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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.
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.
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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
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
The successful results in all of the groups after injections were higher than those in the pretreatment condition (P = .000).
How can P = 0?
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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).
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!
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).
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!
Injection therapy for heel pain
Linear Mode
