Ultrasound guided corticosteroid injection for plantar fasciitis: randomised controlled trial

Abstract

Objective To investigate the effectiveness of ultrasound guided corticosteroid injection in the treatment of plantar fasciitis.Design Randomised, investigator and participant blinded, placebo controlled trial.Setting University clinic in Melbourne, Australia.Participants 82 people with a clinical and ultrasound diagnosis of plantar fasciitis unrelated to systemic inflammatory disease.Interventions Participants were randomly allocated to ultrasound guided injection of the plantar fascia with either 1 mL of 4 mg/mL dexamethasone sodium phosphate (experimental group) or 1 mL normal saline (placebo). Before injection the participants were given an ultrasound guided posterior tibial nerve block with 2% lidocaine (lignocaine).Main outcome measures Primary outcomes were pain, as measured by the foot health status questionnaire (0-100 point scale), and plantar fascia thickness, measured by ultrasound at 4, 8, and 12 weeks.Results Reduction in pain at four weeks favoured the dexamethasone group by 10.9 points (95% confidence interval 1.4 to 20.4, P=0.03). Between group differences for pain scores at eight and 12 weeks were not statistically significant. Plantar fascia thickness measured at four weeks favoured the dexamethasone group by −0.35 mm (95% confidence interval −0.67 to −0.03, P=0.03). At eight and 12 weeks, between group differences for plantar fascia thickness also favoured dexamethasone, at −0.39 mm (−0.73 to −0.05, P=0.02) and −0.43 mm (−0.85 to −0.01, P=0.04), respectively. The number needed to treat with dexamethasone for one successful outcome for pain at four weeks was 2.93 (95% confidence interval 2.76 to 3.12). There were no reported adverse events associated with the intervention.Conclusion A single ultrasound guided dexamethasone injection is a safe and effective short term treatment for plantar fasciitis. It provides greater pain relief than placebo at four weeks and reduces abnormal swelling of the plantar fascia for up to three months. However, clinicians offering this treatment should also note that significant pain relief did not continue beyond four weeks.

Corticosteroid versus placebo injection for plantar fasciitis: A meta-analysis of randomized controlled trials

“…In the present analysis, two studies (8,10) reported that no adverse event occurred. This was not mentioned in two other studies (7,9).…”

“…The incidence rate of the condition increases with age (13). In the present study, the average body mass index was mentioned in three studies (8)(9)(10) and ranged from 30.9 to 32.4 kg/m 2 . The incidence of plantar fasciitis in obese individuals has been found to be 5.6-fold higher than that in the non-obese (16).…”

“…The follow-up duration varied among the included studies, and the results were pooled based on different follow-up durations. The VAS scores after one, two and three month(s) were reported in three (7-9), two (8,9) and three (7,8,10) studies, respectively. The results showed that pain relief was achieved after one month by corticosteroid injection (SMD, -0.32; 95% CI, -0.59--0.06; P=0.02) (Fig.…”

“…At present, several published randomized controlled trials (RCTs) (7)(8)(9)(10) have compared the efficacy of corticosteroid injection with that of placebo injection for the management of plantar fasciitis; however, the efficacy of corticosteroid injection remains controversial. The present meta-analysis was performed to determine the efficacy of corticosteroid versus placebo injection for the treatment of plantar fasciitis.…”

Hyperemia in Plantar Fasciitis Determined by Power Doppler Ultrasound

“…This has clinical implications regarding the management of plantar fasciitis, and suggests that some patients may respond well to treatments targeting neurovascular pain mechanisms, such as injection of corticosteroids or agents with direct sclerosing properties (eg, polidocanol). Furthermore, the findings of this study provide some explanation of the mechanism by which corticosteroids, which exert angiostatic effects (eg, inhibition of endothelial cell proliferation and migration), 21 have been shown to reduce pain 3 and tissue swelling 3,17 in plantar fasciitis over a 3-month period.…”