Injection therapies for plantar fasciopathy ('plantar fasciitis'): a systematic review and network meta-analysis of 22 randomised controlled trials (original) (raw)
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Plantar fasciitis – to jab or to support? A systematic review of the current best evidence
Journal of Multidisciplinary Healthcare, 2011
Background: Plantar fasciitis is a common condition routinely managed by podiatrists in the community and is widely treated conservatively. Two commonly used treatments for plantar fasciitis are customized functional foot orthoses and corticosteroid injections. While common to clinical practice, the evidence base underpinning these treatment strategies is unknown. Therefore, the aim of this systematic review was to assess the effectiveness and safety of customized functional foot orthoses and corticosteroid injections in the treatment of plantar fasciitis. Methods: A systematic literature search was conducted. Experimental studies, in English, from 1998 to 2010 were accepted for inclusion in this review. The PEDro quality assessment tool and the National Health and Medical Research Council's hierarchy of evidence were used to assess the quality of the included studies. Results: Six randomized controlled trials which met the selection criteria were included in this review. Four reported on customized functional foot orthoses and 2 on corticosteroid injections. Current best available evidence highlights that both customized functional foot orthoses and corticosteroid injections can lead to a decrease in pain associated with plantar fasciitis. Additionally, customized functional foot orthoses may also provide an additional benefit in terms of increased functional ability in patients with plantar fasciitis. Corticosteroid injections may have side effects, especially pain (from the injection). Conclusion: Both customized functional foot orthoses and corticosteroid injections can lead to reduction in pain associated with plantar fasciitis. While customized functional foot orthoses may increase the functional outcomes in patients with plantar fasciitis, corticosteroid injections may have side effects (especially pain as a result of the injection), which may limit its acceptability.
2020
To assess the effect of physical therapy and corticosteroid injections injection on the intensity of pain in patients with plantar fasciitis and compare them to find the better option for first-line management and thereafter, to clarify and improve the management protocol of plantar fasciitis with the acceptable and simplest way. Conclusion: Long acting Corticosteroid injection has been sorted out as a better mode of treatment in comparison to physical therapy for short term symptomatic relief. Although more comparative studies on larger scales are needed for labeling the best option and producing a centralized guideline for the treatment of plantar fasciitis. Materials and Methodology: This is a randomized controlled trial conducted at the Department of Orthopaedics, Jinnah Post Graduate Medical Centre (JPMC), Karachi, Pakistan, from 1st January to 31st December 2017. Group A 50 participants underwent physical therapy and Group B 50 participants were given a single dose 80 mg Depomedrol (corticosteroid) injection deep under the planter fascia at planter fascia attachment on calcaneus. All patients were followed up two weeks, four weeks and at three months interval. Outcomes were assessed in terms of the mean visual analog scale (VAS) score, compared between the two treatment groups, first prior to treatment (baseline) and then after three months (final). Results: Out of a total of 100 patients, the mean age of patients was 41.83 ± 14.07 years. There were 62 males (53%) and 38 (47%) females. The mean duration of symptoms was 4.37 ± 4.81 weeks. Group A reported a mean VAS score of 3.62 ± 2.63 as compared to Group B reporting a mean score of 1.13 ± 1.24. A relatively greater improvement in final VAS (2.16 ± 1.97 from 7.51 ± 4.8) was observed in group A as compared to group B (2.97 ± 1.73 from 5.30 ± 4.7). Post rest Painful heel commonly denotes plantar fasciitis (PF) is a most frequently consulted symptom in Orthopaedic practice [1]. The "plantar fasciopathy" suites most to this condition than Fasciitis as none of the inflammatory changes and markers are found raised on ultrasound, histopathology or in blood tests respectively [2,3]. An increased basal metabolic index has commonly been associated with PF [2-4]. Habitual runners are more prone to developing the condition, but it can also occur in people with sedentary lifestyles and with recently putting on weight. 80% of cases improve within 12 months after the appropriate treatment [3]. It usually incepts by a strong tensile stretch in the fascia that is aggravated with repetitive activation and loading [5]. Flat foot deformity and post trauma ankle deformity are other causative factors.
Journal of Foot and Ankle Research, 2023
Background Prolotherapy is the injection of a small volume of sclerosing or irritant solutions into an injured tissue. We aimed to investigate the effect of dextrose prolotherapy (DPT) versus placebo/other non-surgical treatments on pain in chronic plantar fasciitis. Methods We searched seven electronic databases (PubMed/MEDLINE, Web of Science, EMBASE, Scopus, ProQuest, CENTRAL, PEDro) from inception to December 31, 2021 with no language restriction for publications comparing the effect of DPT with placebo/other non-surgical treatments in patients with chronic plantar fasciitis. Our primary outcome was pain and the secondary outcomes were foot function and plantar fascia thickness. The risk of bias was assessed using the Cochrane Collaboration's tool. Results Overall, eight studies with a total of 449 patients were included in the meta-analysis. All the included studies reported short-term pain. A large effect size (dppc2 =-0.97, 95% confidence interval [CI]-1.84 to-0.10) was observed favoring the use of DPT to reduce pain in patients with chronic plantar fasciitis in the short-term. The results for foot function improvement (dppc2 =-1.28, 95% CI-2.49 to-0.07) and plantar fascia thickness reduction (dppc2 =-1.02, 95% CI-1.99 to-0.05) in the short-term were also in favor of DPT. Conclusions Since almost all the included studies had high risk of bias and multiple trials lacked long-term followups, further high-quality research is required to determine the long-term effects of DPT vs placebo/other non-surgical interventions.
Pakistan Journal of Medical and Health Sciences, 2022
Objective: The purpose of this study is to determine the outcomes of corticosteroid injection in reducing the intensity of pain in patients with plantar fasciitis. Study Design: Descriptive study Place and Duration: Orthopaedic surgery department of Mardan Medical Complex, Mardan for the duration of 6 months fromJanuary 2021 to June 2021. Methods: Sixty patients of both genders with ages 20-70 years were presented in this study. Age, gender, and BMI were all recorded after informed written permission obtained from those who were volunteer to participate. Patients who met the inclusion criteria for plantar fasciitis were given a single intra-heel injection of triamcinolone, and they were followed up in the outpatient department at intervals of three, six and nine weeks. The effectiveness of the intervention was evaluated in terms of pain reduction as determined by the Visual analogue scale (VAS). The full data set was analyzed using the SPSS 24.0 edition. Results: In our study most o...
The real risks of steroid injection for plantar fasciitis, with a review of conservative therapies
Current Reviews in Musculoskeletal Medicine, 2008
This article presents a review of conservative therapies for plantar fasciitis pain reduction with a discussion of steroid therapy risks. The therapies reviewed include orthoses, stretching, extracorporeal shockwave, BTX-A, and corticosteroid injection/iontophoresis. These modes were included based on the availability of double blinded randomized controlled trials. We noted the following findings. Orthoses, regardless of type, can improve pain levels. Plantar stretching shows limited short-term benefit (1 month), but can reflect significant long-term improvement (10 months). Extracorporeal shockwave therapy shows equivocal benefit with some studies showing significant improvement and others showing none. Although BTX-A injections were the least studied, significant pain improvement was demonstrated in the short and long term. Steroid injection/iontophoresis showed significant improvement in the short term (1 month). Steroid therapy, when coupled with plantar stretching, can provide efficacious pain relief; however, steroid injections should be combined with ultrasound monitoring to reduce complications.
Conservative therapy for plantar fasciitis: a narrative review of randomized controlled trials
The Journal of the Canadian Chiropractic Association, 2006
A narrative literature review of RCTs only, was conducted to ascertain which conservative treatments provide the best results for plantar fasciitis patients. Stretching, prefabricated and custom-made orthotics and night splints have all been scrutinized in numerous studies with mixed results. Chiropractic manipulative therapy has been examined in one study, with favorable results. Therapeutic ultrasound and low intensity laser therapy have been examined in one study apiece with unsatisfactory results. Based on the trials reviewed a trial of therapy beginning with low-cost, patient-centered treatments is recommended, particularly stretching, over-the-counter orthotics, and patient education. Several (but not all) of the reviewed articles indicated that custom-made orthoses are more beneficial for plantar fasciitis than over-the-counter orthotics. In the event these treatments do not provide satisfactory results, use of night splints should be considered. Based on this review, there i...
Introduction Plantar fasciitis is a common cause of heel pain. Considering different interventions which are applied for patients with plantar fasciitis, dry needling is proposed as a new modality of treatment recently. The aim of this study is to evaluate the effectiveness of dry needling versus steroid injection for plantar fasciitis. Methods Sixty-six patients were recruited to this single-blind clinical trial study. Participants were randomly allocated to receive 1 ml (40 mg) of Depo-Medrol (meth-ylprednisolone acetate) or dry needling. They were followed up for 12 months and monitored for total perception of pain using the visual analogue scale (VAS), with data obtained in baseline and at three weeks, six weeks, three months, six months and one year after treatment. Results Mean VAS score before treatment was 6.96 ± 0.87 for the steroid group and 6.41 ± 0.83 for the dry-needling group (P value = 0.54). Steroid injection reduced VAS scores rapidly until three weeks after treatment compared with dry needling (0.32 ± 0.71 and 3.47 ± 1.32, respectively; P value < 0.001). However, patients who were underwent dry needling reported lower VAS scores at the end of follow-up compared with the steroid group (0.69 ± 0.93 and 2.09 ± 1.58, respectively ; P value = 0.004). Over the long term, 82.3% and 17.6% of changes in pain were contributed to time since treatment and treatment method, respectively (P values < 0.001). Conclusions Steroid injection can palliate plantar heel pain rapidly but dry needling can provide more satisfactory results for patients with plantar fasciitis in the long term.
Journal of Foot and Ankle Research, 2010
Background: Plantar fasciitis is the most commonly reported cause of chronic pain beneath the heel. Management of this condition commonly involves the use of corticosteroid injection in cases where less invasive treatments have failed. However, despite widespread use, only two randomised trials have tested the effect of this treatment in comparison to placebo. These trials currently offer the best available evidence by which to guide clinical practice, though both were limited by methodological issues such as insufficient statistical power. Therefore, the aim of this randomised trial is to compare the effect of ultrasound-guided corticosteroid injection versus placebo for treatment of plantar fasciitis.
Efficacy of Steroids Injection for The Treatment of Plantar Fasciitis
2015
Objective: To evaluated the effect of the steroid injection in the management of pain with plantar fasciitis patients. Methods: This descriptive case series study enrolled 56 patients with symptomatic plantar fasciitis to treatment with SI, aged ?18 years were selected from orthotics departments of HOPE Center, Pakistan from Mar 2013 to Dec 2013. All patients were assessed for patient history and pain relief at 1 and 6 months for pain relief after the initiation of steroid injection treatment. Results: Out of 56 patients; 38(67.85%) were male & 18(32.14%) were female. The mean age and BMI of the patients was 37.76±13.35 years and 28.32±1.52. Only 45/56(83.5%) got relieved after using treatment at one and six months follow–up, four patients became lost to follow up and five patients changed their initial treatment during the 6 month follow-up because did not experience relief. Results showed significant improvement in pain at four weeks was 42/51(82.35%) as compare to six month ...