By Ed Susman
CHICAGO -- December 1, 2009 -- A quick, minimally invasive dry-needling technique appears to provide lasting relief of foot pain caused by plantar fasciitis, according to a study reported here at the Radiological Society of North America (RSNA) 94th Annual Meeting.
"This therapy is quicker, easier, less painful, and less expensive than shockwave therapy," a painful treatment that requires at least 3 hospital visits and is used when conservative methods fail also, said Luca M. Sconfienza, MD, Department of Experimental Medicine, University of Genoa, Genoa, Italy.
The conservative methods -- use of insoles, weight loss, and foot exercises -- have proven less than satisfactory to patients with plantar fasciitis, mainly women aged >50 years, Dr. Sconfienza said in his oral presentation on December 1.
He estimated that >1 million people in the United States experience the discomfort of plantar fasciitis and that many of them have suffered for years until the acute pain becomes chronic and results in loss of work days and ability to perform regular activities of daily living.
In their study, Dr. Sconfienza and colleagues recruited 39 women and 5 men to undergo dry needling using ultrasound imaging. The needle is inserted subcutaneously through the heel until it reaches the fascia. Through the same needle a layer of anaesthesia is administered. The needle is then used without medication to make a series of punctures into the fascia.
The goal of needling is to cause some minor bleeding, Dr. Sconfienza said, which in turn recruits healing properties to the site, enhancing recovery. When the needling is complete, a layer of steroid is then administered to surround the fascia and control against inflammation.
"The dry needling performed on plantar fascia and on periostium produces a local hyperaemia that can be compared to a surgical debridement," he explained.
Following treatment, 39 (86.6%) of the patients achieved complete pain relief from plantar fasciitis within 2 to 3 weeks. Of the patients who did not achieve complete relief, 3 experienced an initial period of increased pain, which later diminished and then disappeared within the same 2 to 3 weeks. Another 2 patients showed no improvement, but Dr. Sconfienza said that they did not have any greater pain than before treatment.
There have been no recurrences of pain among those successfully treated patients for at least 6 months after the procedure.
"Our costs for this treatment amounted to about $96 [per patient]," he said. Shockwave therapy can cost upwards of $460.
[Presentation title: What's New in the Treatment of Plantar Fasciitis: A Percutaneous Ultrasound (US)-Guided Approach. Abstract SSA13-07]
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