 Wearing SC, Smeathers JE, Urry SR, Hennig EM, Hills AP. The pathomechanics of plantar fasciitis. Sports Med 2006; 36 (07) 585-611
  • 41 Lemont H, Ammirati KM, Usen N. Plantar fasciitis: a degenerative process (fasciosis) without inflammation. J Am Podiatr Med Assoc 2003; 93 (03) 234-237
  • 42 Schulhofer SD. Short-term benefits of ultrasound-guided corticosteroid injection in plantar fasciitis. Clin J Sport Med 2013; 23 (01) 83-84
  • 43 Chen CM, Chen JS, Tsai WC, Hsu HC, Chen KH, Lin CH. Effectiveness of device-assisted ultrasound-guided steroid injection for treating plantar fasciitis. Am J Phys Med Rehabil 2013; 92 (07) 597-605
  • 44 Johannsen FE, Herzog RB, Malmgaard-Clausen NM, Hoegberget-Kalisz M, Magnusson SP, Kjaer M. Corticosteroid injection is the best treatment in plantar fasciitis if combined with controlled training. Knee Surg Sports Traumatol Arthrosc 2019; 27 (01) 5-12
  • 45 Hurley ET, Shimozono Y, Hannon CP, Smyth NA, Murawski CD, Kennedy JG. Platelet-rich plasma versus corticosteroids for plantar fasciitis: a systematic review of randomized controlled trials. Orthop J Sports Med 2020; 8 (04) 2325967120915704
  • 46 Mohammed W, Farah S, Nassiri M, McKenna J. Therapeutic efficacy of platelet-rich plasma injection compared to corticosteroid injection in plantar fasciitis: A systematic review and meta-analysis. J Orthop 2020; 22: 124-134
  • 47 Alkhatib N, Salameh M, Ahmed AF. et al. Platelet-rich plasma versus corticosteroids in the treatment of chronic plantar fasciitis: a systematic review and meta-analysis of prospective comparative studies. J Foot Ankle Surg 2020; 59 (03) 546-552
  • 48 Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 1994; 15 (07) 349-353