The effectiveness of dextrose prolotherapy in plantar fasciitis

Abstract

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.

The effect of dextrose prolotherapy versus placebo/other non‐surgical treatments on pain in chronic plantar fasciitis: a systematic review and meta‐analysis of clinical trials

“…However, we were able to pool the eight included studies for the short-term pain and foot function outcomes, leaning towards more conclusive results. On the other hand, Lai et al reported that DPT was inferior to corticosteroid injection in the short-term [21], which is contrary to our results. This can be justified by the different classifications of follow-up periods in their study and ours, as well as combining two heterogeneous foot function indices by Lai et al [21].…”

“…The contradictory findings of these systematic reviews and meta-analyses may be due to the inclusion of a broad range of conditions. Our findings are to some extent in line with those of Lai et al [21], who included a fewer number of trials in their meta-analysis. However, we were able to pool the eight included studies for the short-term pain and foot function outcomes, leaning towards more conclusive results.…”

“…Previous systematic reviews and meta-analyses in this regard have either evaluated the effects of prolotherapy on musculoskeletal pain or lower limb tendinopathy and fasciopathy, or investigated other treatment strategies for the treatment of plantar fasciitis [17][18][19][20]. A very recent systematic review and meta-analysis evaluated the effectiveness of dextrose prolotherapy in plantar fasciitis and reported potential long-term benefits for dextrose prolotherapy [21]; however, some relevant studies were not included. Therefore, we aimed to perform a more comprehensive systematic review and meta-analysis of clinical trials evaluating the efficacy of dextrose prolotherapy versus other non-surgical treatments on pain in chronic plantar fasciitis.…”

Crosslinking chitosan with glucose via the modified Maillard reaction promotes the osteoinduction of mouse MC3T3‐E1 pre‐osteoblasts

“…This reaction can condense the amino group of chitosan with the carbonyl group of a carbohydrate, such as glucose, and significantly alleviate the drawbacks of chitosan 3,9 . Glucose, a necessary nutrient for human beings, has also been indicated as a potential strategy for improving patient discomfort with different diseases through prolotherapy injection 11,12 . Therefore, the Maillard reaction with glucose has been proposed as a hopeful and safe method to improve further and promote the application of chitosan in the repair and regeneration of bone defects.…”

The mechanism of action of pulsed radiofrequency in reducing pain: a narrative review

“…However, they can have adverse effects including flushing, hyperglycemia, allergic reactions, menstrual changes, immunosuppression, and adrenal suppression [ 5 , 6 ]. To date, many injection materials have been suggested as substitutes for corticosteroids [ 7 - 9 ]. However, the effectiveness of materials that substitute corticosteroids is generally inferior to that of corticosteroids.…”