What to expect
At Issaquah Foot and Ankle Specialists, we have developed a treatment protocol and have fine tuned the technique for dry needling for plantar fasciitis. In addition, we have developed adjunctive treatments that help further ensure that chronic plantar fasciitis is resolved. Dr. Young has personally communicated with Dr. Lucia Sconfienza by e-mail soon after the results were first presented. He discussed details of the procedure to make certain that we were able to provide our patients with the best possible treatment and outcome.

Who is a candidate for dry needling
Those individuals who have already tried other means of treatment for plantar fasciitis including but not limited to prescription orthotics, excellent shoes, a night splint, cortisone injections, taping and bracing.

Diagnostic ultrasound imaging typically will show enlargement of the plantar fascia in those individuals with severe plantar fasciitis. The typical thickness of the plantar fascia at the heel is anywhere from 3 to 4 mm thick maximum.  Those individuals with chronic plantar fasciitis typically will be anywhere from 20% to even 100% thicker than normal. This means that the fascia can be 5 mm to 8 mm thick (even up to 10 mm in some severe cases). If an individual does not have significant swelling (edema) of the plantar fascia, then the prognosis for improvement with dry needling and many of the other traditional plantar fasciitis treatments tend to be less effective. In general, it is a severe case without swelling of the fascia and there are other significant causes of the heel pain instead of plantar fasciitis. 

Dry needling description

First, we utilize our electrical stimulation in conjunction with the local anesthetic to help minimize discomfort.  After the local anesthetic has fully taken effect, the procedure is done with no discomfort whatsoever.

High-resolution ultrasound guidance is used to direct the procedure, which allows for the precise finding of the exact location. A needle and syringe is used to repeatedly probe the fascia throughout the thickest portion at the calcaneal attachment site.  This probing can go all the way down to the attachment and periosteum (outer layer bone). Once this has been done for the prescribed time frame, then we typically utilize a combination of Kenalog and dexamethasone phosphate at the interface between the plantar fascia in the plantar fat pad. This is another example of where the ultrasound guidance is essential. Using this technique, we can make certain that the cortisone is not injected into the plantar fascia itself or the plantar fat pad. Injecting into the plantar fascia would raise the risk of a partial tear or rupture of the plantar fascia. In addition, injecting into the plantar fat pad can cause long-term thinning (atrophy) of the fat pad.

New treatment variations on this technique
This is where instead of using cortisone, we use autogenous platelet rich plasma with growth factor. It is also possible to do this procedure without using any cortisone.

Frequently ask questions
Is it safe?
Yes, dry needling is very safe.  There are few risks associated with the procedure and these risks are minimal compared to surgical risks.  A patient may experience an allergic reaction from the anesthesia and they do run a small risk of post-injection infection.  Some patients may have pain for a few days following the procedure as well. 

Is there any pain with the procedure?
No, a patient shouldn't experience any pain during the procedure.  We use a local anesthetic to numb the foot as well as electrical stimulation with our TENS unit to make sure the procedure is pain-free. 

How long have you been doing dry needling? 
Our clinic started providing the service in December of 2008. Our clinic has been providing high-resolution ultrasound guided injections for over 5 years.

Does my insurance cover this procedure? 
We accept many different insurance plans at our office.  This is something that our billing staff can help you with.

Post-procedure treatment protocol essentials:

• Avoid anti-inflammatory medication and icing
• Use a cast boot.  This is done to protect the soft tissue in the heel as it now starts the healing process.
• Allow for bruising and inflammation.  When you tear or sprain a tendon or ligaments, there is deep internal swelling or bruising that occurs due to the need to protect the tissue which allows for soft tissue healing phases to occur. The same should occur with this procedure.

What else can be done to help make sure this is effective:

• Use a night splint every night for the first 2-3 months.
• Prescription orthotics that are specific to your problem and to plantar fasciitis. You want to treat the mechanics that caused the problem to begin with.
• Electrical stimulation may be beneficial to the post-procedure healing time frame.

Contact us today for an appointment or to learn more.