Dry needling for plantar fasciitis

[AttackNME]

There are some patients who don't want steroid shots but still has need and need treatment beyond the usual orthotics and physical therapy. I don't have access to shockwave therapy where I work and am considering dry needling. There's a new rct out comparing dry needling to steroid shots with good 1 year follow-up and a systematic review showing that it reduces pain but needs larger trials. I was wondering if anyone here has anecdotally had success with this?

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[ldsrmdude]

There are some patients who don't want steroid shots but still has need and need treatment beyond the usual orthotics and physical therapy. I don't have access to shockwave therapy where I work and am considering dry needling. There's a new rct out comparing dry needling to steroid shots with good 1 year follow-up and a systematic review showing that it reduces pain but needs larger trials. I was wondering if anyone here has anecdotally had success with this?

I haven’t been the one doing it but my PT has been doing it and I’ve had fair, but not incredible, results. I’d say in my personal experience it’s probably 50/50. I don’t have ESWT either.

Edit to add that the ones who’ve had dry needling have possibly already not improved or had short-loved improvement with an injection. Haven’t used it as 1st or even 2nd line treatment yet.

 

[ExperiencedDPM]

There is an “art” to the procedure. There are some radiologists who are performing the procedure under ultrasound guidance. One of the authorities in this procedure is Lev Nazarian, MD at Jefferson University Hospital in Philadelphia. I’ve read many of his articles and have heard him lecture.

I would caution anyone without training to refer this out. It seems simple but there are a lot of nuances with the procedure in addition to a lot of post procedure pain.

 

[jehjr]

It’s been a while since I’ve done much reading in the topic, but my recollection is that there isn’t any literature comparing cortisone, prp, etc to saline or plain local. I am not certain why the needling would need to be dry. Seems me that a more appropriate control would actually inject something. The eswt literature says they are more effective without local, but I dont know of anything saying that heel injections are less effective with local.

 

[ExperiencedDPM]

It’s been a while since I’ve done much reading in the topic, but my recollection is that there isn’t any literature comparing cortisone, prp, etc to saline or plain local. I am not certain why the needling would need to be dry. Seems me that a more appropriate control would actually inject something. The eswt literature says they are more effective without local, but I dont know of anything saying that heel injections are less effective with local.

The needling is performed dry because it’s action is not the same as an injection.

ESWT and dry needling have similar mechanisms of action. They are used to help decrease fibrotic and scar tissue and to cause angiogenesis which ultimately results in converting a chronic condition into an acute condition. In essence it kick starts the healing process.

That’s why they usually don’t recommend using ice or NSAIDs following these procedures. You don’t want to inhibit the body’s natural response to heal.

Needling isn’t one “poke” but involves peppering the tissue with the needle to break up fibrosis and creating the angiogenesis that starts the cascade of healing.

 

[NatCh]

There are some patients who don't want steroid shots

Do you think it's the steroid they don't want or the needle stick that they don't want?

 

[ExperiencedDPM]

Do you think it's the steroid they don't want or the needle stick that they don't want?

Is this multiple choice?

 

[AttackNME]

Do you think it's the steroid they don't want or the needle stick that they don't want?

The steroids, these are the people who have had steroid shots before and had a poor experience with it, or are the people who don't want to take any medicine or have anything put into their bodies

 

[dtrack22]

or the needle stick that they don't want?

seems like dry needling would be a tough sell if that were the case...

 

[NatCh]

Is this multiple choice?

Ha, yeah really.

The steroids, these are the people who have had steroid shots before and had a poor experience with it, or are the people who don't want to take any medicine or have anything put into their bodies

I get a mix of those who don't want medicines and those who are afraid of the needle itself. Some of my runners simply want to be shown exercises so they can "work through the problem." It's a lot of counseling and emotional support (just let me fix it, okayyyy). I bought an EPAT machine for those who want to go the regenerative medicine route.

seems like dry needling would be a tough sell if that were the case...

Definitely. One could also do a Graston or ASTYM type scraping treatment plus strapping for a patient who wants neither anything invasive nor "unnatural."

 

[ExperiencedDPM]

seems like dry needling would be a tough sell if that were the case...

You obviously have to perform an ankle block before the needling treatment.

 

[dtrack22]

You obviously have to perform an ankle block before the needling treatment.

That also requires a needle stick...

 

[ExperiencedDPM]

That also requires a needle stick...

Thanks for that insightful comment. That wasn’t my point. There were comments regarding dry needling, and if you tell a patient that the procedure involves multiple needle sticks at the bottom of the heel, it certainly sounds brutal.

I’ve never met a patient who likes needles and of course the majority dislike or even fear needles. We all are competent in performing a tibial nerve block and that nerve block can be performed without much discomfort. It’s our job to educate our patients while addressing their fears and concerns. If you can assure a patient the initial nerve block does obviously require a needle, but that can be done with very little discomfort, the majority will agree to have the injection. Once things are numb, you can go to town with your dry needling.

It’s all about perception. Letting a patient know that you’re fully aware and sympathetic about their fear, but also helping them addesss that fear, may allow you to move forward for their benefit.

 

[NatCh]

If it’s on their right foot be ready to call a cab or Lyft so the patient can get home.

 

[ExperiencedDPM]

If it’s on their right foot be ready to call a cab or Lyft so the patient can get home.

You don’t offer luxury limo service in your office? You’re SO primitive.

 

[ExperiencedDPM]

Actually, that reminds me of a funny story. I finished hours and had to leave for an important meeting. Our office was locking up and my last patient was still sitting in the waiting room. Her ride never showed up and all the staff were walking out the door. I didn’t have time to wait for her ride to arrive or call a cab (Uber didn’t exist).

So I basically had to drive her home (I know all the reasons I shouldn’t have). She wasn’t a small woman and I had a two door, two seat sports car that sat very low. I had to basically use a shoehorn to get her in the passenger seat and getting her out of the seat was like reeling in a 400 pound tuna.

It was certainly an adventure, but I couldn’t just leave her standing outside our office. Fortunately, it was the first and last time I ever drove a patient home.

 

[NatCh]

You don’t offer luxury limo service in your office? You’re SO primitive.

We are country mice out here.

That's a funny story about having to drive your patient home in your sports car. I wonder what happened to her ride? We've had Dial-a-ride show up late but I've never had to take someone home myself. I walk to work half of the year so I wouldn't be much help anyway.

 

[ExperiencedDPM]

We are country mice out here.

That's a funny story about having to drive your patient home in your sports car. I wonder what happened to her ride? We've had Dial-a-ride show up late but I've never had to take someone home myself. I walk to work half of the year so I wouldn't be much help anyway.

I thought that in your neck of the woods you were still using Pony Express.

 

[NatCh]

I thought that in your neck of the woods you were still using Pony Express.

Telegraph has pretty much taken over.