Early studies show approximately 50 – 65%% success rate for plantar fasciitis that has not responded to standard treatments
For stubborn plantar fasciitis that does not respond to standard therapy there is a fast, minimally invasive and inexpensive new treatment available to you in our Seattle clinic. Called Percutaneous Ultrasound Guided Approach to Plantar Fasciitis” or “dry needling”, it was developed by researchers at the Department of Experimental Medicine at the University of Genoa, Italy.
In a preliminary study that included 44 patients, researchers achieved a 95% success rate in completely resolving plantar fasciitis symptoms, relief that has so far lasted for more than ten months since the procedure. Newer studies have shown about 50-70% improvement.
While showing some promise for chronic heel pain, this is still a procedure with limited studies so far. There is much more evidence for the use of shockwave therapy for the treatment of chronic plantar fasciitis.
Dry Needling vs. Shockwave Therapy for Plantar Fasciitis
Based on currently available studies shockwave therapy is likely more effective than dry needling for chronic heel pain.
Shockwave, however, is not covered by insurance while dry needling is covered by most insurances (the total cost for shockwave is approximately $450). The insurance issue is frustrating as shockwave has much better outcome studies than does dry needling, but sometimes trying to find logic in insurance coverage decisions is a futile exercise.
The Procedure
The procedure has a terrible name – “dry needling” – but we make sure that it is painless for you. Here is how it works:
- We numb your foot with a local anesthetic. The procedure is not started until you are completely numb. We don’t want you to experience any pain at all.
- Using ultrasound imaging, we use an empty hypodermic needle to repeatedly puncture the plantar fascia. The ultrasound images allow us to precisely place the needle. Then, once again using the ultrasound imaging to ensure precise placement, we place a steroid at the site where you have been having pain.
How Does it Work to Treat Plantar Fasciitis?
The dry needling induces minor bleeding in the tissues. In addition, some researchers feel that it helps to break up scar tissue at the heel. The minor bleeding recruits blood cells to heal this tissue – which normally has rather poor circulation. Injecting the steroid, especially with the precise placement available with the use of ultrasound guidance, reduces inflammation and helps eliminate the risk of fascia rupture.
How Long Does the Procedure Take?
The entire procedure lasts about 15 minutes.
What Happens After the Procedure?
You might experience some tenderness in the foot. This is usually controlled with Tylenol or Advil. Following the procedure, we ask that you wear a removable walking cast-boot for 5 – 7 days. This simply gives the foot a chance to rest and start the healing process. After you finish with the cast, you should wear stable shoes with orthotics or arch supports for the next two weeks.
What are the Benefits of the Procedure?
- Studies show approximately 70% success
- Current studies show relief lasting at 10 months
- Relief within 2 – 3 weeks according to studies
- One-time treatment
- Performed in our office – no need for hospital
- Much less risk than surgery
- Covered by most insurances so less expensive than shockwave therapy
What are the Risks and Drawbacks of the Procedure?
- Less evidence for positive outcomes compared to shockwave therapy.
- Some patients have pain for several days following procedure
- Still a relatively new procedure, so long-term results unknown
- You will be wearing a walking boot for 2 weeks following the procedure
- Could lead to weakening of the plantar fascia and possible rupture. (However, long term inflammation from plantar fasciitis can cause the same problem).
- Small risk of post-injection infection
- Allergic reaction from the anesthesia
Don’t live with heel pain or arch pain. Call today to make an appointment in our convenient Seattle office.
We recently received some questions about this procedure from a patient who was considering dry needling for his plantar fasciitis. His questions and our answers are below.
We had a potential patient ask us some very good questions regarding the dry needling procedure that we use for chonic heel pain at the Seattle Heel Pain Center. He would be driving up from Portland to have the procedure done and wanted to see if he was a good candidate before making the trip. Here are his questions and our answers:
Q: I know the original study/experiment in Italy had success in 42 of 44 patients treated, what is the success rate that you have noted for your patients?
A: I haven’t kept stats, but so far I’ve been very happy with the outcomes. Let’s say about 70% success.
Q: I have read that one of the benefits to this treatment is that a return to normal activities is fairly quick. How long is the recovery period?
A: Keep in mind the that purpose of dry needling is to take a chronic problem and put it into an acute healing period. I put patients in a walking boot for 2 weeks after we do the procedure and then back into normal shoes. You can exercise, but I recommend against running for 3 months and jumping sports such as basketball for 6 months.
Q: I know everything is contingent on a physical examination, but would dry-needling an acceptable option for me despite not having a “super severe” case of PF even though it has been with me over one year in duration?
A: Whether you are a good candidate depends primarily on how thick your plantar fascia is. We will measure it using ultrasound. If it is not excessively thick, then you would not be a good candidate.
Q: What is the cost of the procedure?
A: We bill only for an exam, ultrasound guided injection and steroid injection. I can look tomorrow for exact cost, but I think it comes out to around $400. Most insurances cover the procedure as a ultrasound guided injection as you will receive a steroid injection following the procedure.
Q: In some cases I have heard of doctors injecting plasma/platelets, ala PRP injections instead of a steroid. Would there be any difference or benefit to either one?
A: We have looked at PRP but have seen no studies that make us think it is an effective treatment. The treatment for chronic heel pain with the best documented results is shockwave therapy. In fact, shockwave is likely more effective than dry needling. The downside is that it is not covered by insurance. Total cost for shockwave treatment is about $420.
If you have heel pain, contact us today for an appointment at the Seattle Heel Pain Center.
