Super-Selective Embolization of Plantar Fasciitis with Resorbable Embolics: Technical consideration and Outcomes

To assess plantar fasciitis embolization (PFE) outcomes using combined non-selective posterior tibial artery embolization and super-selective embolization technique.

Patients refractory to conservative treatment who underwent PFE with resorbable embolics were retrospectively reviewed. The temporary embolic agent was injected non-selectively in the posterior tibial artery. If the blush persisted after 5 minutes, the calcaneal branches leading to the hyperemia, were selected and embolized. Embolic agent injection was repeated until disappearance of arterial blush. Visual analog scale (VAS) and FADI (Foot and Ankle Disability Index) scores were collected at baseline, 1, 3 and 6 months. Radiographic findings, duration of symptoms, procedure-related parameters, and need for re-intervention were evaluated. Multiple regression analysis was performed to identify factors associated with symptoms improvements.

41 legs in 34 patients were treated. Median number of embolized arteries were 2 (range 1-5 arteries) with median total intraprocedural embolizations of 3 times (range 1-8). VAS (-2.4 points, 0=0.001) and FADI (22 points, p=0.001) significantly improved at 1 month. At 1,3 and 6 months, patients with >20% FADI and VAS improvements were (70%, 68.7% and 91.6%) and (57%, 76.4%, and 91.6%), respectively (p<0.01). Treatment effects were maintained between 1- and 6-months' time points. FADI or VAS change were no different if bony spur was present on radiograph (p=NS). At 6 months follow-up, 5 legs (12%) required a repeat PFE. There were no major adverse events.

Plantar fasciitis embolization using this combined technique is effective and safe with maintained improvement in pain and function in short-term analysis.