Dry needling is an evidence-based methodology for successfully treating plantar fasciitis. During the procedure, a filament-thin non-medicated (dry) needle is slowly advanced into and withdrawn from pain-generating trigger points in the plantar fascia. The needling procedure causes a twitch response in targeted trigger points that immediately relaxes tightly contracted myofascial fibers.
Since no drugs are involved in dry needling, there are virtually no harmful side effects when administered by a trained and experienced clinician. Guidance by ultrasonography ensures that the needles hit their mark, with minimal discomfort for the patient.
Glucocorticoids (aka corticosteroids) are a group of drugs that mimic the hormone cortisol, with properties that are anti-inflammatory, immunosuppressive, anti-proliferative, and vaso-constrictive. When injected into the plantar fascia, they can temporarily relieve pain and reduce inflammation by blocking the body’s natural immune response.
Unlike dry needling, corticosteroid injections have a number of potentially harmful side effects, some of them serious:
Rupture of the plantar fascia
Steroid injections can cause the plantar fascia to rupture, leading to a serious disruption of the foot’s intrinsic windlass mechanism that plays a key role in locomotion. A rupture can promote further inflammation and pain in the foot’s long arch and lateral mid foot, causing long-term reduced mobility.
Heel fat pad atrophy (shrinkage)
Steroid injections can cause the fat pad that cushions the heel to shrink, subjecting the plantar fascia to further stress and more pain.
Lateral plantar nerve injury
The lateral plantar nerve is an important motor nerve in the foot that innervates the intrinsic muscles on the sole of the foot. Damage from corticosteroids can seriously injure the nerve and disrupt intrinsic foot muscle function.
Calcaneal osteomyelitis
Steroid injections can cause damage to the heel bone via an inflammatory process involving the bone and its structures that can lead to infection.
Harm to the hypothalamic-pituitary-adrenal (HPA) axis
Corticosteroids can exert negative feedback effects on the HPA axis, suppressing the secretion of key adrenal hormones and leading to functional adrenal atrophy that affects the entire organism.
Suppression of the immune system
Corticosteroids target a wide variety of immune cells, including T-lymphocytes, macrophages, fibroblasts, neutrophils, eosinophils, and basophils, thereby suppressing the immune system and inhibiting the healing process.
In addition to ultrasound guided dry needling for plantar fasciitis, NYDNRehab provides several holistic treatment alternatives, such as ESWT and PRP injections, along with foot rehabilitation physical therapy. Our treatment approaches are minimally invasive and highly effective, with low risk for negative side effects.
In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.
Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.
The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.
Dynamic ultrasonography examination demonstrating the full thickness tear and already occurring muscle atrophy due to misdiagnosis and not referring the patient to proper diagnostic workup
Demonstration of how very small muscle defect is made and revealed to be a complete tear with muscle contraction under diagnostic sonography (not possible with MRI)
Complete tear of rectus femoris with large hematoma (blood)
Separation of muscle ends due to tear elicited on dynamic sonography examination
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