CHICAGO — The combination of ultrasound-guided dry-needling and steroid injection was 95% effective in relieving the heel pain associated with plantar fasciitis in a study of 44 patients.
Within 2 to 3 weeks of treatment, symptoms disappeared completely 39 patients, initial worsening was followed by progressive disappearance of symptoms in 3 patients, and no response occured in 2 patients, Dr. Luca Maria Sconfienza reported at the annual meeting of the Radiological Society of North America.
The one-time outpatient procedure took about 15 minutes and required no time off work or in the hospital, said Dr. Sconfienza, a radiologist with the department of experimental medicine at Genova (Italy) University.
At 6 months' follow-up, 41 patients were “very satisfied,” 1 was “satisfied,” and 2 were “unsatisfied.” No adverse events or recurrences have been reported in the patients, whose plantar fasciitis was previously unresponsive to traditional medical therapy. The majority of patients were female (89%), and their mean age was 48 years.
There is no widely accepted treatment for plantar fasciitis, a common condition that results from thickening and inflammation of the plantar fascia and causes stabbing or burning pain. Many patients are treated with shock waves, but this painful approach typically requires three sessions with 14 days off between sessions, and its long-term effectiveness is not fully documented, Dr. Sconfienza told reporters at a press briefing during the meeting. At $450, shock wave therapy also costs five times the $90 price of the new combination therapy.
“There is less pain, less time, and less money” with combination therapy, Dr. Sconfienza said. In an interview, he added, “The procedure can be performed anywhere and by anyone who underwent a basic training in interventional ultrasound.”
The technique involves injecting a small amount of local anesthesia and, under ultrasound guidance, repeatedly inserting a needle into the plantar fascia and on the periostium. The technique produces a small amount of local bleeding. The needle is then retracted to reach the perifascial soft tissue, where a small amount of steroid (1 mL of triamcinolone acetonide 40 mg/mL) is injected. Ultrasound guidance allows the provider to avoid injecting the drugs directly into the plantar fascia, which could lead to a complete rupture, he said.
The steroid reduces inflammation in the plantar fascia, while the local bleeding takes advantage of growth enzymes in the platelets that promote tissue healing. “We allow nature to work for us. This could be useful for other pathologies like tennis elbow,” he said. Orthotic plantar support is strongly encouraged after treatment.
When asked if steroids or dry needling alone could produce similar results, Dr. Sconfienza acknowledged the lack of a control group in the study, but said previous experience has shown that steroids and dry needling are less effective when used as monotherapy. Future studies are needed to validate the findings, he said.
The investigators reported no conflicts of interest.
Ultrasound guidance ensures steroids are not injected into the plantar fascia. Radiological Society of North America