"This therapy is quicker, easier, less painful, and less expensive than shockwave therapy."—Luca M. Sconfienza, MD
“This therapy is quicker, easier, less painful, and less expensive than shockwave therapy," said lead author Luca M. Sconfienza, MD, of the University of Genoa in Genoa, Italy, in a press release. Shockwave therapy requires 3 applications and is extremely painful. "In cases of mild plantar fasciitis, patients should first try noninvasive solutions before any other treatments, but when pain becomes annoying and affects the activities of daily living, dry-needling with steroid injection is a viable option.”Symptoms gone within 3 weeks in 95% of patients
After the 15-minute procedure, symptoms disappeared for 95% of 44 patients within 3 weeks. "There is no widely accepted therapy or standard of care for patients when first-line treatments fail to relieve the pain of plantar fasciitis," Dr. Sconfienza said. "Our new technique is an effective, one-time outpatient procedure."
The new study included 44 patients with clinical and ultrasound diagnosis of plantar fasciitis that was unresponsive to medical therapy. Two radiologists injected a small amount of local anesthetic and then performed a dry-needling on the insertional portion of the plantar fascia and on the periostium to help heal the fasciitis. The radiologists then retracted the needle to reach the perifascial soft tissues and injected 1 ml of triamcinolone acetonide. The technique is performed via ultrasound guidance to improve accuracy and avoid injecting the steroids directly into the plantar fascia. The radiologists suggested that patients wear an orthotic soft arch support to relieve the hind part of the foot following treatment.
Symptoms of plantar fasciitis disappeared in 39 of 44 patients after 2 to 3 weeks. There was, however, a worsening of symptoms in the days following treatment among 3 of 44 patients. This was followed by a progressive reduction and a disappearance of symptoms in about 3 weeks. There was no significant response to the therapy in 2 of 44 patients, the study showed.
Translating research into practice
“This already is standard care,“ said Cary M. Golub, DPM, FACFAS, a podiatrist in private practice in Long Beach, New York. “Our first line of treatment is injections. Whether or not they are guided by ultrasound is another story,” he told MSKreport.com. “This type of treatment is only effective if it’s coupled with supporting the arch,” he said. “We can give all the injections in the world and that will take away the inflammation, but we are still not treating the problem that caused the inflammation in the first place.”
Dr. Golub said that shockwave is an option for chronic plantar fasciitis, but it is “very expensive and insurance companies are not covering it, so I am doing very few.”
References
1. Sconfienza LM, Lacelli F, Serafini G, et al. What’s New in the Treatment of Plantar Fasciitis: A Percutaneous Ultrasound (US)-guided Approach. Presented at: Annual meeting of the Radiological Society of North America; November 30, 2008-December 5, 2008; Chicago, Ill. Presentation No. SSA13-07.
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