From the Guidelines
Ultrasound-guided injection to the posterior tibialis muscle is the recommended approach for treating conditions like posterior tibial tendinopathy or muscle spasm, as it provides superior accuracy and reduces complications compared to blind injections. When performing the procedure, it is essential to position the patient prone or in lateral decubitus with the affected leg slightly flexed, and use a high-frequency linear transducer (7-15 MHz) to visualize the posterior tibialis muscle, which is located deep in the posterior compartment of the leg 1. The needle (typically 22-25 gauge, 1.5-2 inches long) should be inserted using an in-plane approach for optimal visualization, advancing slowly until reaching the target area. Aspiration should be performed before injection to avoid intravascular administration, and the medication, such as a mixture of corticosteroid (like methylprednisolone 40mg or triamcinolone 40mg) with local anesthetic (2-3ml of 1% lidocaine), should be injected slowly while observing distribution via ultrasound 1. Post-procedure, patients should rest the area for 24-48 hours, apply ice for pain, and gradually return to activities. Key benefits of this approach include improved outcomes, reduced complications, and cost-effectiveness, as demonstrated by the growing body of evidence supporting the clinical and economic value of ultrasound-assisted procedures 1. Some of the main advantages of using ultrasound guidance for vascular access and injections, as highlighted in the evidence, include reduced access time, lower risk of complications, and improved success rates 1. Overall, the use of ultrasound guidance for injections to the posterior tibialis muscle is a recommended approach that can lead to better patient outcomes and reduced healthcare costs.
From the Research
Ultrasound Guided Injection to Posterior Tibialis Muscle
- The use of ultrasound guidance for injections into the posterior tibialis muscle has been explored in various studies, including the use of botulinum toxin type-A (BoNT-A) injections for the treatment of spastic equinovarus foot deformity 2.
- A study published in 2021 investigated the ultrasonographic characteristics of three approaches for posterior tibialis muscle injection, including anterior, posteromedial, and posterior approaches, and found significant differences among the parameters of the three approaches 2.
- Another study published in 2023 assessed the safety and efficacy of ultrasound-guided corticosteroid injections into the posterior tibial tendon sheath for posterior tibialis tendinopathy, and found that the injection was a safe nonoperative treatment modality with variable efficacy 3.
Comparison of Injection Techniques
- A study published in 2020 compared the effectiveness of ultrasound-guided platelet-rich plasma (PRP) injections versus ultrasound-guided corticosteroid injections for the treatment of greater trochanteric pain syndrome, and found that PRP injections resulted in better and longer-lasting clinical results 4.
- A case report published in 2017 described the use of ultrasound-guided perineural injection with platelet-rich plasma for the treatment of carpal tunnel syndrome, and found significant improvements in electrophysiological parameters 5.
- A prospective, randomized, controlled study published in 2021 compared the efficacy and safety of ultrasound-guided transforaminal injections of PRP and steroid in patients with lumbar disc herniation, and found similar outcomes for both treatments 6.
Safety and Efficacy
- The studies suggest that ultrasound-guided injections into the posterior tibialis muscle and surrounding tissues are safe and effective treatment modalities for various conditions, including spastic equinovarus foot deformity, posterior tibialis tendinopathy, and greater trochanteric pain syndrome 2, 4, 3.
- The use of platelet-rich plasma (PRP) injections has been shown to be a safe and effective alternative to corticosteroid injections in some cases 4, 5, 6.