Injected corticosteroids for treating plantar heel pain in adults.

NewsBot · Jun 12, 2017

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Injected corticosteroids for treating plantar heel pain in adults.
David JA, Sankarapandian V, Christopher PR, Chatterjee A, Macaden AS
Cochrane Database Syst Rev. 2017 Jun 11;6:CD009348. doi: 10.1002/14651858.CD009348.pub2.

BACKGROUND:
Plantar heel pain, commonly resulting from plantar fasciitis, often results in significant morbidity. Treatment options include nonsteroidal anti-inflammatory drugs (NSAIDs), orthoses, physical therapy, physical agents (e.g. extracorporeal shock wave therapy (ESWT), laser) and invasive procedures including steroid injections.
OBJECTIVES:
To assess the effects (benefits and harms) of injected corticosteroids for treating plantar heel pain in adults.
SEARCH METHODS:
We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials (the Cochrane Library), MEDLINE, Embase, CINAHL, clinical trials registries and conference proceedings. Latest search: 27 March 2017.
SELECTION CRITERIA:
Randomised and quasi-randomised trials of corticosteroid injections in the treatment of plantar heel pain in adults were eligible for inclusion.
DATA COLLECTION AND ANALYSIS:
At least two review authors independently selected studies, assessed risk of bias and extracted data. We calculated risk ratios (RRs) for dichotomous outcomes and mean differences (MDs) for continuous outcome measures. We used a fixed-effect model unless heterogeneity was significant, when a random-effects model was considered. We assessed the overall quality of evidence for individual outcomes using the GRADE approach.
MAIN RESULTS:
We included a total of 39 studies (36 randomised controlled trials (RCTs) and 3 quasi-RCTs) that involved a total of 2492 adults. Most studies were small (median = 59 participants). Participants' mean ages ranged from 34 years to 59 years. When reported, most participants had heel pain for several months. The trials were usually conducted in outpatient specialty clinics of tertiary care hospitals in 17 countries. Steroid injection was given with a local anaesthetic agent in 34 trials. Follow-up was from one month to over two years. With one exception, trials were assessed at high risk of bias in one or more domains, mostly relating to lack of blinding, including lack of confirmation of allocation concealment. With two exceptions, we rated the available evidence as very low quality, implying in each case that we are 'very uncertain about the estimate'.The 39 trials covered 18 comparisons, with six of the seven trials with three or four groups providing evidence towards two comparisons.Eight trials (724 participants) compared steroid injection versus placebo or no treatment. Steroid injection may lead to lower heel pain visual analogue scores (VAS) (0 to 100; higher scores = worse pain) in the short-term (< 1 month) (MD -6.38, 95% CI -11.13 to -1.64; 350 participants; 5 studies; I² = 65%; low quality evidence). Based on a minimal clinically significant difference (MCID) of 8 for average heel pain, the 95% CI includes a marginal clinical benefit. This potential benefit was diminished when data were restricted to three placebo-controlled trials. Steroid injection made no difference to average heel pain in the medium-term (1 to 6 months follow-up) (MD -3.47, 95% CI -8.43 to 1.48; 382 participants; 6 studies; I² = 40%; low quality evidence). There was very low quality evidence for no effect on function in the medium-term and for an absence of serious adverse events (219 participants, 4 studies). No studies reported on other adverse events, such as post-injection pain, and on return to previous activity. There was very low quality evidence for fewer treatment failures (defined variously as persistent heel pain at 8 weeks, steroid injection at 12 weeks, and unrelieved pain at 6 months) after steroid injection.The available evidence for other comparisons was rated as very low quality. We are therefore very uncertain of the estimates for the relative effects on people with heel pain of steroids compared with other interventions in:1. Tibial nerve block with anaesthetic (2 trials); orthoses (4 trials); oral NSAIDs (2 trials); and intensive physiotherapy (1 trial).2. Physical modalities: ESWT (5 trials); laser (2 trials); and radiation therapy (1 trial).3. Other invasive procedures: locally injectable NSAID (1 trial); platelet-rich plasma injections (5 trials); autologous blood injections (2 trials); botulinum toxin injections (2 trials); cryopreserved human amniotic membrane injection (1 trial); localised peppering with a needle (1 trial); dry needling (1 trial); and mini scalpel needle release (1 trial).We are also uncertain about the estimates from trials testing different techniques of local steroid injection: ultrasonography-guided versus palpation-guided (5 trials); and scintigraphy-guided versus palpation-guided (1 trial).An exploratory analysis involving pooling data from 21 trials reporting on adverse events revealed two ruptures of plantar fascia (reported in 1 trial) and three injection site infections (reported in 2 trials) in 699 participants allocated to steroid injection study arms. Five trials reported a total of 27 participants with less serious short-term adverse events in the 699 participants allocated steroid injection study arms. Reported treatments were analgesia, ice or both. Given the high risk of selective reporting for these outcomes and imprecision, this evidence was rated at very low quality.
AUTHORS' CONCLUSIONS:
We found low quality evidence that local steroid injections compared with placebo or no treatment may slightly reduce heel pain up to one month but not subsequently. The available evidence for other outcomes of this comparison was very low quality. Where available, the evidence from comparisons of steroid injections with other interventions used to treat heel pain and of different methods of guiding the injection was also very low quality. Although serious adverse events relating to steroid injection were rare, these were under-reported and a higher risk cannot be ruled out.Further research should focus on establishing the effects (benefits and harms) of injected steroids compared with placebo in typical clinical settings, subsequent to a course of unsuccessful conservative therapy. Ideally, this should be preceded by research, including patient involvement, aimed to obtain consensus on the priority questions for treating plantar heel pain.
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Admin2 · Jun 12, 2017

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Platelet rich plasma vs shock wave vs corticosteroids for plantar fasciitis

NewsBot · Jun 22, 2017

Shall We Inject Superficial or Deep to the Plantar Fascia? An Ultrasound Study of the Treatment of Chronic Plantar Fasciitis.
Gurcay E et al
J Foot Ankle Surg. 2017 Jul - Aug;56(4):783-787. doi: 10.1053/j.jfas.2017.03.004.

We compared the effectiveness of ultrasound (US)-guided corticosteroid, injected superficial or deep to the fascia, in patients with plantar fasciitis. Thirty patients (24 females [75%] and 6 males [25%]) with unilateral chronic plantar fasciitis were divided into 2 groups according to the corticosteroid injection site: superficial (n = 15) or deep (n = 15) to the plantar fascia. Patient heel pain was measured using a Likert pain scale and the Foot Ankle Outcome Scale (FAOS) for foot disability, evaluated at baseline and repeated in the first and sixth weeks. The plantar fascia and heel pad thicknesses were assessed on US scans at baseline and the sixth week. The groups were similar in age, gender, and body mass index (p > .05 for all). Compared with the baseline values, the Likert pain scale (p < .001 for all) and FAOS subscale (p < .01 for all) scores had improved at the first and sixth week follow-up visits in both groups. Although the plantar fascia thickness had decreased significantly in both groups at the sixth week (p < .001 for both), the heel pad thickness remained unchanged (p > .05 for both). The difference in the FAOS subscales (pain, p = .002; activities of daily living, p = .003; sports/recreational activities, p = .008; quality of life, p = .009) and plantar fascia thickness (p = .049) showed better improvement in the deep than in the superficial injection group. US-guided corticosteroid injections are safe and effective in the short-term therapeutic outcome of chronic plantar fasciitis. Additionally, injection of corticosteroid deep to the fascia might result in greater reduction in plantar fascia thickness, pain, and disability and improved foot-related quality of life.
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NewsBot · Jul 15, 2017

Ultrasound Guidance Does Not Improve the Results of Shock Wave for Plantar Fasciitis or Calcific Achilles Tendinopathy: A Randomized Control Trial.
Njawaya MM et al
Clin J Sport Med. 2017 Jul 11. doi: 10.1097/JSM.0000000000000430

OBJECTIVE:
To establish whether the use of ultrasound to direct shock waves to the area of greater calcification in calcaneal enthesopathies was more effective than the common procedure of directing shock waves to the point where the patient has the most tenderness.
DESIGN:
Two-armed nonblinded randomized control trial with allocation concealment.
SETTING:
The Sports Clinic at Sydney University.
PATIENTS:
Participants 18 years or older with symptomatic plantar fasciitis (PF) (with heel spur) or calcific Achilles tendinopathy (CAT). Seventy-four of 82 cases completed treatment protocol and 6-month follow-up.
INTERVENTIONS:
Patients were randomized to receive either ultrasound-guided (UG) or patient-guided (PG) shock wave at weekly intervals over 3 to 5 weeks.
MAIN OUTCOME MEASURES:
Reduced pain on visual analog scale (VAS) and improved functional score on Maryland Foot Score (MFS) (for PF) or Victorian Institute of Sport Assessment-Achilles (VISA-A) (for CAT). Follow-up was at 6 weeks and 3 and 6 months.
RESULTS:
Comparative 6-month improvements in MFS for the 47 PF cases were PG +20/100 and UG +14/100 (P = 0.20). Comparative 6-month improvement in VISA-A score for the 27 CAT cases were PG +35/100 and UG +27/100 (P = 0.37). Comparative (combined PF and CAT) 6-month improvement in VAS pain scores for all 38 PG cases were +38/100 with +37/100 for all 36 UG shock wave cases.
CONCLUSIONS:
Although both treatment groups had good clinical outcomes in this study, results for the 2 study groups were almost identical.
CLINICAL RELEVANCE:
This study shows that there is no major advantage in the addition of ultrasound for guiding shock waves when treating calcaneal enthesopathies (PF and CAT).
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NewsBot · Nov 10, 2017

Comparison of dry needling and steroid injection in the treatment of plantar fasciitis: a single-blind randomized clinical trial.
Rastegar S et al
Int Orthop. 2017 Nov 8. doi: 10.1007/s00264-017-3681-

INTRODUCTION:
Plantar fasciitis is a common cause of heel pain. Considering different interventions which are applied for patients with plantar fasciitis, dry needling is proposed as a new modality of treatment recently. The aim of this study is to evaluate the effectiveness of dry needling versus steroid injection for plantar fasciitis.
METHODS:
Sixty-six patients were recruited to this single-blind clinical trial study. Participants were randomly allocated to receive 1 ml (40 mg) of Depo-Medrol (methylprednisolone acetate) or dry needling. They were followed up for 12 months and monitored for total perception of pain using the visual analogue scale (VAS), with data obtained in baseline and at three weeks, six weeks, three months, six months and one year after treatment.
RESULTS:
Mean VAS score before treatment was 6.96 ± 0.87 for the steroid group and 6.41 ± 0.83 for the dry-needling group (P value = 0.54). Steroid injection reduced VAS scores rapidly until three weeks after treatment compared with dry needling (0.32 ± 0.71 and 3.47 ± 1.32, respectively; P value < 0.001). However, patients who were underwent dry needling reported lower VAS scores at the end of follow-up compared with the steroid group (0.69 ± 0.93 and 2.09 ± 1.58, respectively; P value = 0.004). Over the long term, 82.3% and 17.6% of changes in pain were contributed to time since treatment and treatment method, respectively (P values < 0.001).
CONCLUSIONS:
Steroid injection can palliate plantar heel pain rapidly but dry needling can provide more satisfactory results for patients with plantar fasciitis in the long term.
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NewsBot · Mar 8, 2018

Comparative efficacy of corticosteroid injection and non-invasive treatments for plantar fasciitis: a systematic review and meta-analysis.
Chen CM et al
Sci Rep. 2018 Mar 5;8(1):4033. doi: 10.1038/s41598-018-22402-w.

The first choice of treatment for patients with plantar fasciitis is non-invasive treatment, rather than corticosteroid injection (CSI). However, no comprehensive study has compared the effectiveness of CSI with non-invasive treatments for plantar fasciitis. We conducted a meta-analysis comparing CSI and non-invasive treatment effects on plantar fasciitis. The primary outcome was pain reduction. Nine randomized controlled trials comparing CSI with 4 non-invasive treatment types were included. A trend favoring CSI over non-invasive treatments was indicated regarding reduction in the visual analogue scale (VAS) score at 1-1.5 (mean difference (MD), 1.70; 95% confidence interval (CI) = 0.39-3.01; P = 0.01) and 2-3 months (MD, 1.67; 95% CI = 0.58-2.76; P = 0.003). At 1.5-month follow-up, CSI was associated with improved VAS score compared with physical therapy (PT) (MD, 2.5; 95% CI = 0.1-4.9; P = 0.04). No significant differences in the VAS score reduction were observed between CSI and shock wave therapy within 3 months. In summary, CSI tends to be more effective for pain reduction than non-invasive treatments within 3 months. Moreover, CSI provides significant pain relief at 1.5 months after treatment compared with PT. This study provides important clinical information for selecting therapeutics.
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NewsBot · Jul 18, 2018

The effectiveness of steroid injection in treatment of plantar fasciitis: A systematic review and meta-analysis of controlled-randomized trials
J.LeeY.H.Kim
Annals of Physical and Rehabilitation Medicine; Volume 61, Supplement, July 2018, Pages e150-e151

Introduction/Background
Plantar fasciitis is very troublesome in clinical fields. Although steroid injection has been a widely used treatment option in musculoskeletal disorders, there have been arguments about the effectiveness in plantar fasciitis. This study is to determine the effectiveness of steroid injection in the treatment of plantar fasciitis.

Material and method
Meta-analysis was conducted using searching engines such as Google Scholar, PubMed, CINAHL, Embase and manual searching which were searched to December 2017. The following key search terms were used; plantar fasciopathy fasciitis in google scholar, “fasciitis, plantar”[Mesh] with two filter options “Randomized Controlled Trial” and “human” in PubMed, plantar fasciopathy fasciitis in CINAHL, plantar AND fasciopathy AND (“fasciitis” OR “fasciitis”/exp OR fasciitis) in Embase. Two articles were also found using manual searching. Total 35 articles were found and duplicates were removed. Two reviewers reviewed and selected the articles, which has randomized controlled design and eligible data. Four articles were determined to be relevant, meeting inclusion and exclusion criteria.

Results
We found that the overall standardized mean differences of pain outcome between steroid injection and other treatments or sham was −0.57 (95% confidence interval: −0.83 to −0.30), with low heterogeneity (P = 0.52, I2 = 0%) at 1 month, but −0.33 (95% confidence interval: −0.76 to 0.10, P = 0.13, I2 = 50%) at 3 month. It suggested evidence of the effectiveness of short-term steroid injection, compared with autologous blood injection or other conservative treatment, but limited evidence of long-term effectiveness and functional improvement.

Conclusion
Although steroid injection in treating plantar fasciitis has been arguing, there is evidence of the effectiveness of steroid injection in relieving pain for 1 month. But further study is needed to determine long-term effectiveness of steroid injection.
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NewsBot · Aug 28, 2018

Effectiveness of Four Different Treatment Modalities in the Treatment of Chronic Plantar Fasciitis During a 36-Month Follow-Up Period: A Randomized Controlled Trial
MeriçUğurlarMD et al
The Journal of Foot and Ankle Surgery;Volume 57, Issue 5, September–October 2018, Pages 913-918

No consensus has been reached about the best treatment method of plantar fasciitis and the results of the treatment methods have been inconsistent. The objective of the present study was to compare the therapeutic effects of extracorporeal shock wave therapy, platelet-rich plasma injection, local corticosteroid injection, and prolotherapy for the treatment of chronic plantar fasciitis using a randomized, controlled, prospective study. We performed a randomized controlled prospective clinical study of 4 groups. The first group received extracorporeal shock wave therapy, the second group received prolotherapy, the third group received platelet-rich plasma injection, and the fourth group received a local corticosteroid injection. The study included 158 consecutive patients with a diagnosis of chronic plantar fasciitis with a symptomatic heel spur. The clinical outcomes were assessed using the visual analog scale and Revised Foot Function Index. At the end of the follow-up period, the mean visual analog scale scores for all 4 groups were similar to the mean visual analog scale scores before treatment. At the end of the follow-up period, no significant improvement was noted in the Revised Foot Function Index score in any of the groups. The corticosteroid injection was more effective in the first 3 months and extracorporeal shock wave therapy was an effective treatment method in the first 6 months in regard to pain. The corticosteroid injection lost its effectiveness during the follow-up period. The effect of prolotherapy and platelet-rich plasma was seen within 3 to 12 months; however, at the 36-month follow-up point, no differences were found among the 4 treatments.
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NewsBot · Nov 19, 2018

Corticosteroid injection is the best treatment in plantar fasciitis if combined with controlled training.
Johannsen FE et al
Knee Surg Sports Traumatol Arthrosc. 2018 Nov 15

PURPOSE:
Plantar fasciitis is a very common (lifetime incidence ~ 10%) and long-lasting injury with major impact on daily function. Combining corticosteroid injection and physical training (strength training and stretching) was hypothesized to result in a superior effect compared to each treatment separately.

METHODS:
A single blinded randomized controlled superiority trial conducted in 2013-2014 with a 2-year follow-up (end Sept 2016). 123 consecutive patients (20-65 years) referred to two study centers in Denmark: Institute of Sports Medicine, Bispebjerg Hospital, University of Copenhagen and a private rheumatology clinic with symptoms of plantar fasciitis, and ultrasound measured thickness above 4.0 mm were invited. 25 did not fulfill the inclusion criteria (mainly ultrasound criteria) and 8 refused participation. 90 patients were randomized (pulling sealed envelopes) to 3 groups: (1) 3 months strength training and stretching (n = 30), (2) corticosteroid injections with monthly intervals until thickness < 4.0 mm (maximum 3 injections) (n = 31), (3) combination of the two treatments (n = 29). During the 3 months intervention period load reduction was recommended (cushioning shoes and insoles and abstaining from running and jumping). The main outcome was improvement in Pain at function on a 100-mm VAS score and in Foot Function Index (FFI, range 0-230) at 6 months (Clinicaltrials.gov Identifier: NCT01994759).

RESULTS:
All groups improved significantly over time, but the combination of corticosteroid injection and training (strength training and stretching) had a superior effect at all time points. The mean difference between the combined treatment and training was 40 points in FFI (95% confidence interval (CI) 63-17 points, p < 0.001) and 20 mm for VAS function pain (CI 35-5 mm, p < 0.01). The mean difference between the combined treatment and corticosteroid injections only was 29 points in FFI (CI 52-7 points, p < 0.01) and 17 mm for VAS function pain (CI 32-2 mm, p < 0.05). All differences were clinically relevant.

CONCLUSION:
The best treatment for plantar fasciitis is the combination of corticosteroid injections and training (strength training and stretching). This combined treatment is superior both in the short- and in the longterm. Corticosteroid injections combined with controlled training are recommended as first line treatment in patients with plantar fasciitis.
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NewsBot · Feb 21, 2019

Plantar fasciitis treatment: What is better, oral
nonsteroidal anti-inflammatory agents or locally
injectable steroid?
Dr. Vaibhav Mittal, Dr. Nagakumar JS, Dr. Wayal Utkarsha Ashok and
Dr. Arun HS
International Journal of Orthopaedics Sciences 2018; 4(1): 247-251

Plantar fasciitis is the one of the most common causes of painful heel in adults. It is assumed to be caused
by inflammation and is typically precipitated by biomechanical stress. Conservative management is the
mainstream treatment option for plantar fasciitis like non steroidal anti-inflammatory drugs (NSAIDs),
steroid injections, PRP injection, stretching exercises. There is no consensus on the efficacy of any
particular conservative treatment regimen. This study was taken with objective to compare the efficacy of
NSAID and local steroid injection in treating plantar fasciitis. Method: Sixty patients were randomized
into 2 groups, group I patients were treat with oral NSAIDs and group II patients were treated with local
steroid injection. Patients of both groups are given common supportive measures such as soft heel and
advised same stretching exercises. The patients were evaluated using VAS score for pain assessment at
pre-treatment stage, 1 week, 2 weeks, 4 weeks, 2 months and 3 months. Results: 60 patients were
randomized into 2 groups, both groups had similar demographics. The VAS scores at pre treatment level
in group I was 6.60±1.14 and in group II was 6.46±1.05. The VAS score reduced to 3.10±1.18 in group II
after injection and in group I reduced to 4.9±1.33 after a starting oral NSAIDs. The VAS scores
consistently reduced in both the groups till 4 weeks of follow up but group II VAS scores were always
lower than group I (p-value < 0.001). After 4 weeks, a trend towards increase in VAS scores was noted in
both groups, patients had complaints of relapse of pain or increase in intensity of it. Conclusion : With
this study we concluded that as compared to NSAIDs the use of local injection of steroid gives better and
more sustained pain relief with fewer complications and lesser recurrences of heel pain in cases of plantar
fasciitis.
Keywords:
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NewsBot · Aug 19, 2019

Corticosteroid injection for plantar heel pain: a systematic review and meta-analysis
Glen A. Whittaker, Shannon E. Munteanu, Hylton B. Menz, Daniel R. Bonanno, James M. Gerrard & Karl B. Landorf
BMC Musculoskeletal Disordersvolume 20, Article number: 378 (2019)

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.
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NewsBot · Feb 23, 2020

Corticosteroid injection as a treatment modality in management of plantar fasciitis.
Ahmed M, Kumar M, Hamid R, Nida , Hussain G.
RMJ. 2020; 45(1): 120-122.

Objective: To study the efficacy of corticosteroid injection as treatment modality in management of plantar fascitis.
Methodology: A total of I50 patients of both the genders diagnosed as a case of plantar fascitis were included in study. Patients above the age of 25 years with pain for more than 6 weeks were included and patients with pain secondary to trauma, infection or tumors were excluded from the study. Final results were evaluated by comparison of Visual analog score (VAS) for pain before the corticosteroid injection, immediately after the injection, after the interval of 15 days, I month and 3 months.
Results: Out of 150 patients, 95(63%) were female and 55(37%) males. Mean age was 43ï‚±0.707 years (range 40-49). 109 patients were overweight lying in range of 25-29.9 BMI. Mean BMI was 28.4ï‚±0.212. Mean VAS for pain before the corticosteroid injection was 9.48, and immediately after the corticosteroid injection mean VAS was 1.02 and at 15 days, 1 month and 3 months it was 1.89, 2.21 and 2.52, respectively.
Conclusion: Corticosteroid injection is an effective option for the management of plantar fascitis, as it dramatically reduced the pain in these patients.
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NewsBot · Jun 5, 2020

Treatment outcome of plantar fasciitis with local steroid injection by ultrasound versus
palpation technique
Deepak Kumar Sharma et al
IP International Journal of Orthopaedic Rheumatology, July-December, 2019;5(2):30-34

Introduction: Plantar fasciitis is a degenerative tissue condition that occurs at the site of origin of plantar fascia at the medial tuberosity of
calcaneum. Most commonly reported symptom of plantar fasciitis is described as first step pain. Treatment of plantar fasciitis include
methods such as heat modalities, patient education, massage, stretching and strengthening exercises, extracorporeal shockwave therapy,
non-steroidal anti-inflammatory medications, injections (steroids, local anesthetics, PRP), and surgical interventions (fasciotomy).
Objective: The purpose of the study is to prospectively evaluate comparative efficacy of ultrasound guided steroid injection versus
palpation technique.
Materials and Methods: It is a prospective and interventional randomized comparative study. Eighty cases (40 in each group) in otherwise
healthy individuals with the diagnosis of unilateral or bilateral plantar fasciitis attending Outpatient department of PMR of VMMC &
Safdarjung hospital were enrolled in this study. The diagnosis of plantar fasciitis was made based on history and clinical examination.
Patients who satisfied inclusion and exclusion criteria was randomly assigned by computerized block method to two groups-both groups
were treated with injection of 40 mg(1ml) methyl prednisolone, one group with palpation guided (group A) and other with ultrasound
guided(group B). All patients underwent pain intensity assessment (VAS), ultrasound examination of foot for plantar fascia thickness and
x-ray foot for heel pad thickness at pre injection (0 week), 2 weeks and 8 weeks after steroid injection.
Result: Statistically significant improvement in pain (VAS) at the end of 2 weeks (3.25±0.95 vs 2.65±0.83, p=0.003) and 8weeks
(2.28±1.24 vs 1.12±1.07, p=0.0005) of intervention in both groups but more in USG guided group. There was decrease in plantar fascia
thickness at the end of 2 weeks (0.33±0.02 vs 0.31±0.02, p=0.0005) and 8 weeks (0.30±0.02 vs 0.28±0.02, p=0.0005) of intervention in
both groups but more in USG guided group, this was statistically significant. No significant difference in heel pad thickness at the end of 2
weeks (18.08±0.76 vs 18.23±0.80, p=0.356) and 8weeks (18.00±0.75 vs 18.12±0.79, p=0.444) of intervention in both groups.
Conclusion: Ultrasound guided injection is better than palpation method as it enhances the accuracy of injection by precisely localizing the
lesion and needle placement giving more relief in symptoms and normalization of plantar fascia thickness.
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NewsBot · Feb 14, 2023

The role of corticosteroid injections in treating plantar fasciitis: A systematic review and meta-analysis
Ishith Seth et al
Foot (Edinb). 2023 Feb 3

Background: Plantar fasciitis is a recurrent cause of heel pain and is often treated by corticosteroid infections (CSI). The current study reviewed and analysed the role of CSI with platelet rich plasma (PRP), and CSI with extracorporeal shock wave therapy (EWST) for plantar fasciitis treatment.

Methods: PubMed, Medline, Web of Science, Embase, Cochrane, and Google Scholar databases were searched for relevant studies. Preferred Reporting in Systematic Review & Meta-Analysis (PRISMA) guidelines were used to search relevant studies published from infinity to April 2021. The risk of bias was performed using Cochrane Collaboration's tool. GRADE assessment was used for quality of evidence. Data analysis was performed with the use of R software and P < 0.05 was considered statistically significant. CSI was compared with PRP and EWST.

Results: Eighteen studies comprising 1180 patients were included in this meta-analysis. When compared to PRP, CSI with lignocaine/lidocaine had significantly higher mean difference on visual analogue scale (VAS) pain scores at 3 months (0.62 [0.13; 1.12], P = 0.01) and 6 months (MD = 1.49 [0.22; 2.76], P = 0.02). At 6 months, VAS scores were higher in the CSI group than the ESWT group (MD = 0.8 [0.38; 1.22], P = 0.1). At 6 months, a significant reduction in the American Orthopaedic Foot and Ankle Score (AOFAS) was observed in the CSI group compared to PRP (MD = - 11.53 [- 16.62; - 6.43], P < 0.0001).

Conclusion: Patients suffering from plantar fasciitis, PRP achieved better VAS scores compared to CSI at 3 and 6-month follow-up. In addition, ESWT had better VAS score outcomes at 6 months compared to CSI. Regarding AOFAS score, PRP was more efficacious than CSI at 6 months of follow-up. Only through the development of high-quality, large-scale longitudinal studies, will the findings and conclusions of this meta-analysis be strengthened and influence our clinical practice in the treatment of plantar fasciitis.
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NewsBot · Jul 25, 2023

Effect of corticosteroids over plantar fascia thickness in plantar fasciitis: a systematic review and meta-analysis
Víctor M. Peña-Martínez et al
The Physician and Sportsmedicine: 13 Jun 2023

Objectives
Corticosteroid injections have been typically used for the management of plantar fasciitis with apparently good clinical outcomes; however, there is no information of the effect of corticosteroids on the thickness of the plantar fascia which is typically altered in this pathology. We aimed determine whether treatment with corticosteroid injections induces plantar fascia thickness changes in plantar fasciitis

Methods
MEDLINE, Embase, Web of Science, and Scopus databases were searched for randomized controlled trials (RCT) reporting the use of corticosteroid injection to treat plantar fasciitis to July 2022. Studies must have reported plantar fascia thickness measurement. The risk of bias in all studies was assessed with the Cochrane Risk of Bias 2.0 tool. Meta-analysis was conducted using a random-effects model and the generic inverse variance method.

Results
Data from 17 RCT (including 1109 subjects) were collected. The follow-up period ranged from one to six months. Most studies measured the thickness of the plantar fascia at the insertion into the calcaneus using ultrasound. Pooled analysis revealed that corticosteroid injections had no significant effect on plantar fascia thickness (weighted mean differences [WMD], 0.06 mm [95% CI: −0.17, 0.29]; p = 0.61) or pain relief (WMD, 0.12 cm [95% CI: −0.36, 0.61]; p = 0.62) above active controls.

Conclusion
Corticosteroid injections do not perform better than other common interventions in terms of a decrease of plantar fascia thickness and pain relief for plantar fasciitis.
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NewsBot · Aug 1, 2023

Effectiveness of corticosteroid injection in the treatment of plantar fasciitis: Review.
Indian Journal of Basic & Applied Medical Research . Jun2023, Vol. 12 Issue 3, p156-161. 6p.
NAVEEN P. R.; BHARATH, NAVEEN; BADAMI, RAMCHANDRA; S. N., NAVEEN PRASAD

Background: Plantar fasciitis is a common cause of heel pain, characterized by inflammation and micro-tears in the plantar fascia. Corticosteroid injections have been used as a treatment option due to their potent anti-inflammatory properties. However, the long-term effectiveness and potential side effects of corticosteroid injections are still debated. Methods: This review study evaluated the effectiveness of corticosteroid injections in plantar fasciitis by analyzing 10 randomized controlled trials (RCTs). A systematic search was conducted on PubMed and the Cochrane Central Register of Controlled Trials. The selected RCTs were assessed using the Jadad scoring system. The analysis focused on pain reduction and functional outcomes as the main outcome measures. Results: The analysis of the selected RCTs demonstrated that corticosteroid injections significantly reduced pain associated with plantar fasciitis. Patients receiving corticosteroid injections showed improved mobility, increased ability to perform daily activities, and enhanced overall quality of life compared to control groups. However, the effectiveness varied across studies, possibly due to differences in study design, injection techniques, dosages, and follow-up durations. Temporary adverse effects, such as pain at the injection site and local tissue atrophy, were reported in some studies. Conclusion: Corticosteroid injections can be an effective treatment option for plantar fasciitis, providing significant pain reduction and improved functional outcomes. However, individual patient characteristics and potential risks should be considered when deciding on treatment. Further well-designed studies are needed to assess the long-term effects and safety profile of corticosteroid injections in plantar fasciitis management.
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NewsBot · Aug 3, 2023

Does a corticosteroid injection plus exercise or exercise alone add to the effect of patient advice and a heel cup for patients with plantar fasciopathy? A randomised clinical trial
Henrik Riel et al
Source

Objective To compare the effectiveness of patient advice plus heel cup alone (PA) versus PA and lower limb exercise (PAX) versus PAX plus corticosteroid injection (PAXI) to improve self-reported pain in patients with plantar fasciopathy.

Methods We recruited 180 adults with plantar fasciopathy confirmed by ultrasonography for this prospectively registered three-armed, randomised, single-blinded superiority trial. Patients were randomly allocated to PA (n=62), PA plus self-dosed lower limb heavy–slow resistance training consisting of heel raises (PAX) (n=59), or PAX plus an ultrasound-guided injection of 1 mL triamcinolone 20 mg/mL (PAXI) (n=59). The primary outcome was changed in the pain domain of the Foot Health Status Questionnaire (ranging from 0 ‘worst’ to 100 ‘best’) from baseline to the 12-week follow-up. The minimal important difference in the pain domain is 14.1 points. The outcome was collected at baseline and at 4, 12, 26, and 52 weeks.

Results The primary analysis found a statistically significant difference between PA and PAXI after 12 weeks favouring PAXI (adjusted mean difference: −9.1 (95% CI −16.8 to −1.3; p=0.023)) and over 52 weeks (adjusted mean difference: −5.2 (95% CI −10.4 to −0.1; p=0.045)). At no follow-up did the mean difference between groups exceed the pre-specified minimal important difference. No statistically significant difference was found between PAX and PAXI or between PA and PAX at any time.

Conclusion No clinically relevant between-group differences were found after 12 weeks. The results indicate that combining a corticosteroid injection with exercise is not superior to exercise or no exercise.
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NewsBot · Aug 9, 2023

Effect of corticosteroids over plantar fascia thickness in plantar fasciitis: a systematic review and meta-analysis
Víctor M Peña-Martínez et al
Phys Sportsmed. 2023 Jun 13;1-12

Objectives: Corticosteroid injections have been typically used for the management of plantar fasciitis with apparently good clinical outcomes; however, there is no information of the effect of corticosteroids on the thickness of the plantar fascia which is typically altered in this pathology. We aimed determine whether treatment with corticosteroid injections induces plantar fascia thickness changes in plantar fasciitis.

Methods: MEDLINE, Embase, Web of Science, and Scopus databases were searched for randomized controlled trials (RCT) reporting the use of corticosteroid injection to treat plantar fasciitis to July 2022. Studies must have reported plantar fascia thickness measurement. The risk of bias in all studies was assessed with the Cochrane Risk of Bias 2.0 tool. Meta-analysis was conducted using a random-effects model and the generic inverse variance method.

Results: Data from 17 RCT (including 1109 subjects) were collected. The follow-up period ranged from one to six months. Most studies measured the thickness of the plantar fascia at the insertion into the calcaneus using ultrasound. Pooled analysis revealed that corticosteroid injections had no significant effect on plantar fascia thickness (weighted mean differences [WMD], 0.06 mm [95% CI: -0.17, 0.29]; p = 0.61) or pain relief (WMD, 0.12 cm [95% CI: -0.36, 0.61]; p = 0.62) above active controls.

Conclusion: Corticosteroid injections do not perform better than other common interventions in terms of a decrease of plantar fascia thickness and pain relief for plantar fasciitis.
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NewsBot · Sep 19, 2023

CORTICOSTEROID INJECTION FOR PLANTAR FASCIITIS: AN AUDIT OF FINDINGS

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