Dry Needling vs Steroid Injections for Plantar Fasciitis Heel Pain

Dry Needling

Plantar fasciitis is a common chronic foot condition that often begins with heel pain that worsens over time, sometimes radiating to the foot arch. The condition involves inflammation and micro tearing of the plantar fascia, a strong band of ligamentous tissue that connects the heel to the toes along the bottom of the foot. Pain is often more pronounced upon waking, and tends to subside once the foot is warmed up. If left untreated, plantar fasciitis pain can become debilitating, making it difficult to walk or stand.

There are a number of treatment methods for plantar fasciitis, ranging from rest and over-the-counter pain medications, to steroid injections and surgery. However, over 90% of plantar fasciitis can be successfully resolved with conservative, non-invasive or minimally invasive treatment approaches.

Dry Needling vs Steroid Injections

Dry needling is becoming increasingly popular as a treatment option for plantar fasciitis. During the procedure, a thin sterile needle is gradually advanced and withdrawn into the pain trigger point of the heel. In a number of studies, patients have reported a gradual decrease in pain as a result of dry needling.

Corticosteroid injections are another common treatment approach for managing plantar fasciitis pain. In this method, steroids are injected directly into the trigger point site. However, while often effective in reducing pain in the short run, corticosteroid injections present some common complications, including fat-pad atrophy (shrinking), rupture of the plantar fascia, and injury to the lateral plantar nerve.

A Study Comparing Dry Needling to Steroid Injections

In a recent study, Rastegar et al. (2018) wanted to see if dry needling was as effective as corticosteroid injections for reducing plantar fasciitis heel pain. The research team randomly assigned 66 subjects with plantar fasciitis to either the steroid group or the dry needling group. The test subjects were all patients who did not respond well after three months of conservative treatment that included stretching, NSAIDs and use of orthotics.

Participants were followed up for 12 months, with data recorded at baseline, three weeks, six weeks, three months, six months and one year after treatment. The visual analog scale (VAS) was the instrument used for monitoring total perception of pain.

At three weeks after treatment, the corticosteroid injection group showed a rapid and significant reduction in pain, although the dry needling group also reported some less significant pain relief. At six months after treatment, pain reported by the dry needling group was similar to that of the steroid group, and at one year, pain levels of the steroid group had increased, while those of the dry needling group continued to decrease.

The study’s authors concluded that dry needling was superior to steroid injections over the long run for patients with plantar fasciitis pain, although steroids provided rapid short-term pain relief.

Plantar Fasciitis Pain Treatment at NYDNRehab

The foot pain specialists at NYDNRehab take a holistic approach to treatment, seeking not only to relieve pain, but to identify the exact cause and correct it. In addition to dry needling, we offer other conservative treatment methods for plantar fasciitis, including ESWT (extracorporeal shock wave therapy), gait analysis and retraining, stretching and strengthening exercises, and manual therapy. For the most comprehensive and up-to-date treatment for your plantar fasciitis pain, contact NYDNRehab in the heart of Manhattan, and let us help restore your feet to full pain-free function.


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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