Comparative Effectiveness of Minimally Invasive Nonsurgical Treatments for Plantar Fasciitis: A Network Meta-analysis of 30 Randomized Controlled Trials

Pain Physician. 2021 Nov;24(7):E955-E971.

Abstract

Background: Several minimally invasive nonsurgical treatments have been widely applied for plantar fasciitis (PF). To date, controversy still exists regarding the effectiveness of these approaches for treating PF.

Objective: The purpose of this study was to perform a comprehensive comparison of the currently available invasive nonsurgical treatments for PF regarding short- and mid-term reductions in pain using a network meta-analysis (NMA).

Study design: NMA of randomized controlled trials (RCTs) for minimally invasive nonsurgical treatments of PF.

Methods: The EMBASE, PubMed, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched for eligible studies. Patients were adults age >= 18 years with PF. The outcome measures were the visual analog scale (VAS) scores at 3-6 weeks and 4-6 months. Pairwise meta-analysis and NMA based on a Bayesian analysis were performed, and all potential comparisons and rank of probabilities were calculated.

Results: Thirty RCTs were included in the NMA. The trials investigated 20 treatments or combined treatments, including autologous whole blood, botulinum toxin A (BTA), ultrasound-guided gastrocnemius injection of botulinum toxin (BTA in the gastrocnemius), corticosteroid (CS), miniscalpel-needle (MSN), placebo, platelet-rich plasma (PRP), and the ultrasound-guided technique and peppering technique (PEP). The MSN treatment may be the best choice.

Limitations: Some treatments were investigated in only one study or at one follow-up period and were separated from the network at 4-6 months. Other limitations include the inconformity of the treatment schedule and dose.

Conclusions: The MSN treatment should be recommended as the best therapy, followed by BTA in the gastrocnemius and BTA. CS and PRP are common medications that remain valuable in clinical practice. PEP can be performed after the injection of medication.

Keywords: Bayesian analysis; botulinum toxin A; network meta-analysis; randomized controlled trials; visual analog scale; Plantar fasciitis.