Cone-Beam CT (CBCT)-Guided versus Non-CBCT Transarterial Micro-Embolization for Refractory Plantar Fasciitis: A Prospective Comparative Study

Purpose: To compare clinical outcomes and safety between cone-beam CT (CBCT)-guided and non-CBCT transarterial micro-embolization (TAME) for refractory plantar fasciitis.

Materials and Methods: In a single-center prospective cohort, adults with chronic plantar fasciitis refractory to conservative care underwent TAME with superselective embolization using fast soluble gelfoam(KIPZA). Hypervascular targets were identified with DSA with or without CBCT guidance. All patients underwent pre-procedural foot/ankle MRI. Patients were grouped into CBCT-guided and non-CBCT. The primary endpoints were technical success and safety (procedure-related complications). The secondary endpoint was clinical response at 1 month, defined as ≥50% reduction in VAS from baseline. Group comparisons used Fisher’s exact test.

Results: A total of 14 procedures were analyzed (CBCT: 6 patients/7 procedures; non-CBCT: 7 patients/7 procedures). Technical success was 100% in both groups (7/7 vs 7/7; p=1.000), and no procedure-related complications occurred in either group (0/7 vs 0/7; p=1.000). At 1 month, the secondary endpoint (≥50% VAS reduction) was achieved by 85.7% (6/7) with CBCT, compared with 28.6% (2/7) without CBCT (p = 0.103, two-sided Fisher’s exact test). Mean VAS improved from 7.43 to 2.14 (Δ −5.29) with CBCT and from 7.86 to 4.86 (Δ −3.00) without CBCT.

Conclusion: CBCT-guided TAME showed a higher early pain response than non-CBCT TAME with comparable safety. Technical success was 100% in both groups. These findings support the adoption of CBCT guidance for TAME in refractory plantar fasciitis; larger, adequately powered studies are needed to confirm durability.