A targeted, minimally invasive treatment for chronic, treatment-resistant tennis elbow and plantar fasciitis — blocking the abnormal blood vessels linked to persistent pain.
Chronic tennis elbow (lateral epicondylitis) and chronic plantar fasciitis are, despite their names, not thought to be primarily inflammatory conditions in their persistent, long-standing form — they're better understood as a failed healing response within the tendon or fascia, called tendinosis or fasciosis. In this chronic state, imaging often shows an increase in small, abnormal blood vessels growing into and around the damaged tissue, alongside accompanying small nerve fibres — a process called neovascularisation. This abnormal vessel growth is thought to be closely linked to the persistent pain, since these new vessels bring inflammatory signalling and pain-sensing nerve fibres directly into tissue that wouldn't normally be so richly supplied.
Transcatheter arterial embolization works on this specific finding: by selectively blocking these abnormal vessels — rather than the tendon's or fascia's normal blood supply — while sparing surrounding healthy tissue, the aim is to reduce this neovascularisation and, with it, the associated pain signalling, giving the tissue's own healing process a better chance to catch up.
Pain, reduced grip strength, and difficulty with daily activities present for several months or longer.
Persistent heel pain, particularly first-step-in-the-morning pain, unresponsive to standard care.
Physiotherapy, activity modification, orthotics, or standard injections tried over several months.
A small needle puncture is made at the wrist or ankle, well away from the painful area.
An angiogram identifies the abnormal, hypervascular pattern associated with the chronic pain.
Embolic material is injected selectively into the abnormal vessels.
The procedure takes about an hour; most patients go home the same day.
This treatment is aimed specifically at patients with chronic, refractory symptoms — not as a first-line treatment for new or mild tendon pain, which usually responds well to standard conservative care. Typical candidates include:
Chronic tennis elbow (lateral epicondylitis) or chronic golfer's elbow (medial epicondylitis) causing pain, reduced grip strength, and difficulty with daily activities, present for several months or longer.
Chronic plantar fasciitis causing persistent heel pain, particularly the classic first-step-in-the-morning pain, that hasn't settled with standard care.
Symptoms that have not responded adequately to a structured course of physiotherapy, activity and load modification, orthotics or bracing where relevant, and standard injections (such as corticosteroid or platelet-rich plasma), typically over a period of several months.
Patients looking to avoid, or who aren't good candidates for, open or arthroscopic surgical release, or who want to try a less invasive option first.
A careful clinical assessment, together with ultrasound (often using Doppler imaging to look specifically for the abnormal vessel pattern described above), helps confirm that a patient's case fits the profile most likely to benefit from this treatment.
Access: under local anaesthesia, a small needle puncture is made in an artery — usually at the wrist for elbow treatment, or at the ankle for foot treatment — well away from the painful area itself.
Mapping: a fine microcatheter is guided under X-ray (fluoroscopic) guidance into the small artery branches supplying the affected tendon or fascia, and an angiogram is used to identify the abnormal, hypervascular pattern associated with the chronic pain.
Embolization: a small amount of embolic material is injected selectively into these abnormal vessels, reducing blood flow to them while preserving normal circulation to the surrounding tissue.
Closure and recovery: the puncture site is closed with simple pressure, and the whole procedure typically takes about an hour. Most patients go home the same day.
Some mild, temporary soreness, bruising, or swelling at the treated area is common in the days immediately following the procedure and usually settles within a week or so.
This is a genuinely newer application of embolization compared with many other procedures on this site, and it's worth understanding that context. The technique — sometimes referred to in the literature as transarterial micro-embolization (TAME) — was developed and has been most extensively studied by interventional radiologists in Japan, with encouraging results from pilot studies and case series: reported improvements in validated pain and function scores, sustained over follow-up periods extending to a couple of years in some studies, without evidence of damage to the underlying bone or joint. Plantar fasciitis embolization has a shorter track record than the elbow application, drawing on a smaller but growing body of case series and early clinical experience.
As with any newer technique, this evidence base is still smaller than that supporting more established, decades-long treatments, and larger, controlled studies are ongoing to define exactly which patients benefit most and how durable the results are over the longer term. It's offered here as a reasonable option for appropriately selected patients with genuinely treatment-resistant symptoms, discussed openly as an evolving field rather than a guaranteed fix.
Because this treatment targets a specific vascular pattern rather than the tendon or fascia problem in general, its best results come from confirming that pattern is actually present, and from careful, selective catheter technique that treats the abnormal vessels without affecting the surrounding normal tissue. This depends on close coordination between the interventional radiology team and the referring orthopaedic, sports medicine, or physiotherapy team who has already worked through conservative treatment with the patient, so that embolization is offered at the right point in a patient's overall care — after appropriate conservative treatment, and as part of an honest conversation about what the current evidence can and can't yet promise.
No — it's considered only after a proper trial of conservative treatment, typically physiotherapy, activity modification, and standard injections over several months, hasn't given lasting relief.
Chronic tendinosis and fasciosis are associated with abnormal new blood vessel growth into the damaged tissue, which also carries pain-sensing nerve fibres. Selectively reducing blood flow to these abnormal vessels is thought to reduce this pain signalling and support the tissue's own healing.
It's done under local anaesthesia, so the procedure itself isn't painful. Mild soreness, bruising, or swelling at the treated area is common for a few days to about a week afterward, and most patients return to normal activity quickly.
It's an emerging technique, with encouraging results from pilot studies and case series — particularly for tennis elbow — but a smaller evidence base than long-established treatments. It's offered as an option for carefully selected patients with treatment-resistant symptoms, alongside an honest discussion of what's currently known.
No — physiotherapy and appropriate activity modification generally remain an important part of overall recovery and are usually continued alongside or after the procedure, rather than replaced by it.
Book a consultation with Dr. Giragani to discuss whether embolization is right for you.