Inside access

Gill S, Hely R, Harrison B, et al. Transarterial Embolization to Improve Plantar Heel Pain: 6-Month Results from a Prospective Case Series. JVIR 2026;37.

 Tell us about you, your team, and your institution.

Steve Landers, MBBS: I am an interventional radiologist who previously worked at Barwon Medical Imaging University Geelong Hospital, where we conducted the research. I now work at Radius Imaging and St John of God Hospital as Director of Clinical Precision.

Our team is deliberately multidisciplinary:

• Lead author Stephen D. Gill, BPT Hons, PhD, a clinician-researcher and Senior Research Fellow at the Barwon Centre for Orthopaedic Research and Education (B-CORE) in the School of Medicine, Deakin University, and affiliated with Barwon Health/GIRADI Research Institute in Geelong, Victoria, Australia.
• Rachael Hely, a physiotherapist with Barwon Medical Imaging and the GIRADI Research Institute.
• Benjamin Harrison, MSD, an interventional radiolists with GIRADI Research Institute
•  Andrew Hely of the GIRADI Research Institute
•  Andrew Hely, a physiotherapist with the GIRADI Research Institute and Lake Imaging

The work was done at Barwon Health, a busy regional public health service where we look after a lot of patients with stubborn musculoskeletal problems. We’ve spent several years building experience with transcatheter arterial embolization, mainly for knee osteoarthritis, and this heel-pain pilot was a natural extension of that program.

Why did you pursue this topic?

Dr. Landers: Plantar heel pain is incredibly common, yet the long-term outlook is surprisingly poor and the usual treatments leave a lot of people stuck. When we looked at the literature, the evidence for any one intervention was equivocal, while the role of abnormal neovascularisation kept coming up in fasciopathy and other chronic tendon-bone problems. We already had encouraging safety and early outcome data with embolization in the knee, and the few published reports on heel pain were limited to tiny case series.

So, we asked a very practical question: could this minimally invasive, image-guided approach help the group of patients we see every week who have already failed months of orthotics, exercises, injections and shockwave? That’s why we ran the pilot.

What are the key takeaways from your research?

Dr. Landers: Seventy-one percent of our 24 participants with long-standing, treatment-resistant heel pain met responder criteria at six months. We saw large, clinically meaningful gains across the board—pain improved 70%, function in daily living and sport around 80–100%, and quality-of-life scores more than doubled on the FAOS. There were zero adverse events, technical success was 100%, and 83% of people said they would definitely recommend the procedure. Even the non-responders did not get worse. These are early, uncontrolled data, but for a group who had already tried everything else they were impressive numbers.

How might this research influence treatment, practice, or clinical processes in interventional radiology?

Dr. Landers: It suggests that embolization could become a useful second-line tool in the IR toolkit for patients with recalcitrant plantar heel pain once standard conservative care has been exhausted. The procedure is straightforward—30 to 60 minutes under light sedation, clear angiographic target (the typical “blush” at the fascia insertion), same-day discharge—and our patients tolerated it well. It expands the conversation about what IRs can offer beyond joints to include the fascia. At the same time, it reminds us to select patients carefully, discuss the small but real vascular risks, and continue to collect structured outcome data so we can refine the technique.

Was clinical response correlated with angiographic neovessel burden or specific “hot spot” targeting during TAE?

Dr. Landers: We didn’t analyze that formally in this pilot. Every patient had identifiable neovessels and we embolized until the blush disappeared; many commented that their usual heel pain was reproduced during the injection, which was interesting. Whether the amount of neovascularity or the precision of targeting predicts who responds best is a great question for the next study.

How did the authors account for natural symptom fluctuation or placebo effect given the non-randomized case series design?

Dr. Landers: We were very open about this being the biggest limitation. We tried to reduce the chance of natural recovery by only including people who had already had symptoms for a median of 1.5 years and had failed multiple proper treatments. We also tracked concomitant care and saw very little change—only four people started anything new and overall analgesia use dropped. Nobody got worse, even the non-responders.

Still, without a control arm we cannot claim causality. That’s exactly why we finish the paper calling for proper randomized trials.

Was technical success standardized, and could differences in embolic choice or endpoint affect outcomes across operators?

Dr. Landers: Yes, it was deliberately standardized. One experienced interventional radiologist performed every case using the same microcatheter, the same Imipenem/Cilastatin protocol we have used in our knee work, and the same angiographic endpoint (disappearance of the blush). All 24 procedures were technically successful. That said, we know other centers use different embolics and endpoints. So, operator experience, agent choice and how aggressively you embolize will almost certainly influence results across sites—another reason we need comparative studies.

Any next steps or plans for follow-up research?

Dr. Landers: We believe the next logical step is adequately powered randomized controlled trials comparing transarterial embolization head-to-head with corticosteroid injection—one of the most commonly used best-practice injection therapies that many of our patients had already tried without lasting benefit—or with a sham procedure. We also need longer follow-up, exploration of alternative embolic agents, and inclusion of more comprehensive outcomes such as the AOFAS score and imaging biomarkers. Ultimately, we want to know exactly where this technique fits in the treatment algorithm so we can offer the right patients the best chance of meaningful, lasting relief.