Dry Needling vs Steroid Injections for Plantar Fasciitis Heel Pain

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 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 During the procedure, a thin sterile needle is gradually advanced and withdrawn into the pain trigger point of the heel.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.

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.