Comparative Effectiveness of Radial Extracorporeal Shockwave Therapy and Ultrasound-Guided Local Corticosteroid Injection Treatment for Plantar Fasciitis
Abstract:Both rESWT and corticosteroid injection therapy are effective modalities for treatment of chronic plantar fasciitis. However, rESWT seems to be superior to corticosteroid injection therapy due to its longer duration of action.
“…1) [20–66]. Data were unable to be obtained from three trials [32, 48, 55] after contacting the authors, and five trials [33, 34, 37, 47, 53] could not be included in meta-analyses as the data were from composite outcome measures. Data from a four group trial [56] that sub-divided participants on the presence of perifascial oedema were combined to two groups so the data were similar to other trials.…”
Section: Resultsmentioning
confidence: 99%
“…Data from a four group trial [56] that sub-divided participants on the presence of perifascial oedema were combined to two groups so the data were similar to other trials. Finally, one trial [33] reported medians and interquartile ranges, which were converted to means and standard deviations [67]. Fig.…”
“…In the medium term (7 to 12 weeks), there was low quality evidence that corticosteroid injection is similar to physical therapy (SMD -0.74; 95% CI, − 1.51 to 0.03) [25, 37, 52], and very-low quality evidence corticosteroid injection is similar to autologous blood injection (SMD -0.31; 95% CI, − 0.83 to 0.21) [22, 38, 42, 62], foot orthoses (SMD -0.17; 95% CI; − 1.30 to 0.97) [40, 61], platelet-rich plasma injection (SMD 0.32; 95% CI, − 0.19 to 0.83) [21, 35, 36, 44, 57, 58, 60], extracorporeal shockwave therapy (SMD -0.05; 95% CI, − 0.60 to 0.49) [29, 30, 33, 34, 41, 45, 50, 54, 58, 63], and local anaesthetic injection (SMD 0.04; 95% CI, − 0.34 to 0.42) [26].…”
Section: Resultsmentioning
confidence: 99%
“…In the longer term (13 to 52 weeks), there was low quality evidence that corticosteroid injection is less effective than dry needling (SMD 1.45; 95% CI, 0.70 to 2.19) [51, 59], and very low-quality evidence corticosteroid injection is less effective than platelet-rich plasma injection (SMD 0.61; 95% CI, 0.16 to 1.06) [21, 35, 36, 57, 58, 60]. There was very-low quality evidence that corticosteroid injection is similar to physical therapy (SMD -0.00; 95% CI − 0.39 to 0.38) [25, 37] autologous blood injection (SMD -0.05; 95% CI, − 0.31 to 0.21) [22, 39, 42, 62], extracorporeal shockwave therapy (SMD 0.45; 95% CI, − 0.09 to 0.99) [30, 33, 34, 50, 58], and local anaesthetic injection (SMD 0.22; 95% CI, − 0.87 to 1.31) [26].…”
Background
Corticosteroid injection is frequently used for plantar heel pain (plantar fasciitis), although there is limited high-quality evidence to support this treatment. Therefore, this study reviewed randomised trials to estimate the effectiveness of corticosteroid injection for plantar heel pain.
Methods
A systematic review and meta-analysis of randomised trials that compared corticosteroid injection to any comparator. Primary outcomes were pain and function, categorised as short (0 to 6 weeks), medium (7 to 12 weeks) or longer term (13 to 52 weeks).
Results
A total of 47 trials (2989 participants) were included. For reducing pain in the short term, corticosteroid injection was more effective than autologous blood injection (SMD -0.56; 95% CI, − 0.86 to − 0.26) and foot orthoses (SMD -0.91; 95% CI, − 1.69 to − 0.13). There were no significant findings in the medium term. In the longer term, corticosteroid injection was less effective than dry needling (SMD 1.45; 95% CI, 0.70 to 2.19) and platelet-rich plasma injection (SMD 0.61; 95% CI, 0.16 to 1.06). Notably, corticosteroid injection was found to have similar effectiveness to placebo injection for reducing pain in the short (SMD -0.98; 95% CI, − 2.06, 0.11) and medium terms (SMD -0.86; 95% CI, − 1.90 to 0.19). For improving function, corticosteroid injection was more effective than physical therapy in the short term (SMD -0.69; 95% CI, − 1.31 to − 0.07). When trials considered to have high risk of bias were excluded, there were no significant findings.
Conclusions
Based on the findings of this review, corticosteroid injection is more effective than some comparators for the reduction of pain and the improvement of function in people with plantar heel pain. However, corticosteroid injection is
not
more effective than placebo injection for reducing pain or improving function. Further trials that are of low risk of bias will strengthen this evidence.
Registration
PROSPERO registration number
CRD42016053216
.
Electronic supplementary material
The online version of this article (10.1186/s12891-019-2749-z) contains supplementary material, which is available to authorized users.
“…1) [20–66]. Data were unable to be obtained from three trials [32, 48, 55] after contacting the authors, and five trials [33, 34, 37, 47, 53] could not be included in meta-analyses as the data were from composite outcome measures. Data from a four group trial [56] that sub-divided participants on the presence of perifascial oedema were combined to two groups so the data were similar to other trials.…”
Section: Resultsmentioning
confidence: 99%
“…Data from a four group trial [56] that sub-divided participants on the presence of perifascial oedema were combined to two groups so the data were similar to other trials. Finally, one trial [33] reported medians and interquartile ranges, which were converted to means and standard deviations [67]. Fig.…”
“…In the medium term (7 to 12 weeks), there was low quality evidence that corticosteroid injection is similar to physical therapy (SMD -0.74; 95% CI, − 1.51 to 0.03) [25, 37, 52], and very-low quality evidence corticosteroid injection is similar to autologous blood injection (SMD -0.31; 95% CI, − 0.83 to 0.21) [22, 38, 42, 62], foot orthoses (SMD -0.17; 95% CI; − 1.30 to 0.97) [40, 61], platelet-rich plasma injection (SMD 0.32; 95% CI, − 0.19 to 0.83) [21, 35, 36, 44, 57, 58, 60], extracorporeal shockwave therapy (SMD -0.05; 95% CI, − 0.60 to 0.49) [29, 30, 33, 34, 41, 45, 50, 54, 58, 63], and local anaesthetic injection (SMD 0.04; 95% CI, − 0.34 to 0.42) [26].…”
Section: Resultsmentioning
confidence: 99%
“…In the longer term (13 to 52 weeks), there was low quality evidence that corticosteroid injection is less effective than dry needling (SMD 1.45; 95% CI, 0.70 to 2.19) [51, 59], and very low-quality evidence corticosteroid injection is less effective than platelet-rich plasma injection (SMD 0.61; 95% CI, 0.16 to 1.06) [21, 35, 36, 57, 58, 60]. There was very-low quality evidence that corticosteroid injection is similar to physical therapy (SMD -0.00; 95% CI − 0.39 to 0.38) [25, 37] autologous blood injection (SMD -0.05; 95% CI, − 0.31 to 0.21) [22, 39, 42, 62], extracorporeal shockwave therapy (SMD 0.45; 95% CI, − 0.09 to 0.99) [30, 33, 34, 50, 58], and local anaesthetic injection (SMD 0.22; 95% CI, − 0.87 to 1.31) [26].…”
Background
Corticosteroid injection is frequently used for plantar heel pain (plantar fasciitis), although there is limited high-quality evidence to support this treatment. Therefore, this study reviewed randomised trials to estimate the effectiveness of corticosteroid injection for plantar heel pain.
Methods
A systematic review and meta-analysis of randomised trials that compared corticosteroid injection to any comparator. Primary outcomes were pain and function, categorised as short (0 to 6 weeks), medium (7 to 12 weeks) or longer term (13 to 52 weeks).
Results
A total of 47 trials (2989 participants) were included. For reducing pain in the short term, corticosteroid injection was more effective than autologous blood injection (SMD -0.56; 95% CI, − 0.86 to − 0.26) and foot orthoses (SMD -0.91; 95% CI, − 1.69 to − 0.13). There were no significant findings in the medium term. In the longer term, corticosteroid injection was less effective than dry needling (SMD 1.45; 95% CI, 0.70 to 2.19) and platelet-rich plasma injection (SMD 0.61; 95% CI, 0.16 to 1.06). Notably, corticosteroid injection was found to have similar effectiveness to placebo injection for reducing pain in the short (SMD -0.98; 95% CI, − 2.06, 0.11) and medium terms (SMD -0.86; 95% CI, − 1.90 to 0.19). For improving function, corticosteroid injection was more effective than physical therapy in the short term (SMD -0.69; 95% CI, − 1.31 to − 0.07). When trials considered to have high risk of bias were excluded, there were no significant findings.
Conclusions
Based on the findings of this review, corticosteroid injection is more effective than some comparators for the reduction of pain and the improvement of function in people with plantar heel pain. However, corticosteroid injection is
not
more effective than placebo injection for reducing pain or improving function. Further trials that are of low risk of bias will strengthen this evidence.
Registration
PROSPERO registration number
CRD42016053216
.
Electronic supplementary material
The online version of this article (10.1186/s12891-019-2749-z) contains supplementary material, which is available to authorized users.
BackgroundCorticosteroid (CS) injections have been proven to be effective in ameliorating symptoms of plantar fasciitis. Shock-wave (SW) therapy is another common treatment of plantar fasciitis, and several meta-analyses have documented its advantages when compared to placebo treatment. Despite this, few studies have focused on comparing the use of CS and SW in the treatment of plantar fasciitis. The purpose of this meta-analysis is to assess whether SW is superior to CS in managing plantar fasciitis, both in terms of ameliorating pain as well as improving functionality.MethodsA systematic search of the literature was conducted to identify relevant articles that were published in Pubmed, Medline, Embase, the Cochrane Library, SpringerLink, Clinical Trials.gov and OVID from the databases’ inception to July 2018. All studies comparing the efficacy of SW and CS in terms of pain levels and functionality improvement were included. Data on the two primary outcomes were collected and analyzed using the Review Manager 5.3.ResultsSix studies were included in the current meta-analysis. A significant difference in VAS score (MD = − 0.96, Cl − 1.28 to − 0.63, P < 0.00001, I2 = 96%) was noted between the SW group and the CS group. No significant difference was seen in the Mayo CSS or FFI or HFI or 100 Scoring System score at the 3 months follow-up (Chi2 = 0.62, I2 = 0%, P > 0.05).ConclusionsThe clinical relevance of the present study is that both SW and CS were effective and successful in relieving pain and improving self-reported function in the treatment of plantar fasciitis at 3 months. Although inter-group differences were not significant, the VAS score was better improved in the SW group, highlighting that shock-wave therapy may be a better alternative for the management of chronic plantar fasciitis.
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