Ultrasound-Guided Treatment Eliminates Heel Pain Caused by Plantar Fasciitis

Combining an ultrasound-guided technique with steroid injection is 95% effective at relieving the common and painful foot problem called plantar fasciitis, according to recent research.

"There is no widely accepted therapy or standard of care for patients when first-line treatments fail to relieve the pain of plantar fasciitis,” said the study's lead author, Luca M. Sconfienza, M.D., from the University of Genoa (Italy). "Our new technique is an effective, one-time outpatient procedure.”

Plantar fasciitis, the most common cause of heel pain, is an inflammation of the connective tissue called the plantar fascia that runs along the bottom of the foot, from the heel to the ball of the foot. The condition accounts for 11-15% of all foot symptoms requiring professional care and affects one million people annually in the United States. Conservative treatments, which may take up to a year to be effective, include rest, exercises to stretch the fascia, night splints and arch supports.

When the condition does not respond to conservative treatments, patients may chose shockwave therapy, in which sound waves are directed at the area of heel pain to stimulate healing. Shockwave therapy is painful, requires multiple treatments, and is not always effective. Complications may include bruising, swelling, pain, numbness or tingling, and rupture of the plantar fascia. In the most severe cases of plantar fasciitis, patients may undergo invasive surgery to detach the fascia from the heel bone.

For this study, Dr. Sconfienza and colleagues used a new ultrasound-guided technique, along with steroid injection, on 44 patients with plantar fasciitis that was unresponsive to conservative treatments. After injection of a small amount of anesthesia, the anesthetic needle is used to repeatedly puncture the site where the patient feels the pain. This technique is known as dry-needling.

Dry-needling creates a small amount of local bleeding that helps to heal the fasciitis. Lastly, a steroid is injected around the fascia to eliminate the inflammation and pain. The technique is performed with ultrasound guidance to improve accuracy and to avoid injecting the steroids directly into the plantar fascia, which could result in rupture. After the 15-minute procedure, symptoms disappeared for 42 of the study's 44 patients (95%) within three weeks.

"This therapy is quicker, easier, less painful, and less expensive than shockwave therapy,” Dr. Sconfienza said. "In cases of mild plantar fasciitis, patients should first try noninvasive solutions before any other treatments. But when pain becomes annoying and affects the activities of daily living, dry-needling with steroid injection is a viable option.”

The study's results were presented in December 2008 at the annual meeting of the Radiological Society of North America (RSNA), held in Chicago, IL, USA.

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