A Stepwise Endovascular Approach to the Treatment of Refractory Plantar Fasciitis

Objectives: To assess the feasibility, safety, and clinical effectiveness of a response-guided, stepwise endovascular treatment strategy for patients with refractory plantar fasciitis. Methods: This single-center retrospective study included consecutive patients with chronic plantar fasciitis refractory to conservative therapy who were treated between January and June 2025. All patients initially underwent ultrasound-guided direct puncture of the posterior tibial artery, followed by intra-arterial administration of imipenem/cilastatin as a temporary embolic agent. Clinical response was evaluated at 1 month using the visual analogue scale (VAS). Patients showing a <50% pain reduction were classified as non-responders and underwent second-line transcatheter arterial embolization (TAME) via transfemoral access, with selective embolization of pathological neovessels using bioresorbable microspheres. Technical success, pain outcomes, and procedure-related adverse events were assessed during follow-up for up to 6 months. Results: Twelve patients (13 treated feet) were included. First-line embolization was technically successful in all cases. At the 1-month follow-up, 6/13 feet (46.2%) demonstrated clinically meaningful pain reduction and required no further intervention. The remaining 7/13 feet (53.8%) underwent second-line TAME, which was technically successful in all cases and was associated with further pain reduction. Mean VAS scores decreased from 7.36 ± 1.12 at baseline to 1.37 ± 0.52 at 6 months. No major adverse events occurred; minor complications were self-limited. Conclusions: A stepwise endovascular treatment strategy for refractory plantar fasciitis appears feasible and safe, providing a high rate of symptom improvement while allowing procedural complexity to be escalated according to early clinical response.