Abstract
BackgroundIt is controversial whether ultrasound-guided injection of corticosteroid is superior to palpation-guided injection for plantar fasciitis. This meta-analysis was performed to compare the effectiveness of ultrasound-guided and palpation-guided injection of corticosteroid for the treatment of plantar fasciitis.MethodsDatabases (MEDLINE, Cochrane library and EMBASE) and reference lists were searched from their establishment to August 30, 2013 for randomized controlled trials (RCTs) comparing ultrasound-guided with palpation-guided injection for plantar fasciitis. The Cochrane risk of bias (ROB) tool was used to assess the methodological quality. Outcome measurements were visual analogue scale (VAS), tenderness threshold (TT), heel tenderness index (HTI), response rate, plantar fascia thickness (PFT), hypoechogenicity and heel pad thickness (HPT). The statistical analysis was performed with software RevMan 5.2 and Stata 12.0. When I2<50%, the fixed-effects model was adopted. Otherwise the randomized-effects model was adopted. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to assess the quality of evidence.ResultsFive RCTs with 149 patients were identified and analyzed. Compared with palpation-guided injection, ultrasound-guided injection was superior with regard to VAS, TT, response rate, PFT and hypoechogenicity. However, there was no statistical significance between the two groups for HPT and HTI.ConclusionUltrasound-guided injection of corticosteroid tends to be more effective than palpation-guided injection. However, it needs to be confirmed by further research.
Highlights
Up to 10% adults will suffer heel pain during the lifetime[1] and about 80% patients are caused by plantar fasciitis.[2]
Patients with plantar fasciitis feel heel pain when rising from bed and during initial weight-bearing in the morning
plantar fascia thickness (PFT) was thinner (MD = 20.12, 95%confidence intervals (CI) (20.22, 20.01), P = 0.03) (Figure 6) and hypoechogenicity was less detected (RR = 0.30, 95%CI (0.12, 0.77), P = 0.01) (Figure 7) in ultrasound-guided injection group than those in palpation-guided injection group
Summary
Up to 10% adults will suffer heel pain during the lifetime[1] and about 80% patients are caused by plantar fasciitis.[2]. Palpation-guided injection is an effective and common treatment.[4] it is somewhat subjective and varies with the practitioners.5 It is not always successful and may need repeated injections occasionally, which may be accompanied with potential complications including fat pad atrophy and rupture of plantar fascia.[2] Real-time ultrasound is a noninvasive, relative low-cost method without radiation. It is considered to be more effective than palpationguided injection.[6,7] several studies[8,9,10] reported that no difference in visual analogue score (VAS) following steroid injection between both groups It is controversial whether ultrasound-guided injection of corticosteroid is superior to palpation-guided injection for plantar fasciitis. This meta-analysis was performed to compare the effectiveness of ultrasound-guided and palpation-guided injection of corticosteroid for the treatment of plantar fasciitis
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