Comparison of super selective transcatheter arterial embolization versus non-selective ultrasound guided embolization technique in plantar fascitis refractory to conservative management: an open-label pilot randomised controlled trial

Super-selective transcatheter arterial embolisation (TAE) is being established as a standard procedure in the pain management of musculoskeletal inflammatory conditions, particularly in patients who are refractory to conservative management. These conditions include knee osteoarthritis, frozen shoulder, and Achilles tendinopathy. The mechanism involves abnormal neo-vessel occlusion resulting from inflammation, leading to decreased inflammation.

However, evidence for TAE in plantar fascitis is limited to small observational studies and case reports. These studies describe two approaches: standard super-selective embolization and non-selective ultrasound-guided (USG) embolization, the latter involving the injection of a temporary embolic agent (imipenem/cilastatin) into the posterior tibial artery. Each method has distinct advantages and drawbacks. Super-selective embolization offers greater safety but is time-intensive and involves radiation exposure for both the patient and the operator. Conversely, non-selective USG-guided embolization requires fewer resources, such as microcatheters and digital subtraction angiography (DSA) equipment, but carries a minor theoretical risk of inadvertent embolization. The comparative efficacy of these techniques for pain relief in plantar fascitis remains inadequately explored due to a lack of robust comparative data.

This study is therefore designed to study the feasibility and compare the clinical outcomes of patients treated with super selective TAE versus Non-selective USG-guided embolization technique.