Superselective Embolization of Plantar Fasciitis with Resorbable Embolics: Technical Consideration and Outcomes

To assess plantar fasciitis embolization (PFE) outcomes using combined nonselective posterior tibial artery embolization and superselective embolization technique.

Patients refractory to conservative treatment who underwent PFE with resorbable embolics were retrospectively reviewed. The temporary embolic agent was injected nonselectively into 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 Foot and Ankle Disability Index (FADI) scores were collected at baseline, 1 month, 3 months, and 6 months. Radiographic findings, duration of symptoms, procedure-related parameters, and need for reintervention were evaluated. Multiple regression analysis was performed to identify factors associated with symptoms improvements.

Forty-one legs in 34 patients were treated. Median number of embolized arteries was 2 (range, 1-5 arteries) with median total intraprocedural embolizations of 3 times (range, 1-8 times). VAS (-2.4 points, P = .001) and FADI (22 points, P = .001) scores significantly improved at 1 month. At 1, 3, and 6 months, the proportions of patients with >20% improvements in FADI and VAS were 70%, 68.7%, and 91.6% and 57%, 76.4%, and 91.6%, respectively (P < .01). Treatment effects were maintained between time points of 1 and 6 months. FADI or VAS changes were no different if bony spur was present on radiograph (P = nonsignificant). At 6 months' follow-up, 5 legs (12%) required a repeat PFE. There were no major adverse events.

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