New Twist on Treatment of Foot Pain

MONDAY Dec. 1, 2008 -- Italian researchers say they've developed a fast, effective, non-invasive treatment for the painful foot condition known as plantar fasciitis.

Using a combination of "dry-needling" and steroid injections guided by ultrasound, the researchers say their approach achieved a 95 percent success rate in tackling a condition that afflicts about one million Americans every year and accounts for up to 15 percent of all foot problems.

"On a long-term basis, patients recover almost completely from their fasciitis" following the procedure, said study lead author Dr. Luca M. Sconfienza, from the University of Genoa department of experimental medicine. "Overall, the ultrasound guidance allows performing the procedure in total safety."

Sconfienza was to present the findings Monday at the Radiological Society of North America annual meeting, in Chicago.

Plantar fasciitis produces pain caused by stress placed on the bottom of the foot, which occurs when the plantar fascia -- a band of connective tissue running from the heel to the ball -- becomes inflamed. It can result from aerobic injury or even improper shoe support, and is the most common muscular-skeletal problem that foot doctors face in the United States, according to the American Academy of Podiatric Sports Medicine.

Non-surgical treatment is often effective, involving a combination of anti-inflammatory medication; foot rest; switching to shoes with improved arch support and orthotics; and physical therapy, according to the academy.

The study authors noted, however, that such a standard line of treatment may take up to a year to produce benefits, and doesn't help everyone. Patients can then try shockwave therapy, which involves multiple applications of sound waves directed at the affected area. This treatment is often painful and can lead to swelling, bruising, and numbness, however. The next option is surgery.

Searching for an alternative treatment, Sconfienza and his colleagues focused on 44 plantar fasciitis patients who had proven "unresponsive to medical therapy." Radiologists first applied a local anesthetic to the patients' affected heel area, and then repeatedly poked the region with a solid needle -- a procedure known as dry-needling -- to provoke more blood flow to the area.

A small amount of steroids was then injected into the same area, with ultrasound guidance used to improve accuracy and to avoid injecting the steroids into the plantar fascia, which could rupture the tissue. Following a single 15-minute treatment, orthotics were inserted into each patient's footwear to take pressure off the rear part of the foot.

The result: 42 of the 44 patients were cured of their symptoms within two to three weeks of treatment, the researchers said.

"As it is conceived, our procedure is new," said Sconfienza. "To our best knowledge, the combination of dry-needling and steroid has never been described. We think that this combination is the strength of the therapy, and being so simple and cheap, the procedure can be performed anywhere and by anyone who underwent a basic training in interventional ultrasound."

Dr. Johanna Youner, a New York City podiatrist and a member of the American Podiatric Medical Association, said that while the combination of steroids and dry-needling may be novel, the use of steroids itself is not.

"But what is interesting," she added, "is the notion of using dry-needling -- that is poking at the inflamed area repeatedly. This would increase the trauma to the area a little, and by doing that increase blood flow. That is not a traditional treatment. And it might seem counterintuitive. But when you increase inflammation and blood flow to an area you can help it heal faster. And the fascia itself is a ligament that does not have a lot of blood flow, so it heals slowly. So this could theoretically help."

More information

To learn more about plantar fasciitis, visit the American Academy of Orthopaedic Surgeons.

Posted: December 2008


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