The role of corticosteroid injections in treating plantar fasciitis: A systematic review and meta-analysis

Foot (Edinb). 2023 Mar:54:101970. doi: 10.1016/j.foot.2023.101970. Epub 2023 Feb 3.

Abstract

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.

Level of clinical evidence: II.

Keywords: Corticosteroid injections; Plantar fasciitis; Plantar heel pain; Platelet rich plasma.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Extracorporeal Shockwave Therapy*
  • Fasciitis, Plantar* / drug therapy
  • Humans
  • Lidocaine / therapeutic use
  • Pain / drug therapy
  • Platelet-Rich Plasma*
  • Treatment Outcome

Substances

  • Adrenal Cortex Hormones
  • Lidocaine