CHICAGO, Dec. 2 -- For patients with plantar fasciitis, a notoriously difficult condition to treat, an Italian team has come up with a novel approach that uses dry-needling combined with a steroid injection, researchers said here.
Dry needling creates a small amount of local bleeding that helps to heal the fascia, and the accompanying steroid injected into the perifascial soft tissue, rather than directly into the fascia, reduces inflammation, Luca M. Sconfienza, M.D., of the University of Genoa, said at the Radiological Society of North America meeting.
"It's a very good [method] because we allow nature to work for us," Dr. Sconfienza said. When bleeding is induced around the fascia, platelets respond, helping the tissue to heal spontaneously.
Action Points
- Explain to interested patients that this study found ultrasound-guided dry-needling of the fascia with a steroid injection of the perifascial soft tissues reduced pain for plantar fasciitis patients who were previously unresponsive to treatment.
- Note that this study was published as an abstract and presented orally at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
He said the combination treatment could be a good alternative to other remedies that have met with varying degrees of success for treating plantar fasciitis,
No widely accepted therapy for the disease has been established, the researchers said. Shockwaves, which send sound waves through the heel, is expensive and painful, Dr. Sconfienza said, and its long-term efficacy has not been established.
Other more conservative treatments, such as stretching in the morning, weight loss, and NSAIDS, are frequently used as well. Surgery is a last resort.
To assess the efficacy of dry needling and steroids, the researchers conducted a study of 44 patients ages 35 to 80 who were unresponsive to previous therapy.
Each patient received a local anesthetic before dry-needling guided by ultrasound was performed on the insertional portion of the plantar fascia and the periosteum to induce hyperemia. They then pulled the needle back into the perifascial soft tissues and injected 1 mL of triamcinolone acetonide 40 mg/mL to reduce inflammation. The entire procedure took about 15 minutes.
Of the 44 patients, who were followed for four to six months, 39 had a complete response two to three weeks after the treatment, Dr. Sconfienza said.
Three patients showed initial worsening in the first days of treatment followed by a progressive reduction and a disappearance of symptoms in about three weeks.
Only two patients didn't respond to therapy, Dr. Sconfienza said.
He estimated the cost of the therapy to be about $96, compared with shockwave treatment, which typically costs about $450.
"It's more effective in terms of time and cost than currently available treatments," Dr. Sconfienza said.
The study, however, had no control group, and Dr. Sconfienza said further research is needed, possibly comparing three groups: dry-needling alone, dry-needling with steroids, and no treatment.
"It's an interesting approach, but they should still try to try to repeat the study [with a control group]," commented Philip O. Alderson, M.D., of Saint Louis University, who moderated the session at which the study was presented and was not involved in the research. "However, there is still such a good amount of pain relief [shown in this study] and it should be looked at further."
Dr. Sconfienza said the treatment could potentially be used to treat tennis elbow as well.
The authors reported no disclosures. |