Effectiveness of dextrose prolotherapy for the treatment of chronic plantar fasciitis: A systematic review and meta‐analysis of randomized controlled trials

Abstract

Objective To systematically investigate the efficacy and safety of dextrose prolotherapy for treating chronic plantar fasciitis. Literature survey EMBASE, PubMed, Scopus, and Google Scholar (from inception to December 9, 2021). Methodology Comprehensive review of randomized controlled trials investigating dextrose prolotherapy for chronic plantar fasciitis was done. Two investigators independently screened the titles, abstracts, and full texts and extracted data from eligible studies. The changes in visual analog scale (VAS) pain score, foot function index (FFI), American Orthopaedic Foot and Ankle Society (AOFAS) score, and plantar fascia thickness were analyzed. Reports of complications of the procedure were collected. Synthesis Eight randomized controlled trials (RCTs) were included in the meta‐analysis, analyzing 444 patients in total. The subgroup analysis showed that at short‐term follow‐up (<6 months) dextrose prolotherapy was more effective in reducing VAS pain score compared to the non‐active treatment control group including exercise and normal saline solution (NSS) injection. However, there was no difference in the change of VAS pain score between dextrose prolotherapy and active treatment control group, which included extracorporeal shock wave therapy (ESWT), steroid injection, and platelet‐rich plasma (PRP) injection. Dextrose prolotherapy was more effective in reducing FFI, increasing AOFAS score, and reducing plantar fascia thickness at short‐term (<6 months) follow‐up compared to other comparators. For long‐term (≥6 months) follow‐up, there was no significant difference in the change in VAS pain score and FFI between the dextrose prolotherapy group and other comparators. No serious complication was reported. Conclusions Dextrose prolotherapy is an effective treatment of chronic plantar fasciitis to reduce pain, improve foot functional score, and decrease plantar fascia thickness at short‐term follow‐up. Further studies in larger populations are needed to identify the optimal treatment regimen including dextrose concentration, volume, injection site, injection technique, and the number of injections required. The long‐term effects of these treatments also require further examination.

A protocol for a randomized clinical trial assessing the efficacy of hypertonic dextrose injection (prolotherapy) in chronic ankle instability

“…Dextrose prolotherapy (DPT) is an injection used to treat chronic painful musculoskeletal conditions through stimulation of tissue proliferations [14][15][16][17]. It consists of injections of hypertonic dextrose with a concentration between 10 and 25% to ligament-bone or tendonbone system or in the intra-articular space, which is performed repeatedly at the established interval.…”

Plantar Fasciitis: An Updated Review

“…However, the long-term effect (>6 months) was unclear. [ 50 ] As for the regimen, the most frequently used concentration of dextrose was 15% and 20%, and the injectate volume ranged between 2 mL to 10 mL at a time. The number of injections ranged between 1 to 3 times at a 1-week to 3-week interval.…”

“…Due to the highly heterogeneous protocols in previous studies, the optimal regimen of dextrose prolotherapy in treating PF was still undetermined. [ 50 ]…”

Prolotherapy in Musculoskeletal Disorders, Guideline for Orthopedic Application

“…A needle is inserted medially, perpendicular to the long axis of the transducer, approaching the most thickened and hypoechogenic area under sonographicguidance [49] [51]. In the palpation method, the injection can be administered in various techniques, including needle insertion into the most tender point of the heel [47] Compared with non-active treatments (normal saline injection and exercises), prolotherapy is significantly better at improving short-term pain [53]. Prolotherapy has been more effective than corticosteroid injection in long-term outcomes, while corticosteroid injection demonstrated more significant improvements in short-term evaluation [44].…”