Effectiveness of Four Different Treatment Modalities in the Treatment of Chronic Plantar Fasciitis During a 36-Month Follow-Up Period: A Randomized Controlled Trial

J Foot Ankle Surg. 2018 Sep-Oct;57(5):913-918. doi: 10.1053/j.jfas.2018.03.017.


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.

Keywords: corticosteroid; extracorporeal shock wave therapy; injection; plantar fasciitis; platelet-rich plasma; prolotherapy.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use*
  • Adult
  • Anesthetics, Local / administration & dosage
  • Bupivacaine / administration & dosage
  • Chronic Disease
  • Extracorporeal Shockwave Therapy*
  • Fasciitis, Plantar / complications
  • Fasciitis, Plantar / therapy*
  • Female
  • Follow-Up Studies
  • Heel Spur / complications
  • Humans
  • Injections
  • Male
  • Middle Aged
  • Pain Measurement
  • Platelet-Rich Plasma*
  • Prolotherapy*
  • Prospective Studies
  • Treatment Outcome
  • Visual Analog Scale
  • Young Adult


  • Adrenal Cortex Hormones
  • Anesthetics, Local
  • Bupivacaine