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 2–3 weeks of treatment, symptoms disappeared completely in 39 patients, initial worsening was followed by progressive disappearance of symptoms in 3 patients, and 2 patients had no response, Dr. Luca Maria Sconfienza reported at the annual meeting of the Radiological Society of North America.
The one-time outpatient procedure takes about 15 minutes and requires no time off work or in the hospital, said Dr. Sconfienza, a radiologist with the department of experimental medicine at Genova (Italy) University.
No adverse events or recurrences have been reported among the patients, whose plantar fasciitis was previously unresponsive to traditional medical therapy.
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, “Being so simple and cheap, 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 clinician 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,” he said. “This could be useful for other pathologies like tennis elbow.”
After the treatment, orthotic plantar support is strongly encouraged, said Dr. Sconfienza, who reported no conflicts of interest.
'There is less pain, less time, and less money' with combination therapy. DR. SCONFIENZA
Ultrasound guidance is used to improve accuracy and avoid injecting steroids directly into the plantar fascia, which could result in rupture. Radiological Society of North America