I am not dry needling certified, so I have not tried it with patients. My biggest take away was the reduction in first step pain in the dry needling group vs the sham group. My first thought when I have a patient who has plantar fasciitis and their biggest compliant is first step pain in the morning, is to consider a night splint and change sleeping posture. Although I am not certified in DN, I will start to assess and address the soft tissue restrictions manually for a patient with first step pain – keeping in mind that it might take 4-6 weeks to see a significant change. I also think that DN would be a very valuable tool for someone coming out of a walking boot s/p ankle or foot injury, who then develop a new plantar fascia pain after coming out of the boot. I would think that the calf tissues are tight after immobilization and may also contribute to their plantar fascia pain. DN may be a quick intervention for this population.

I think the clinical factors that would drive my decision on choosing DN as an option would be if I were to make changes manually in pain/motion, but the effects were short lasting, or the manual intervention was taking too much of the treatment time. I would then consider asking another therapist at our clinic to dry needle that patient. There is not enough research to support DN for heel pain, but it may be the right intervention to help an individual who cannot completely eliminate the pain. For many of individuals who have had chronic plantar fasciitis, they have tried every orthotic, shoe, massage, stretch, tape, etc…I would think that most of them would be willing to try anything to help decrease their pain. I would also think that the patient would be more likely to buy in to DN if they were seeing positive results with manual trigger point massage. The limitations the authors state seem appropriate. The Pedro score was a 9/10 so I feel confident with their results. DN is a relatively new intervention for PT, so future CPG recommendations for this are not available.

After reading some of these articles posted, I feel like I have a better idea on how to layer treatment approaches for plantar fasciitis. I might start considering using DN, orthotics, and plantar fascia off-loading education for short term pain reduction early on in the plan of care followed up by long term stretching/strengthening/mobilization. Since this tissue can take a long time to heal for chronic cases, maybe our best bet is to decrease their pain in 6 weeks or so and get them on a 6-12-month self-management strengthening/stretching program. Just a thought, would love to hear other’s take on this.