Abstract
Ultrasound (US)-guided corticosteroid injection has been shown to be safe and effective for varied causes of plantar fasciitis; however, its use for Achilles tendinitis is controversial. We studied the efficacy and changes in US findings at Achilles enthesitis after corticosteroid injection in patients with spondyloarthropathy (SpA). Patients with SpA with symptomatic Achilles enthesitis, refractory to 6 weeks of full-dose NSAIDs, were offered US-guided local corticosteroid injection. Injected entheses were examined by US (both B mode and power Doppler) at baseline and 6 weeks after injection. Standard OMERACT definitions were used to define enthesitis. Achilles tendon thickness >5.29 mm, 2 cm proximal to insertion in long axis, was considered thickened. Twenty-seven symptomatic Achilles tendons (in 18 patients) were injected with 20 mg methylprednisolone under US guidance baseline, and 6-week follow-up US features were compared. All patients reported improvement in pain (VAS) in the affected tendon after injection (p < 0.0001). Simultaneously, improvement in local inflammatory changes were noted, in the form of significant reduction in tendon thickness (p < 0.0001), vascularity (p < 0.0001), peritendinous oedema (p = 0.001), bursitis and bursal vascularity (p < 0.001 and < 0.0001, respectively). There was no change in bone erosions and enthesophyte. None of the patients had tendon rupture or other injection-related complications at 6 weeks of follow-up. US-guided local corticosteroid injection is an effective and safe modality for refractory Achilles enthesitis in patients with SpA and leads to reversion of acute changes at entheseal site.
References
D’Agostino MA, Olivieri I (2006) Enthesitis. Best Pract Res Clin Rheumatol 20(3):473–486
Song I-H, Hermann KG, Haibel H et al (2011) Effects of etanercept versus sulfasalazine in early axial spondyloarthritis on active inflammatory lesions. Ann Rheum Dis 70:590–596
Kayhan A, Gökay NS, Alpaslan R, Demirok M, Yılmaz I, Gökçe A (2011) Sonographically guided corticosteroid Injection for treatment of plantar fasciosis. J Ultrasound Med 30:509–515
Ferrero G, Fabbro E, Orlandi D et al (2012) Ultrasound-guided injection of platelet-rich plasma in chronic Achilles and patellar tendinopathy. J Ultrasound 15:260–266
Aydin SZ, Karadag O, Filippucci E et al (2010) Monitoring Achilles enthesitis in ankylosing spondylitis during TNF-α antagonist therapy: an ultrasound study. Rheumatology 49:578–582
Huang Z, Cao J, Li T, Zheng B, Wang M, Zheng R (2011) Efficacy and safety of ultrasound-guided local injections of etanercept into entheses of ankylosing spondylitis patients with refractory Achilles enthesitis. Clin Exp Rheumatol 29(4):642–649
Fredberg U, Ostgaard R (2009) Effect of ultrasound-guided, peritendinous injections of adalimumab and anakinra in chronic Achilles tendinopathy: a pilot study. Scand J Med Sci Sports 19:338–344
Tsai WC, Hsu CC, Chen CP, Chen MJ, Yu TY, Chen YJ (2006) Plantar fasciitis treated with local steroid injection: comparison between sonographic and palpation guidance. J Clin Ultrasound 34:12–16
McMillan AM, Landorf KB, Gilheany MF, Bird AR, Morrow AD, Menz HB (2012) Ultrasound guided corticosteroid injection for plantar fasciitis: randomised controlled trial. BMJ 344:e3260
Li Z, Xia C, Yu A, Qi B (2014) Ultrasound-versus palpation-guided injection of corticosteroid for plantar fasciitis: a meta-analysis. PLoS One 9(3):e92671
Yucel I, Yazıcı B, Degirmenci E, Erdogmus B, Dogan S (2009) Comparison of ultrasound-, palpation-, and scintigraphy-guided steroid injections in the treatment of plantar fasciitis. Arch Orthop Trauma Surg 129:695–701
Acevedo JI, Beksin JL (1998) Complications of plantar fascia rupture associated with corticosteroid injection. Foot Ankle Int 19:91–97
Kim C, Cashdollar MR, Mendicino RW, Catanzariti AR, Fuge L (2010) Incidence of plantar fascia ruptures following corticosteroid injection. Foot Ankle Spec 3:335–337
Brown AK, Machold KP, Conaghan PG, OMERACT 7 Special Interest Group (2005) Musculoskeletal ultrasound including definitions for ultrasonographic pathology. J Rheumatol 32:2485–2487
Aydın SZ, Filippucci E, Atagündüz P, Yavuz S, Grassi W, Direskeneli H (2014) Sonographic measurement of Achilles tendon thickness in seronegative spondyloarthropathies. Eur J Rheum 1:7–10. doi:10.5152/eurjrheum.2014.002
Doral M, Alamm M, Bozkurt M et al (2010) Functional anatomy of the Achilles tendon. Knee Surg Sports Traumatol Arthrosc 18:638–643
Kachlik D, Baca V, Cepelik M et al (2008) Clinical anatomy of the retrocalcaneal bursa. Surg Radiol Anat 30:347–353
Theobald P, Bydder G, Dent C, Nokes L, Pugh N, Benjamin M (2006) The functional anatomy of Kager’s fat pad in relation to retrocalcaneal problems and other hindfoot disorders. J Anat 208:91–97
Wong SM, Li E, Griffith JF (2001) Ultrasound guided injection of plantar fasciitis. Ann Rheum Dis 60:639
Genc H, Saracoglu M, Nacir B, Erdem HR, Kacar M (2005) Long-term ultrasonographic follow-up of plantar fasciitis patients treated with steroid injection. Joint Bone Spine 72:61–65
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflicts of interest.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the institutional ethics committee (IEC Code No. 2012-156-DM-EXP5).
Informed consent
Informed consent was obtained from all individual participants included in the study.
Rights and permissions
About this article
Cite this article
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 36, 875–880 (2016). https://doi.org/10.1007/s00296-016-3440-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00296-016-3440-4