Effect of Dextrose Prolotherapy on Pain Intensity, Disability, and Plantar Fascia Thickness in Unilateral Plantar Fasciitis

Abstract

Objective The aim of the study was to evaluate the efficacy of dextrose prolotherapy in the treatment of chronic resistant plantar fasciitis through comparison with a control group. Design In this double-blind, randomized, controlled study, the patients were divided into two groups. The prolotherapy group (n = 30) was administered 5 ml of 30% dextrose, 4 ml of saline, and 1 ml of 2% lidocaine mixture (15% dextrose solution) and the control group was given 9 ml of saline and 1 ml of 2% lidocaine mixture twice at a 3-wk interval. During the 15-wk follow-up period, pain intensity was measured using the visual analog scale during activity and at rest. The foot function index was used to measure pain and disability. The plantar fascia thickness was measured by ultrasonography. The measurements were undertaken before treatment and at posttreatment weeks 7 and 15. Results Improvements in visual analog scale during activity, at rest, foot function index (all subgroups), and plantar fascia thickness measured at the 7th and 15th weeks were significantly higher in the prolotherapy group compared with the control group (P < 0.001). Conclusions Dextrose prolotherapy has efficacy up to 15 wks and can be used as an alternative method in the treatment of chronic resistant plantar fasciitis.

The effectiveness of dextrose prolotherapy in plantar fasciitis

“…[ 18 ] Regarding dextrose prolotherapy (DPT) protocols, the concentrations of the injected dextrose solution ranged from 1.5% [ 18 ] to 20%, [ 19 , 21 ] and only in 2 studies, [ 19 , 21 ] injected dextrose solution did not add any local anesthetics (lidocaine or bupivacaine). Various injection regimens were adopted: 2 studies [ 18 , 20 ] had 3 prolotherapy sessions; 3 studies [ 17 , 21 , 22 ] had 2 sessions; and 1 study involved 1 session. [ 19 ] The comparative arms included 1 or more of normal saline injection, extracorporeal shock wave therapy (ESWT), exercise control, platelet-rich plasma (PRP), and corticosteroid injection.…”

“…Data from 2 studies [ 20 , 22 ] were pooled and analyzed. The DPT group had significantly lower pain scores both in the short-term (SMD: −1.163, 95%CI: −2.17 to −0.156, I 2 = 83.5%) and medium-term (SMD: −1.394, 95%CI: −2.702 to −0.085, I 2 = 89.5%).…”

“…3 A and B). In addition, 1 study [ 22 ] found significantly decreased PF thickness over short-term ( P < .001) and medium-term follow-up ( P < .001) in the DPT group as compared with the group that received normal saline injections.…”

“…However, Rabago et al [ 34 ] and Bertrand et al [ 35 ] reported symptom improvement without accompanying connective tissue change on imaging (ultrasonography or magnetic resonance imaging) studied in patients receiving DPT, which cannot be explained by the analgesic effect of dextrose alone. In this review, 3 included studies [ 19 , 21 , 22 ] found that DPT was able to decrease abnormal swelling of PF in patients and reduce pain intensity. Other related physiological changes following injection of local dextrose injection as well as their correlation to clinical symptoms require further research.…”

Evaluation of the Treatment Efficacy of Corticosteroid Injection in Reducing the Pain Intensity in the Patients Diagnosed with the Plantar Fasciitis

“…Its distribution is bimodal. It affect both sedentary and sports person [7][8] . It is self-limiting process but sometimes it become, worsen over-time.…”