Injection therapy for heel pain

NewsBot · Jul 26, 2006

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Comparison of Injection Modalities in the Treatment of Plantar Heel Pain: A
Randomized Controlled Trial
J Am Podiatr Med Assoc 96(4): 293–296, 2006

In a prospective randomized study of plantar heel pain, 44 patients were treated with injection of 1 mL of 2% prilocaine using the peppering technique, 1 mL of 2% prilocaine combined with 2 mL of autologous blood, or 1 mL of 2% prilocaine mixed with 40 mg of methylprednisolone acetate. At 6-month follow-up, clinical improvement was evaluated by using a 10-cm visual analog scale and the rearfoot score of the American Orthopaedic Foot and Ankle Society. Results were analyzed using sample t-tests within groups and repeated-measures analyses of variance between groups. Mean ± SD visual analog scale scores in the peppering technique, autologous blood injection, and corticosteroid injection groups improved from 6.4 ± 1.1, 7.6 ± 1.3, and 7.28 ± 1.2 to 2.0 ± 2.2 (P < .001), 2.4 ± 1.8 (P < .001), and 2.57 ± 2.9 (P < .001), respectively. Mean ± SD rearfoot scores in the same groups improved from 64.1 ± 15.1, 71.6 ± 1, and 65.7 ± 12.7 to 78.2 ± 12.4 (P = .018), 80.9 ± 13.9 (P = .025), and 80.07 ± 17.5 (P = .030), respectively. There were no statistically significant differences among the groups. Good outcomes have been documented using the peppering technique and autologous blood injection for the treatment of lateral epicondylitis. Although the curative mechanisms of both injection modalities are based on a hypothesis, they seem to be good alternatives to corticosteroid injection for the treatment of plantar heel pain.
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Admin2 · Jul 26, 2006

Related threads:
Cortisone injections (Australia)
Ibuprofin injection in Achilles tendinopathy
Injection therapy research studies
Botulinum toxin and plantar fasciitis
Plantar fasciitis treated with local steroid injection

NewsBot · Sep 21, 2007

Intralesional autologous blood injection compared to corticosteroid injection for treatment of chronic plantar fasciitis. A prospective, randomized, controlled trial.Lee TG, Ahmad TS.
Foot Ankle Int. 2007 Sep;28(9):984-90.

BACKGROUND: The response of chronic plantar fasciitis to any treatment is unpredictable. Autologous blood might provide cellular and humoral mediators to induce healing in areas of degeneration, the underlying pathology in plantar fasciitis. This study compared the efficacy of intralesional autologous blood with corticosteroid injection for plantar fasciitis present for more than 6 weeks.

METHODS: A prospective, randomized, controlled, observer-blinded study was done over a period of 6 months. Sixty-four patients were randomly allocated to either the autologous blood or corticosteroid treatment group. All patients were assessed for the worst pain daily on visual analogue scale (VAS) and tenderness threshold (TT) at the plantar fascia origin using a pressure algometer before treatment, and at 6 weeks, 3 months, and 6 months after treatment. A p value of 0.05 was considered significant.

RESULTS: Data were complete for 61 patients. The reduction in VAS and increase in TT for both groups was significant over time (p < 0.0001). At 6 weeks and 3 months, the corticosteroid group had significantly lower VAS than the autologous blood group (p < 0.011 and p < 0.005, respectively), but the difference was not significant at 6 months. The corticosteroid group had significantly higher TT than the autologous blood group at 6 weeks, 3 months and 6 months (p < 0.003, p < 0.003, p < 0.008, respectively). Although the trends were different, repeated-measures F test of both VAS and TT showed no significant difference in improvement between the groups over time.

CONCLUSIONS: Intralesional autologous blood injection is efficacious in lowering pain and tenderness in chronic plantar fasciitis, but corticosteroid is more superior in terms of speed and probably extent of improvement
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NewsBot · Mar 19, 2009

Treatment of Plantar Fasciitis Using Four Different Local Injection Modalities
A Randomized Prospective Clinical Trial
Aydiner Kalaci, Hüsamettin Çakici, Onur Hapa, Ahmet Nedim Yanat, Yunus Dogramaci and Teoman Toni Sevinç
Journal of the American Podiatric Medical Association Volume 99 Number 2 108-113 2009

Background: To determine the effectiveness of four different local injection modalities in the treatment of plantar fasciitis.

Methods: In a prospective randomized multicenter study of plantar fasciitis, 100 patients were divided into four equal groups and were treated using four different methods of local injection: group A was treated with 2 mL of autologous blood alone; group B, an anesthetic (2 mL of lidocaine) combined with peppering; group C, a corticosteroid (2 mL of triamcinolone) alone; and group D, a corticosteroid (2 mL of triamcinolone) combined with peppering. The outcome was defined by using a 10-cm visual analog scale and modified criteria of the Roles and Maudsley score 3 weeks and 6 months after the injection and compared with the pretreatment condition.

Results: The successful results in all of the groups after injections were higher than those in the pretreatment condition (P = .000). In groups C and D, in which local corticosteroid injections were used, excellent results were obtained, with superior effect in the group in which peppering was used (P < .05).

Conclusions: In the treatment of plantar fasciitis, combined corticosteroid injections and peppering is effective and produces better clinical results
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Robertisaacs · Mar 19, 2009

Am I being dense here?!:bash:

The successful results in all of the groups after injections were higher than those in the pretreatment condition (P = .000).
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How can P = 0?

In groups C and D, in which local corticosteroid injections were used, excellent results were obtained, with superior effect in the group in which peppering was used (P < .05).
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And Groups A & B? Good results? Bad? Indifferent? Seem odd to just ignore them! Based on the P=0 for improvement one would think it would be worth mentioning!

When i get a min I might have to have a look at the raw data! Seems a bit Pete Tong to me!

Regards
Robert

Robertisaacs · Mar 19, 2009

Visual analog scale heel pain scores measured 6 months after treatment were 3.53 in group A, 3.40 in group B, 1.52 in group C, and 0.96 in group D compared with pretreatment scores of 6.84, 6.72, 6.96, and 7.24, respectively. These improved results in groups C and D were significantly inferior compared with those in groups A and B (P < .05) (Table 3).
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So the pain reduction was by almost 50% in A and B and considerably better in C&D.

Which raises an interesting question. Given that the improvement was similar for blood and LA in groups A & B, what was the mechanism for this? And why did the peppering create a different effect in the steroid group but not in the La / Blood groups!

Prolotherapy or placebo. Will we ever know?

Regards
Robert

AllForThePatient · Feb 4, 2010

I paid no attention to platelet gel therapy until a meeting a few months back where a f/a MD was chatting about it during a break. i tried it with a few of my chronic pf patients who had already had multiple cortisone injections which had stopped working. 3-5 of my patients had dramatic relief 2 weeks out. One had relief after the 2nd treatment and one had negligible pain subsidence.

If you allow yourself to strip down the science of what is happening, it is difficult to shun the idea that this is an effective and commen-sense treatment for an infinite quanity of podiatry applications and just about every other area of medicine. Cortisone draws inflammation away from a site. When platelets are ignited by the thrombin, they release an army of growth factors which create inflamation and facilitate the healing process. I now spend half of a day per week essentially with a pf clinic, injecting patients who line up by referal even though they have to pay cash. I have the kits on the shelves of my office at as much of a discount as is given and frankly, the system has become a cash cow. Not one patient has complained of the expense. I've also begun to use platelet gel for many other areas of my practice and I believe that we will soon look back and laugh about the days that we went without it.

Mike

Griff · Feb 4, 2010

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Griff · Feb 4, 2010

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NewsBot · May 21, 2010

This clinical trial was just registered:

Treatment of Plantar Fasciitis With Platelet Rich Plasma

The purpose of this investigator-initiated study is to clinically evaluate the efficacy of a new treatment for plantar fasciitis. This treatment consists of a platelet rich plasma injection into the origin of the plantar fascia. It is thought that plasma rich plasma injection will dramatically improve outcomes for patients suffering from plantar fasciitis.

Subjects will be randomized by choosing a slip of paper from an envelope. This process will randomize 25 patients to the experimental group, and 25 patients to the control. The experimental group will undergo a blood draw, allowing for an injection of platelet rich plasma into the origin of the plantar fascia. The control group will undergo a corticosteroid injection into the plantar fascia as the sole treatment. Patients will be followed for three months for pain, and will fill out questionnaires at the initial visit prior to receiving the injection, as well as six and twelve weeks post injection.

These questionnaires will give insight into functionality and pain changes that the plantar fascia is experiencing due to treatment.

Subjects will be outpatients. Subjects may include employees, students, minorities, and elderly, although no subsets of these will be formed.

Subjects will be between 18 and 89 years of age.

In total, subject participation will last approximately 3 months.
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NewsBot · Jun 22, 2010

Image Intensifier-Guided Injection of Corticosteroid and Local Anesthetic Agent for the Treatment of Recalcitrant Plantar Fasciitis.
Atkins KL, Chin KF, Noorani AM, Nairn DS.
Foot Ankle Spec. 2010 Jun 18. [Epub ahead of print]

Plantar fasciitis is the most common cause of plantar heel pain. The condition is potentially self-limiting and can respond to conservative treatment, but patients may opt for surgery if the treatments fail. Surgical intervention is associated with potential complications. This study set out to explore the efficacy of the specific nonsurgical intervention offered to treatment-resistant cases in a local clinical setting. The technique involves image intensifier-guided injection of corticosteroid and local anesthetic agents under general anesthesia. Nineteen patients with recalcitrant plantar fasciitis of over 12 months' duration received injections. A simple follow-up questionnaire was given to patients after the procedure that focused on their subjective opinion of any change in their pain. They were also asked if the injection had solved their problems with heel pain. The improvements that the patients reported were found to be statistically significant (P = .012).
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NewsBot · Apr 5, 2011

Sonographically guided corticosteroid injection for treatment of plantar fasciosis.
Kayhan A, Gökay NS, Alpaslan R, Demirok M, Yilmaz I, Gökçe A.
J Ultrasound Med. 2011 Apr;30(4):509-15.

Objectives- The purpose of this study was to prospectively investigate the effect of sonographically guided corticosteroid injection on the clinical and radiologic responses in patients with proximal plantar fasciosis.

Methods- Thirty-one consecutive patients with unilateral plantar fasciosis were enrolled. A 4-cm 21-gauge needle was positioned in a caudocranial oblique manner, and the needle was withdrawn to the near edge of the fascia so that the solution dispersed around the edge. Two milliliters (20 mg/mL) of lignocaine/prilocaine, 1%, and 0.5 mL (20 mg) of methylprednisolone acetate solutions were injected separately. The plantar fascia and fat pad thickness, fascial echogenicity, and perifascial edema were assessed with a 10-5 MHz linear array transducer. The American Orthopedic Foot and Ankle Society midfoot scale was used to assess function, alignment, and pain. The initial radiologic and clinical measurements were compared with data obtained not less than 6 weeks after the injections.

Results- A statistically significant decrease in the mean plantar fascia thickness was detected after treatment (P < .0001). There was no statistically significant difference in the plantar fascia echogenicity before and after treatment (P = .11). A statistically significant decrease was found for perifascial edema (P < .0001), and a statistically significant increase in American Orthopedic Foot and Ankle Society scores was detected (P = .0007). There was no decrease in fat pad thickness (P > .1). Plantar fascia rupture was detected in 1 patient.

Conclusions- Sonographically guided corticosteroid injection enables real-time imaging of the plantar fascia during needle insertion. A caudocranial oblique injection beneath the fascia may have an incremental value in the treatment response in patients with plantar fasciosis.
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NewsBot · Jun 10, 2011

Plantar fasciitis - to jab or to support? A systematic review of the current best evidence
Uden H, Boesch E, Kumar S.
J Multidiscip Healthc. 2011;4:155-64.

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.
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NewsBot · Jan 13, 2012

This clinical trial was recently registered:

Treatment of Plantar Fasciitis With Injection af Platelet-rich Plasma Into the Origin of the Plantar Fascia

The purpose of our study i to determine whether one injection with plasma into the origin of the plantar fascia is an effective treatment of plantar fasciitis.

90 patients will be randomized into three groups. 30 patients will be treated with one plasma injection, 30 patients will be treated with one injection with saline and 30 patients will do physiotherapy and use heel cups. The two groups who receive injections will do the same physiotherapy and use heel cups, as the conservatively treated group.

Both groups randomized to receive an injection will have a 10 ml blood sample taken from their cubital vein. The sample is centrifuged for 5 minutes at 5000 rpm. No additives are added. 3 ml of plasma i obtained, and the syringe i blinded. Is the patient randomized to receive an injection with saline, a similar syringe is blinded with 3 ml of saline. The injection into to the origin of the plantar fascia i done 10 minutes after the sample of blood is obtained. The content of the syringe i blinded to both the investigator and the patient.

The injection i performed from the medial aspect of the heel under guidance of ultrasound. No local/systemic analgetic is used. The content of the syringe is spread using peppering technique into the origin of the plantar fascia.

Patients will do questionnaires at inclusion and after 1, 2, 3, 6 and 12 months. The questionaires will be Foot Function Index and SF-36 as well as questions about their use of analgetics, use of heel cups and intensity of their physiotherapy
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NewsBot · Feb 17, 2012

Platelet-Rich Rich Plasma is More Effective than Cortisone for Chronic Severe Plantar Fasciitis
Raymond R. Monto
Presented at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting. Feb. 7-11. San Francisco.

INTRODUCTION
Chronic plantar fasciitis is a common but sometimes difficult condition to successfully treat. Platelet rich plasma (PRP), a concentrated bioactive component of autologous blood that is rich in cytokines and other growth factors, was compared with cortisone injection in the treatment of severe cases of plantar fasciitis resistant to traditional non-operative paradigms.

METHODS
Thirty-six patients (16 males, 20 females) with severe chronic plantar fasciitis who had failed traditional non-operative treatment (rest, heel lifts, PT, NSAIDS, cam walker immobilization, night splinting, local modalities) were randomized into two study groups and evaluated prospectively. All patients had pre-treatment MRI and ultrasound studies consistent with plantar fasciitis. Group 1 was treated with a single ultrasound-guided injection of 40 mg methylprednisolone at the injury site and Group 2 was treated with a single ultrasound-guided injection of un-buffered autologous PRP at the injury site. All patients were then immobilized fully weight bearing in a cam walker for two weeks, started on eccentric home exercises and then allowed to return to normal activities as tolerated and without support.

RESULTS
Group 1 had an average age of 59 (24-74) and had failed 5.4 months (4-24) of standard non-operative management and had pre-treatment AOFAS scores of 52 (24-60). The PRP group had an average age of 51 (21-67) and had failed 5.7 months (4-26) of standard non-operative management and had pre-treatment AOFAS scores of 37 (30-56). Post-treatment AOFAS scores in Group 1 initially improved to 81 (60-90) at three months but decreased to 74 (56-85) at six months and dropped further to 58 (45-77) at 12 months follow up. Post-treatment AOFAS scores in Group 2 improved to 95 (84-90) at three months and remained excellent at 94 (87-100) at six months and stayed at 94 (86-100) at 12 months follow up (CI 95% P=0.001). No patients were lost to follow up.

DISCUSSION AND CONCLUSION
This study suggests that platelet rich plasma injection is significantly more effective and durable than cortisone injection for the treatment of severe chronic plantar fasciitis refractory to traditional non-operative management.
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Simon Spooner · Feb 17, 2012

Robertisaacs said: ↑

Am I being dense here?!:bash:

How can P = 0?
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It's not. It is being reported here to three decimal places.

Dawn Bacon · Feb 17, 2012

Some really interesting work going on in this area at present. It seems that there are two main approaches to the autologous injection treatments:
Platelet-rich plasma
IL1 receptor antagonist protein

Having had a good look around the research in the area the vets appear to have done some extensive work and I would suggest that this paper is worth a look:

http://www.sciencedirect.com/science/article/pii/S0749073911000241

Best wishes,
Dawn

Perthpod · Oct 10, 2012

Robertisaacs said: ↑

So the pain reduction was by almost 50% in A and B and considerably better in C&D.

Which raises an interesting question. Given that the improvement was similar for blood and LA in groups A & B, what was the mechanism for this? And why did the peppering create a different effect in the steroid group but not in the La / Blood groups!

Prolotherapy or placebo. Will we ever know?

Regards
Robert
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Hi Robert,

We wont know whether peppering created a different effect in LA and autolog groups, because peppering was too painful with the autologous group (even though their lit reveiew includes Kiter who performed this method) and there was no normal ligno injection. The only data on peppering left to compare is the cort. group. Hmmm. They also used peppering with saline (too painful to cont.). Makes you wonder whether people even think about methodology? I would have liked to have at least seen ligno normal vs. ligno pepp and cort normal and cort pepp. They could have neatly left it at that. Also the validity of the modified Roles and Maudsley Score is questionable. Was it only modified from a tennis elbow study to a weightbearing study by these authors?

Pip

N.Knight · Oct 10, 2012

I am currently doing a literature review in the use of autologous blood (PRP and whole blood) and it’s use in sporting injuries and grading the current levels of evidence.

Pip, I agree reading quite a few articles now, I pull my hair out at some of these methods, people put hard work in the studies and appear lazy in their methods that really affect the level of evidence. There is a few level 4 studies, however nothing really above that for heel pain. There is a study in USA in the recruitment phase that reading the initial method looks promising

I have attached the full version of this paper.

Thanks,

Nick

Perthpod · Oct 12, 2012

Thanks Nick,

That is the Kiter referenced by Kalaci that I was talking about. I feel that there really needs to be some solid trials separating out the methods, rather than mixing them up. It is hard to explain results when the variables are jumbled eg the aforementioned Kalaci missing variable and the ligno/autolog mix in Kiter. As we were saying.

Cheers, Pip

NewsBot · Dec 26, 2021

The effectiveness of dextrose prolotherapy in plantar fasciitis: A systemic review and meta-analysis
Wei-Fu Lai et al
Medicine (Baltimore). 2021 Dec 23;100(51)

Background: Dextrose prolotherapy (DPT) is considered to be a type of regenerative therapy and is widely used in various musculoskeletal disorders. Plantar fasciitis is a common cause of heel pain that affects the quality of life of many people. We aimed to evaluate the effectiveness and safety of DPT for plantar fasciitis.

Methods: PubMed, Embase, and the Cochrane Library were searched from their respective inception dates to June 2021. Only randomized controlled trials comparing DPT and other interventions for plantar fasciitis were included in this review. Standardized mean differences (SMDs) with 95% confidence intervals were calculated for comparison. The outcome measurements included visual analog score, numeric rating scale, Foot Function index, Revised Foot Function index, American Orthopedic Foot and Ankle Score, and plantar fascia thickness. Post-treatment duration was classified as short-term (1-2 months), medium-term (3 months), or long-term (6 months).

Results: Six studies with 388 adult patients diagnosed with plantar fasciitis were included for the meta-analysis. In terms of pain scores improvement, DPT was superior to placebo or exercise in the short-term (SMD: -1.163, 95%CI: -2.17 to -0.156) and the medium-term (SMD: -1.394, 95%CI: -2.702 to -0.085). DPT was inferior to corticosteroid injection in the short-term (SMD: 0.781, 95%CI: 0.41 to 1.152). For functional improvement, DPT was superior to placebo or exercise in the short-term (SMD: -1.51, 95%CI: -2.96 to -0.059), but inferior to corticosteroid injection (SMD: 0.526, 95%CI: 0.161 to 0.89) and extracorporeal shock wave therapy in the short-term (SMD: 0.484, 95%CI: 0.145 to 0.822). Randomized controlled trials showed a better pain improvement in the long-term for patients treated with DPT compared to corticosteroid (P = .002) and exercise control (P < .05). No significant differences were found between patients treated with DPT and patients treated with platelet-rich plasma.

Conclusion: Dextrose prolotherapy was a safe and effective treatment option for plantar fasciitis that may have long-term benefits for patients. The effects were comparable to extracorporeal shock wave therapy or platelet-rich plasma injection. Further studies with standardized protocols and long-term follow-up are needed to address potential biases.
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NewsBot · Jan 25, 2022

Perforating Fat Injections for Chronic Plantar Fasciitis: A Randomized, Crossover Clinical Trial
Gusenoff, Beth R. D.P.M.; Minteer, Danielle Ph.D.; Gusenoff, Jeffrey A. M.D.
Plastic and Reconstructive Surgery: February 2022 - Volume 149 - Issue 2 - p 297e-302e

Plantar fasciitis affects 2 million patients per year. Ten percent of cases are chronic, with thickened plantar fascia. Treatment may lead to prolonged recovery, foot instability, and scar. The authors hypothesized that perforating fat injections would decrease plantar fascia thickness, reduce pain, and improve quality of life. Adults with plantar fascia greater than 4 mm for whom standard treatment had failed were included in a prospective, randomized, crossover pilot study. Group 1 (intervention) was followed for 12 months. Group 2 was observed for 6 months, injected, and then followed for 6 months. Validated patient reported outcome measures, ultrasound, and complications were assessed. Group 1 had nine female patients and group 2 had five patients. A total of 2.6 ± 1.6 ml of fat was injected per foot at one to two sites. In group 1, plantar fascia thickness decreased from screening at 6 and 12 months (p < 0.05). Group 2 had decreased plantar fascia thickness from screening to 6 months after injection (p < 0.05). Group 1 had pain improvements at 6 and 12 months compared with screening (p < 0.01). Group 2 reported no pain difference after injections (p > 0.05). Group 1 had improved activities of daily living and sports activity at 6 and 12 months compared with screening (p < 0.003). Group 2 noted increased sports activity 6 months after injection compared with screening (p < 0.03). In conclusion, perforating fat injections for chronic plantar fasciitis demonstrate significant improvement in pain, function, and plantar fascia thickness.
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NewsBot · Mar 28, 2022

Effectiveness of Dextrose prolotherapy for the treatment of chronic Plantar Fasciitis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Tunchanok Chutumstid et al
PM R. 2022 Mar 25.

Objective: To systematically investigate the efficacy and safety of dextrose prolotherapy for treating chronic plantar fasciitis.

Literature survey: EMBASE, PubMed, Scopus, and Google Scholar (from inception to December the 9th, 2021) METHODOLOGY: Comprehensive review of randomized controlled trials investigating dextrose prolotherapy for chronic plantar fasciitis was done. Two investigators independently screened the titles, abstracts, and full texts and extracted data from eligible studies. The change in visual analog scale (VAS) pain score, foot function index (FFI), American Orthopaedic Foot and Ankle Society (AOFAS) score, and plantar fascia thickness were analyzed. Reports of complications of the procedure were collected.

Synthesis: Eight randomized controlled trials (RCTs) were included in the meta-analysis, analyzing 444 patients in total. The subgroup analysis showed that at short-term follow-up (<6 months) dextrose prolotherapy was more effective in reducing VAS pain score compared to non-active treatment control group including exercise and NSS injection. However, there was no difference in the change of VAS pain score between dextrose prolotherapy and active treatment control group, which include ESWT, steroid injection, and PRP injection. Dextrose prolotherapy was more effective in reducing FFI, increasing AOFAS score and reducing plantar fascia thickness at short-term (<6 months) follow-up compared to other comparators. For long-term (≥6 months) follow-up, there was no significant difference in the change in VAS pain score and FFI between the dextrose prolotherapy group and other comparators. No serious complication was reported.

Conclusions: Dextrose prolotherapy is an effective treatment of chronic plantar fasciitis to reduce pain, improve foot functional score and decrease plantar fascia thickness at short-term follow-up. Further studies in larger populations are needed to identify the optimal treatment regimen including dextrose concentration, volume, injection site, injection technique, and the number of injections required. The long-term effects of these treatments also require further examination
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NewsBot · Mar 28, 2022

Effectiveness of Dextrose prolotherapy for the treatment of chronic Plantar Fasciitis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Tunchanok Chutumstid et al
PM R. 2022 Mar 25.

Objective: To systematically investigate the efficacy and safety of dextrose prolotherapy for treating chronic plantar fasciitis.

Literature survey: EMBASE, PubMed, Scopus, and Google Scholar (from inception to December the 9th, 2021) METHODOLOGY: Comprehensive review of randomized controlled trials investigating dextrose prolotherapy for chronic plantar fasciitis was done. Two investigators independently screened the titles, abstracts, and full texts and extracted data from eligible studies. The change in visual analog scale (VAS) pain score, foot function index (FFI), American Orthopaedic Foot and Ankle Society (AOFAS) score, and plantar fascia thickness were analyzed. Reports of complications of the procedure were collected.

Synthesis: Eight randomized controlled trials (RCTs) were included in the meta-analysis, analyzing 444 patients in total. The subgroup analysis showed that at short-term follow-up (<6 months) dextrose prolotherapy was more effective in reducing VAS pain score compared to non-active treatment control group including exercise and NSS injection. However, there was no difference in the change of VAS pain score between dextrose prolotherapy and active treatment control group, which include ESWT, steroid injection, and PRP injection. Dextrose prolotherapy was more effective in reducing FFI, increasing AOFAS score and reducing plantar fascia thickness at short-term (<6 months) follow-up compared to other comparators. For long-term (≥6 months) follow-up, there was no significant difference in the change in VAS pain score and FFI between the dextrose prolotherapy group and other comparators. No serious complication was reported.

Conclusions: Dextrose prolotherapy is an effective treatment of chronic plantar fasciitis to reduce pain, improve foot functional score and decrease plantar fascia thickness at short-term follow-up. Further studies in larger populations are needed to identify the optimal treatment regimen including dextrose concentration, volume, injection site, injection technique, and the number of injections required. The long-term effects of these treatments also require further examination
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NewsBot · Apr 12, 2022

A Randomized Control Study of Comparison of Standard Care
versusUltrasonography Guided Single Dose of MethylprednisoloneAcetate
Injection for Planar Fasciopathy
Keshav Dev et al
European Journal of Molecular & Clinical Medicine

Objectiveslantar fasciitis is a painful condition but can be self-limiting condition.
Among the different treatment which exit, physiotherapy and corticosteroid injection
are effective and popular. In this study, the author evaluated the efficacy of standard
care versus ultrasonography guided single dose of methylprednisolone acetate injection
for planar fasciopathy.
Design:This randomized clinical trial conducted in Physical Medicine & Rehabilitation
department of S M S medical college.
Methodatients were allocated to standard care physiotherapy group (n=35) and
ultrasonography guided steroid injection group (n=35) equally. Pain and functional
ability on a visual analog scale (VAS), plantar fascia thickness and Foot Ankle
Disability Index (FADI) were evaluated at baseline and at 6 weeks after treatment.
Results:The mean age was not different between both groups (40.60±10.64 years versus
41.43±9.66 years, p=0.734). There was a reduction in VAS from baseline to weeks 6
(after treatment) (65.315±7.182 vs 32.57±4.235, respectively) (P<0.001). PF thickness at
6 weeks significantly reduced to 3.895±0.18 compared to baseline (P<0.001).FADI had a
considerable improved at week 6 (76.675±2.131) compared to baseline (62.915±1.823)
(P<0.001).
Conclusion:Both interventions caused improvement in pain and functional ability 2
months after treatment. Although inter difference were not significant.
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NewsBot · May 1, 2022

Normal saline injection produces a therapeutic effect in patients with plantar fasciitis: a systematic review and meta-analysis of randomized controlled trials
Víctor ManuelPeña-Martínez et al
Foot and Ankle Surgery; 29 April 2022

Background
Injectable therapies have been increasingly investigated to treat plantar fasciitis in randomized controlled trials (RCT) where normal saline injections are frequently used as placebo. The purpose was to quantify the effect of saline injections and compared against available minimal clinically important difference criteria (MCID) specific for plantar fasciitis to assess if changes were clinically meaningful.

Methods
RCT including a placebo group (normal saline) and reporting changes in pain and functional outcomes in plantar fasciitis were identified through a search in MEDLINE, Embase, Web of Science, and Scopus to February 2022. PRISMA guidelines and a registered protocol (PROSPERO: CRD42020214035) were followed to conduct the study.

Results
Pooled analysis of 13 RCT (379 subjects) included for analysis revealed a significant improvement on pain (P <.00001) and functional scores (P <.00001) after normal saline injections. These changes exceeded the established MCID criteria.

Conclusions
Normal saline injections in plantar fasciitis showed a therapeutic effect with statistically and clinically meaningful improvement when administered in the setting of an RCT for up to 12 months. The control of potential confounders influencing the effect of saline injections is required for future research.
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NewsBot · Oct 27, 2022

Outcome of Corticosteroid Injection in Reducing the Intensity of Pain
in Patients with Plantar Fasciitis
ABDUS SAMAD KHAN et al
P J M H S Vol. 16, No.01, JAN 2022 1115

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 of the cases were males 38 (63.3%) and rest 22 (36.7%) were females. Age with
mean standard deviation was 37.55±17.13 years and had body mass index 25.13±10.43 kg/m2
. Majority of the
patients 21 (35%) were from age group 31-40 years followed by age group 41-50 in 18 (30%) cases. Pre injection
mean pain score was 7.34±7.5 reduced to 1.03±4.9 after nine months of follow up. Recurrence of pain was found
among 2 (3.3%) cases.
Conclusion: In this study we concluded that corticosteroid injection in reducing the intensity of pain in patients
with plantar fasciitis was effective and useful with only 3.3% recurrence rate.
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NewsBot · Nov 12, 2022

Evaluation of the Treatment Efficacy of Corticosteroid Injection in
Reducing the Pain Intensity in the Patients Diagnosed with the Plantar
Fasciitis
ABDUL WAHID et al
Source

Background: Plantar fasciitis is an orthopedic ailment that affects athletes and non-athletes equally. The 10% of the general
population attend the orthopedic surgeons with heel pain in their lifetime. The degenerative changes in plantar fasciitis worsen
the conditions of patients.
Objective: The study aimed to evaluate the treatment efficacy of corticosteroid injection in reducing the pain intensity in the
patients clinically diagnosed with the plantar fasciitis.
Study design: This descriptive study was conducted on 40 patients who attended the orthopedics department of Lady Reading
Hospital Peshawar. The duration of study was one year from April 2021 to March 2022.
Material and Methods: The patients who were clinically diagnosed with the plantar fasciitis and met the inclusion criteria were
selected for the study. The study was approved by the ethical and review board committee of the hospital. The selected patients
were administrated with the Triamcinolone injection in the heel. The visual analog scale was used to assess the outcomes. The
data was collected and SPSS was used for the statistical analysis.
Results: The total 40 patients were selected for the study. The mean calculated age was 42.83± 7.07. Out of 40 patients the
(22) 55% were male and remaining (18) 45% were female. The mean pre injection VAS improved from 6.30±2.1 to 1.5±6 post
injection. The p-value was 0.03.
Conclusion: It was concluded that the single injection of corticosteroid significantly reduce the pain intensity associated with
plantar fasciitis.
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NewsBot · May 10, 2023

Effectiveness of hypertonic dextrose injection (prolotherapy) in plantar fasciopathy: A systematic review and meta-analysis of randomized controlled trials
Hugo Py Fong et al
Arch Phys Med Rehabil. 2023 Apr 23

Objective: To systematically review the effectiveness of hypertonic dextrose prolotherapy (DPT) in plantar fasciopathy (PF) compared with other non-surgical treatments.

Data sources: PubMed/MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science, AMED, Global Health, Ovid Nursing Database, Dimensions, and WHO ICTRP were searched from inception to 30th April 2022.

Study selection: Two independent reviewers selected randomized controlled trials (RCTs) that evaluated the effectiveness of DPT in PF compared with non-surgical treatments. Outcomes included pain intensity, foot and ankle function, and plantar fascia thickness.

Data extraction: Two independent reviewers conducted data extraction. Risk of bias assessment was conducted using the Cochrane Risk of Bias 2 (RoB 2) tool, and certainty of evidence was assessed with Grading of Recommendation Assessment, Development, and Evaluation (GRADE).

Data synthesis: Eight RCTs (n=469) met the inclusion criteria. Pooled results favored the use of DPT versus normal saline (NS) injections in reducing pain [WMD -41.72; 95% CI -62.36 to -21.08; P<0.01; low certainty evidence] and improving function [WMD -39.04; 95% CI -55.24 to -22.85; P<0.01; low certainty evidence] in the medium term. Pooled results also showed corticosteroid (CS) injections was superior to DPT in reducing pain in the short term [SMD 0.77; 95% CI 0.40 to 1.14;, P<0.01; moderate certainty evidence]. Overall RoB varied from "some concerns" to "high". The overall certainty of evidence presented ranges from very low to moderate based on the assessment with the GRADE approach.

Conclusion: Low certainty evidence demonstrated that DPT was superior to NS injections in reducing pain and improving function in the medium term, but moderate certainty evidence showed that it was inferior to CS in reducing pain in the short term. Further high-quality RCTs with standard protocol, longer-term follow-up, and adequate sample size are needed to confirm its role in clinical practice
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Injection therapy for heel pain

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