Full-length silicone insoles versus ultrasound-guided corticosteroid injection in the management of plantar fasciitis

Abstract

Background: Plantar fasciitis often leads to disability. Optimal treatment for this clinical condition is still unknown. Objective: To compare the effectiveness of wearing a full-length silicone insole with ultrasound-guided corticosteroid injection in the management of plantar fasciitis. Study design: Randomized clinical trial. Methods: Forty-two patients with chronic unilateral plantar fasciitis were allocated randomly to have an ultrasound-guided corticosteroid injection or wear a full-length silicone insole. Data were collected before the procedure and 1 month after. The primary outcome measures included first-step heel pain via Visual Analogue Scale and Heel Tenderness Index. Other outcome measures were the Foot and Ankle Outcome Score and ultrasonographic thickness of the plantar fascia. Results: After 1 month, a significant improvement was shown in Visual Analogue Scale, Heel Tenderness Index, Foot and Ankle Outcome Score, and ultrasonographic thickness of plantar fascia in both groups. Visual Analogue Scale scores, Foot and Ankle Outcome Score pain, Foot and Ankle Outcome Score for activities of daily living, Foot and Ankle Outcome Score for sport and recreation function, and plantar fascia thickness were better in injection group than in insole group (p < 0.05). Conclusions: Although both ultrasound-guided corticosteroid injection and wearing a full-length silicone insole were effective in the conservative treatment of plantar fasciitis, we recommend the use of silicone insoles as a first line of treatment for persons with plantar fasciitis. Clinical relevanceSilicone insole may be considered as a first-line treatment option in patients with plantar fasciitis.

The effectiveness of corticosteroid injection in the treatment of plantar fasciitis

“…Yucel et al (17) found significant improvement in HTI in both the US-guided/steroid injection group and the insole group from baseline, although there was no significant difference between the two groups. To measure TT, Lee et al (20) used a pressure algometer, in which the minimal pressure required to elicit pain was defined as the TT recorded on the 11-kg range algometer (i.e.…”

“…The duration of their symptoms was 2-180 months, with the majority suffering from plantar heel pain for at least six months. (7,13,16,17,(19)(20)(21) Five of the ten RCTs included study populations that had failed conservative therapies for at least 2-6 months. …”

“…Five RCTs explored the use of long-acting corticosteroids, i.e. dexamethasone (14,16,18) and betamethasone, (17,19) while the other five investigated the use of intermediate-acting corticosteroids, i.e. methylprednisolone, (13,15,21) prednisolone (7) and triamcinolone.…”

“…methylprednisolone, (13,15,21) prednisolone (7) and triamcinolone. (20) To guide the corticosteroid injections, seven RCTs used the palpation method, (7,15,16,(18)(19)(20)(21) two used USguidance, (14,17) and one used both US-and palpation-guided injections in different arms. (13) Three approaches of injections were employed in the studies: eight RCTs adopted the medial approach, (7,(14)(15)(16)(17)(18)(19)(20) one adopted the posterior approach (13) and one involved injections through the plantar aspect of the heel pad.…”

“…Three studies showed significant pain reduction in the corticosteroid injection group compared to the other types of intervention, namely use of insole, (17) autologous blood injection (20) and local anaesthetic injection with or without tibial nerve block. (7) One study (18) reported better results in the botulinum toxin A injection group (intervention group) compared to the corticosteroid injection group.…”