Fluoroscopically guided injections into the foot and ankle: Localization of the source of pain as a guide to treatment - Prospective study

PURPOSE: To determine the value of injections of local anesthetic and steroids in the foot and ankle in localizing the source of pain and their effect on clinical confidence and decision making. MATERIALS AND METHODS: In 47 patients, fluoroscopically guided injections of local anesthetic and steroid into the foot and ankle were performed in 106 intra- and extraarticular sites. Questionnaires were completed by the referring surgeon before and after injections to evaluate the level of confidence with regard to the source of pain for each site injected and the proposed treatment plan. RESULTS: Forty-three (91%) patients reported pain relief after injections. The level of confidence that the site injected was the source of pain increased in 68 (64%) sites, decreased in 19 (18%) sites, and remained unaltered in 19 (18%) sites (P < .01). The treatment plan was changed from nonsurgical initially to surgical in three (8%) of 36 patients and was changed from surgical to nonsurgical in three (27%) of II patients after injections. Of the remaining eight patients, treatment was altered in three (37%) as a result of pain relief after the injections. CONCLUSION Fluoroscopically guided injections of local anesthetic and steroid in the foot and ankle can improve clinical confidence with regard to the site of pain and may be valuable in clinical decision making and patient treatment.