Semin Musculoskelet Radiol 2022; 26(06): 744-754
DOI: 10.1055/s-0042-1760120
Review Article

Interventional Imaging Techniques as Alternative to Surgery of the Foot and Ankle

1   Department of Radiology, NYU Langone Orthopedic Center, Center for Musculoskeletal Care, New York, New York
,
William R. Walter
1   Department of Radiology, NYU Langone Orthopedic Center, Center for Musculoskeletal Care, New York, New York
,
Ronald S. Adler
1   Department of Radiology, NYU Langone Orthopedic Center, Center for Musculoskeletal Care, New York, New York
› Author Affiliations

Abstract

A variety of foot and ankle pathologies can impair patient's daily activities, ultimately requiring surgical management. However, with improvements in image-guided intervention, the joints, soft tissues, and osseous structures may be accessible using various percutaneous techniques as a potential alternative therapeutic tool, avoiding the need for surgery with its associated risks and morbidity. This article discusses the potential range of image-guided interventional treatments. Injections, aspiration, biopsies, cryoablation, and radiofrequency ablation are described. Newer novel treatments are also covered. Finally, the common pathologies of Morton's neuroma, Achilles tendinopathy, and plantar fasciitis are addressed.



Publication History

Article published online:
15 February 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Peterson CK, Buck F, Pfirrmann CW, Zanetti M, Hodler J. Fluoroscopically guided diagnostic and therapeutic injections into foot articulations: report of short-term patient responses and comparison of outcomes between various injection sites. AJR Am J Roentgenol 2011; 197 (04) 949-953
  • 2 Burke CJ, Adler RS. Ultrasound-guided percutaneous tendon treatments. AJR Am J Roentgenol 2016; 207 (03) 495-506
  • 3 Sconfienza LM, Adriaensen M, Albano D. et al. Clinical indications for image-guided interventional procedures in the musculoskeletal system: a Delphi-based consensus paper from the European Society of Musculoskeletal Radiology (ESSR)-part VII, nerves of the lower limb. Eur Radiol 2022; 32 (03) 1456-1464
  • 4 Stephens MB, Beutler AI, O'Connor FG. Musculoskeletal injections: a review of the evidence. Am Fam Physician 2008; 78 (08) 971-976
  • 5 Reach JS, Easley ME, Chuckpaiwong B, Nunley II JA. Accuracy of ultrasound guided injections in the foot and ankle. Foot Ankle Int 2009; 30 (03) 239-242
  • 6 Drakonaki EE, Allen GM, Watura R. Ultrasound-guided intervention in the ankle and foot. Br J Radiol 2016; 89 (1057): 20150577
  • 7 Fox MG, Wright PR, Alford B, Patrie JT, Anderson MW. Lateral mortise approach for therapeutic ankle injection: an alternative to the anteromedial approach. AJR Am J Roentgenol 2013; 200 (05) 1096-1100
  • 8 Hansford BG, Mills MK, Hanrahan CJ, Yablon CM. Pearls and pitfalls of fluoroscopic-guided foot and ankle injections: what the radiologist needs to know. Skeletal Radiol 2019; 48 (11) 1661-1674
  • 9 Walter WR, Burke CJ, Adler RS. Ultrasound-guided therapeutic injections for neural pathology about the foot and ankle: a 4 year retrospective review. Skeletal Radiol 2017; 46 (06) 795-803
  • 10 Stegeman M, van Ginneken BT, Boetes B, Tuinhout M, Louwerens JW, Swierstra BA. Can diagnostic injections predict the outcome in foot and ankle arthrodesis?. BMC Musculoskelet Disord 2014; 15: 11
  • 11 van Vendeloo SN, Ettema HB. Skin depigmentation along lymph vessels of the lower leg following local corticosteroid injection for interdigital neuroma. Foot Ankle Surg 2016; 22 (02) 139-141
  • 12 Vallone G, Vittorio T. Complete Achilles tendon rupture after local infiltration of corticosteroids in the treatment of deep retrocalcaneal bursitis. J Ultrasound 2014; 17 (02) 165-167
  • 13 Boesen AP, Hansen R, Boesen MI, Malliaras P, Langberg H. Effect of high-volume injection, platelet-rich plasma, and sham treatment in chronic midportion Achilles tendinopathy: a randomized double-blinded prospective study. Am J Sports Med 2017; 45 (09) 2034-2043
  • 14 Henning PR, Grear BJ. Platelet-rich plasma in the foot and ankle. Curr Rev Musculoskelet Med 2018; 11 (04) 616-623
  • 15 Yausep OE, Madhi I, Trigkilidas D. Platelet rich plasma for treatment of osteochondral lesions of the talus: a systematic review of clinical trials. J Orthop 2020; 18: 218-225
  • 16 Melick G, Hayman N, Landsman AS. Mesenchymal stem cell applications for joints in the foot and ankle. Clin Podiatr Med Surg 2018; 35 (03) 323-330
  • 17 Ilić N, Atkinson K. Manufacturing and use of human placenta-derived mesenchymal stromal cells for phase I clinical trials: establishment and evaluation of a protocol. Vojnosanit Pregl 2014; 71 (07) 651-659
  • 18 Goldberg AJ, Zaidi R, Brooking D. et al. Autologous stem cells in Achilles tendinopathy (ASCAT): protocol for a phase IIA, single-centre, proof-of-concept study. BMJ Open 2018; 8 (05) e021600
  • 19 Kakkos GA, Klontzas ME, Koltsakis E, Karantanas AH. US-guided high-volume injection for Achilles tendinopathy. J Ultrason 2021; 21 (85) e127-e133
  • 20 Malliaras P, Connell D, Boesen AP. et al. Efficacy of high-volume injections with and without corticosteroid compared with sham for Achilles tendinopathy: a protocol for a randomised controlled trial. BMJ Open Sport Exerc Med 2021; 7 (04) e001136
  • 21 Sofka CM, Adler RS, Ciavarra GA, Pavlov H. Ultrasound-guided interdigital neuroma injections: short-term clinical outcomes after a single percutaneous injection–preliminary results. HSS J 2007; 3 (01) 44-49
  • 22 Morath O, Kubosch EJ, Taeymans J. et al. The effect of sclerotherapy and prolotherapy on chronic painful Achilles tendinopathy—a systematic review including meta-analysis. Scand J Med Sci Sports 2018; 28 (01) 4-15
  • 23 Chang KV, Hsiao MY, Chen WS, Wang TG, Chien KL. Effectiveness of intra-articular hyaluronic acid for ankle osteoarthritis treatment: a systematic review and meta-analysis. Arch Phys Med Rehabil 2013; 94 (05) 951-960
  • 24 Jantzen C, Ebskov LB, Andersen KH, Benyahia M, Rasmussen PB, Johansen JK. The effect of a single hyaluronic acid injection in ankle arthritis: a prospective cohort study. J Foot Ankle Surg 2020; 59 (05) 961-963
  • 25 Berona K, Abdi A, Menchine M. et al. Success of ultrasound-guided versus landmark-guided arthrocentesis of hip, ankle, and wrist in a cadaver model. Am J Emerg Med 2017; 35 (02) 240-244
  • 26 Sinha MK, Mishra P, Mishra TS, Barman A. Aspiration and steroid injection in ganglion cysts: an ultrasound guided evaluation of the response. J Clin Orthop Trauma 2019; 10 (Suppl. 01) S252-S257
  • 27 Hughes P, Miranda R, Doyle AJ. MRI imaging of soft tissue tumours of the foot and ankle. Insights Imaging 2019; 10 (01) 60
  • 28 Mammarappallil JG, Seyler TM, Lenchik L, Wuertzer SD, Plate JF. Impact of fluoroscopically guided bone biopsy on antibiotic management of osteomyelitis in the lower extremity. J Surg Orthop Adv 2018; 27 (04) 277-280
  • 29 Said N, Chalian M, Fox MG, Nacey NC. Percutaneous image-guided bone biopsy of osteomyelitis in the foot and pelvis has a low impact on guiding antibiotics management: a retrospective analysis of 60 bone biopsies. Skeletal Radiol 2019; 48 (09) 1385-1391
  • 30 Friedman T, Richman D, Adler R. Sonographically guided cryoneurolysis: preliminary experience and clinical outcomes. J Ultrasound Med 2012; 31 (12) 2025-2034
  • 31 Burke CJ, Sanchez J, Walter WR, Beltran L, Adler R. Ultrasound-guided therapeutic injection and cryoablation of the medial plantar proper digital nerve (Joplin's nerve): sonographic findings, technique, and clinical outcomes. Acad Radiol 2020; 27 (04) 518-527
  • 32 Burke CJ, Adler RS. Tibial nerve block using an ultrasound-guided inframalleolar medial plantar nerve perineural injection: a technical Note. J Clin Ultrasound 2017; 45 (03) 134-137
  • 33 Cazzato RL, Garnon J, Ramamurthy N. et al. Percutaneous MR-guided cryoablation of Morton's neuroma: rationale and technical details after the first 20 patients. Cardiovasc Intervent Radiol 2016; 39 (10) 1491-1498
  • 34 Perini L, Perini C, Tagliapietra M. et al. Percutaneous alcohol injection under sonographic guidance in Morton's neuroma: follow-up in 220 treated lesions. Radiol Med (Torino) 2016; 121 (07) 597-604
  • 35 Jordan RW, Koç T, Chapman AW, Taylor HP. Osteoid osteoma of the foot and ankle–A systematic review. Foot Ankle Surg 2015; 21 (04) 228-234
  • 36 De Filippo M, Russo U, Papapietro VR. et al. Radiofrequency ablation of osteoid osteoma. Acta Biomed 2018; 89 (1-S): 175-185
  • 37 Lassalle L, Campagna R, Corcos G. et al. Therapeutic outcome of CT-guided radiofrequency ablation in patients with osteoid osteoma. Skeletal Radiol 2017; 46 (07) 949-956
  • 38 Tordjman M, Perronne L, Madelin G, Mali RD, Burke C. CT-guided radiofrequency ablation for osteoid osteomas: a systematic review. Eur Radiol 2020; 30 (11) 5952-5963
  • 39 Rehnitz C, Sprengel SD, Lehner B. et al. CT-guided radiofrequency ablation of osteoid osteoma and osteoblastoma: clinical success and long-term follow up in 77 patients. Eur J Radiol 2012; 81 (11) 3426-3434
  • 40 Izzo A, Zugaro L, Fascetti E, Bruno F, Zoccali C, Arrigoni F. Management of osteoblastoma and giant osteoid osteoma with percutaneous thermoablation techniques. J Clin Med 2021; 10 (24) 5717
  • 41 Xie C, Jeys L, James SL. Radiofrequency ablation of chondroblastoma: long-term clinical and imaging outcomes. Eur Radiol 2015; 25 (04) 1127-1134
  • 42 Kulkarni SS, Shetty NS, Gala KB. et al. Percutaneous radiofrequency ablation of appendicular skeleton chondroblastoma-an experience from a tertiary care cancer center. J Vasc Interv Radiol 2021; 32 (04) 504-509
  • 43 Cobianchi Bellisari F, Palumbo P, Masciocchi C, Zoccali C, Barile A, Arrigoni F. Needleless ablation of osteoid osteoma and osteoblastoma: the emergent role of MRgFUS. J Clin Med 2021; 11 (01) 128
  • 44 Vajapey S, Ghenbot S, Baria MR, Magnussen RA, Vasileff WK. Utility of percutaneous ultrasonic tenotomy for tendinopathies: a systematic review. Sports Health 2021; 13 (03) 258-264
  • 45 Shah A, Best AJ, Rennie WJ. Percutaneous ultrasound-guided TOPAZ radiofrequency coblation: a novel coaxial technique for the treatment of recalcitrant plantar fasciitis—our experience. J Ultrasound Med 2016; 35 (06) 1325-1331
  • 46 Bhatia M, Thomson L. Morton's neuroma. Current concepts review. J Clin Orthop Trauma 2020; 11 (03) 406-409
  • 47 Choi JY, Lee HI, Hong WH, Suh JS, Hur JW. Corticosteroid injection for Morton's interdigital neuroma: a systematic review. Clin Orthop Surg 2021; 13 (02) 266-277
  • 48 Klontzas ME, Koltsakis E, Kakkos GA, Karantanas AH. Ultrasound-guided treatment of Morton's neuroma. J Ultrason 2021; 21 (85) e134-e138
  • 49 Edwards RT, Yeo ST, Russell D. et al. Cost-effectiveness of steroid (methylprednisolone) injections versus anaesthetic alone for the treatment of Morton's neuroma: economic evaluation alongside a randomised controlled trial (MortISE trial). J Foot Ankle Res 2015; 8: 6
  • 50 Edwards SR, Fleming S, Landorf KB. Efficacy of a single corticosteroid injection for Morton's neuroma in adults: a systematic review. J Am Podiatr Med Assoc 2021; 111 (04) Article_13
  • 51 Saygi B, Yildirim Y, Saygi EK, Kara H, Esemenli T. Morton neuroma: comparative results of two conservative methods. Foot Ankle Int 2005; 26 (07) 556-559
  • 52 Matthews BG, Hurn SE, Harding MP, Henry RA, Ware RS. The effectiveness of non-surgical interventions for common plantar digital compressive neuropathy (Morton's neuroma): a systematic review and meta-analysis. J Foot Ankle Res 2019; 12: 12
  • 53 Gurdezi S, White T, Ramesh P. Alcohol injection for Morton's neuroma: a five-year follow-up. Foot Ankle Int 2013; 34 (08) 1064-1067
  • 54 Masala S, Cuzzolino A, Morini M, Raguso M, Fiori R. Ultrasound-guided percutaneous radiofrequency for the treatment of Morton's neuroma. Cardiovasc Intervent Radiol 2018; 41 (01) 137-144
  • 55 Maffulli N, Longo UG, Kadakia A, Spiezia F. Achilles tendinopathy. Foot Ankle Surg 2020; 26 (03) 240-249
  • 56 Chan O, O'Dowd D, Padhiar N. et al. High volume image guided injections in chronic Achilles tendinopathy. Disabil Rehabil 2008; 30 (20-22): 1697-1708
  • 57 Maffulli N, Spiezia F, Longo UG, Denaro V, Maffulli GD. High volume image guided injections for the management of chronic tendinopathy of the main body of the Achilles tendon. Phys Ther Sport 2013; 14 (03) 163-167
  • 58 Krogh TP, Ellingsen T, Christensen R, Jensen P, Fredberg U. Ultrasound-guided injection therapy of Achilles tendinopathy with platelet-rich plasma or saline: a randomized, blinded, placebo-controlled trial. Am J Sports Med 2016; 44 (08) 1990-1997
  • 59 Nauwelaers AK, Van Oost L, Peers K. Evidence for the use of PRP in chronic midsubstance Achilles tendinopathy: a systematic review with meta-analysis. Foot Ankle Surg 2021; 27 (05) 486-495
  • 60 Menz HB, Jordan KP, Roddy E, Croft PR. Characteristics of primary care consultations for musculoskeletal foot and ankle problems in the UK. Rheumatology (Oxford) 2010; 49 (07) 1391-1398
  • 61 Thomas MJ, Whittle R, Menz HB, Rathod-Mistry T, Marshall M, Roddy E. Plantar heel pain in middle-aged and older adults: population prevalence, associations with health status and lifestyle factors, and frequency of healthcare use. BMC Musculoskelet Disord 2019; 20 (01) 337
  • 62 Khurana A, Dhankhar V, Goel N, Gupta R, Goyal A. Comparison of midterm results of platelet rich plasma (PRP) versus steroid for plantar fasciitis: a randomized control trial of 118 patients. J Clin Orthop Trauma 2020; 13: 9-14
  • 63 Malahias MA, Cantiller EB, Kadu VV, Müller S. The clinical outcome of endoscopic plantar fascia release: a current concept review. Foot Ankle Surg 2020; 26 (01) 19-24