At the 94th Scientific Assembly and Annual Meeting of the Radiological Society of North America in December, Italian radiologists presented results from their study of a novel treatment for plantar fasciitis. Dr. Luca M. Sconfienza and his research team evaluated 44 patients with plantar fasciitis who were unresponsive to therapy. Each patient had a local anesthetic at the heel area and then application of a technique called dry needling. Dry needling is a technique involving ultrasound guided, repeated needle punctures to an area without the injection of any medication. The goal is to cause injury to a localized area to stimulate the healing response. An ultrasound guided steroid injection was given after the treatment and patients were given orthotics and followed for six months. After 3 weeks, 95% of the patients had complete resolution of their symptoms. These patients remained pain-free after 6 months.
Plantar fasciitis is the microscopic tearing and resultant inflammation of the plantar fascia, a long ligament type structure in the bottom of the foot which helps support the arch. Common treatments include rest, anti-inflammatory medications, stretching exercises, physical therapy, taping, supportive shoes, orthotics/inserts, night splints, shockwave therapy and surgery if conservative therapies have failed. Most individuals will respond to conservative therapies, but treatment periods can last for 6 to 12 months.
Dry needling is not a new procedure and steroid injections are a common treatment for heel pain, but the combination is a novel treatment and has encouraging initial results. Dry needling will cause additional trauma to the already injured plantar fascia. The plantar fascia has very low vascularity and causing localized inflammation at the point of injury will increase blood flow to the area. This may actually increase the healing process. By contrast, steroids decrease inflammation and work when inflammation becomes overwhelming and inhibits healing. Using both needling and a steroid injection is not necessarily an intuitive combination for the treatment of plantar fasciitis. Further studies will be needed to fully evaluate it’s effectiveness.
RSNA 2008: 94th Scientific Assembly and Annual Meeting of the Radiological Society of North America: Scientific Session A10-07. Presented November 30, 2008.
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