Abstract
BackgroundCorticosteroid injection is frequently used for plantar heel pain (plantar fasciitis), although there is limited high-quality evidence to support this treatment. Therefore, this study reviewed randomised trials to estimate the effectiveness of corticosteroid injection for plantar heel pain.MethodsA systematic review and meta-analysis of randomised trials that compared corticosteroid injection to any comparator. Primary outcomes were pain and function, categorised as short (0 to 6 weeks), medium (7 to 12 weeks) or longer term (13 to 52 weeks).ResultsA total of 47 trials (2989 participants) were included. For reducing pain in the short term, corticosteroid injection was more effective than autologous blood injection (SMD -0.56; 95% CI, − 0.86 to − 0.26) and foot orthoses (SMD -0.91; 95% CI, − 1.69 to − 0.13). There were no significant findings in the medium term. In the longer term, corticosteroid injection was less effective than dry needling (SMD 1.45; 95% CI, 0.70 to 2.19) and platelet-rich plasma injection (SMD 0.61; 95% CI, 0.16 to 1.06). Notably, corticosteroid injection was found to have similar effectiveness to placebo injection for reducing pain in the short (SMD -0.98; 95% CI, − 2.06, 0.11) and medium terms (SMD -0.86; 95% CI, − 1.90 to 0.19). For improving function, corticosteroid injection was more effective than physical therapy in the short term (SMD -0.69; 95% CI, − 1.31 to − 0.07). When trials considered to have high risk of bias were excluded, there were no significant findings.ConclusionsBased on the findings of this review, corticosteroid injection is more effective than some comparators for the reduction of pain and the improvement of function in people with plantar heel pain. However, corticosteroid injection is not more effective than placebo injection for reducing pain or improving function. Further trials that are of low risk of bias will strengthen this evidence.RegistrationPROSPERO registration number CRD42016053216.
Highlights
Corticosteroid injection is frequently used for plantar heel pain, there is limited high-quality evidence to support this treatment
The findings of this systematic review indicate that for the outcome of pain, corticosteroid injection is more effective than autologous blood injection and foot orthoses in the short term, but platelet-rich plasma and dry needling are more effective in the longer term
For the outcome of pain in the short term, we found low quality evidence that corticosteroid injection is more effective than autologous blood injection and foot orthoses
Summary
Corticosteroid injection is frequently used for plantar heel pain (plantar fasciitis), there is limited high-quality evidence to support this treatment. This study reviewed randomised trials to estimate the effectiveness of corticosteroid injection for plantar heel pain. Several interventions are used to treat plantar heel pain, there is limited evidence to suggest which interventions are more effective [4]. Previous systematic reviews [6,7,8,9,10] have summarised the effectiveness of corticosteroid injection for plantar heel pain but they have limitations, such as; not incorporating meta-analysis [6, 9], only including studies that compared corticosteroid injection to specific comparators [7, 8, 10], and not evaluating the strength of the evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach [6, 7, 10]. When previous reviews are considered together, the limitations outlined above reduce the validity of their findings
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