<p>Ultrasound-Guided Injection of High Molecular Weight Hyaluronic Acid versus Corticosteroid in Management of Plantar Fasciitis: A 24-Week Randomized Clinical Trial</p>

Abstract

Background and Aims: Plantar fasciitis (PF) is the leading cause of heel pain in adults. This study was designed to evaluate the effect of hyaluronic acid (HA) injection in reducing the symptoms of PF, compared with corticosteroid (CS) injection as a conventional treatment. Methods: In this triple-blind, randomized, clinical trial, 75 patients who had the symptoms of PF for at least 3 months were randomly divided into two groups of 38 and 37 individuals. Then, each patient received either a single injection of high molecular weight (>2000 kDa) HA (1 mL HA 20 mg + 1 mL lidocaine 2%) or CS (1 mL methylprednisolone 40 mg + 1 mL lidocaine 2%) under the ultrasonography (US) guidance. Visual analog scale (VAS), foot ankle ability index (FAAI), pressure pain threshold (PPT), functional foot index (FFI), and plantar fascia thickness (PFT) were measured using US at baseline, 6 weeks and 24 weeks after the injection. Eventually, at the end of the treatment period, the patients' satisfaction was measured. Intention to treat analysis was used to assess the results. Results: After 24 weeks of follow-up, results from 60 subjects were fully obtained; however, results of 73 patients included into intention to treat analysis in the sixth-week followup. In both groups, VAS, PFT and FFI decreased, while FAAI and PPT increased significantly (P <0.001). At the baseline and at the 24th-week, no significant difference between the two groups was observed in any of the variables. However, a comparison between the baseline and the sixth-week results shows a prominent decrease in PPT and PFT in the CS group compared to the HA group (P = 0.004 and P = 0.011). Finally, there were no statistical differences between the two groups in treatment satisfaction (P = 0.618). Conclusion: Both CS and HA were effective modalities for PF and can improve pain and function with no superiority in 24th-week follow-ups, although CS seems to have a faster trend of improvement in the short term.

Effectiveness of prolotherapy vs local anesthetic infiltration guided by ultrasound in the treatment of shoulder pain syndrome

“…Raeissadat et al demonstrated in a prospective study that CS and PT in patients with plantar fasciitis has the same efficacy in pain relief after a 24-weeks follow up. 12 In this study, we have also demonstrated that the use of PT has the same efficacy as LA infiltration for chronic shoulder pain. We also found that pain relief does not depend on basal pain severity.…”

“…The copyright holder for this this version posted December 24, 2020. ; https://doi.org/10.1101/2020. 12…”

“…In figure 1 most common words used in PubMed publication about PT are represented. PT has demonstrated beneficial effects in function, pain relief, and quality of life in patients with osteoarthritis, plantar fasciitis and adhesive capsulitis; with high treatment adherence and patient satisfaction 12 13 . Bertrand et al demonstrated prolotherapy efficacy vs placebo in Painful Rotator Cuff Tendinopathy treatment with pain improvement and a higher patient satisfaction.…”

“…Therapy guided by ultrasonography (US) is an economic and fast tool to improve previously needle blinded procedures. It has the advantage of being less traumatic to tissues, because it allows puncture to the exact site of infiltration, making this therapy more accurate 1512 . PT has not been studied previously in should pain syndrome.…”

Beliefs, attitude, and knowledge of the Iranian physiatrists towards neuromusculoskeletal ultrasound and common barriers in its application

“…Currently, the most common indications of using ultrasound in PM&R by the practitioners are as follows: as a guide in peripheral nerve block, local anesthesia and other pain control procedures, intraarticular and spinal injections (epidural block, facet joints, ganglions and …), soft tissue injections, and the diagnostic role in pathologies such as tendon, muscle, and nerve injuries [3][4][5][6][7][8][9][10][11][12][13]. Also, this method has been used in evaluating joint disorders such as knee osteoarthritis and temporomandibular joint derangement [14,15].…”