Plantar fasciitis injections – Research on effectiveness

Marc Darrow, MD, JD

Most people suffering from plantar fasciitis have a similar path to continued pain. Internet research, self-care, self-medication, shoe inserts, and finally a doctor’s visit. They have tried rest or staying off their feet, stretching, foot exercises and rolling a tennis ball with the soles of their feet. What has happened to them is that despite their efforts, they still have pain that runs from the heel to the base of the toes in one or both feet.

If you have been suffering with plantar fasciitis you know that “fasciitis” means inflammation of the fascia and plantar means the bottom of the foot.

As you have been unresponsive to your own attempts to provide yourself pain relief, you moved unto the doctor’s visit. Unfortunately you may have become unresponsive to the mainstay and conventional treatments your doctor prescribed. Her/she gave you stronger anti-inflammatories. They may have helped at the beginning but their relief was not long lasting. Eventually you may have been moved unto physical therapy. PT may have helped some but not all the way. Then your doctor may have prescribed a cortisone injection. This may have helped for weeks or months, but it did not make the problem go away.

The search for plantar fasciitis treatments that are effective

Shockwave therapy (ESWT) or Ultrasound for plantar fasciitis?

There are many treatments that will work for plantar fasciitis. However these treatments will not work for everyone. One popular treatment is Extracorporeal (from outside the body – an electric device) shock wave therapy  (ESWT). Extracorporeal shock wave therapy does what its name implies, it delivers shock waves to the injured tissue of the plantar fascia with the hopes of stimulating the immune system to heal the injured area.

A January 2022 study (1) compared the outcomes of extracorporeal shockwave therapy versus ultrasound therapy for the treatment of plantar fasciitis. What the researchers wanted to compare was morning and activity pain, functional impairment, and pain scores. Secondary outcomes included the fascial thickness, primary efficacy success rate, activity limitations, pain intensity, and satisfaction. The two treatments provided similar results with the suggestion by the researchers that extracorporeal shockwave therapy is superior to ultrasound therapy for plantar fasciitis as it improves pain activity and intensity, primary efficacy success rate, and activity limitations.

Corticosteroid injections for plantar fasciitis

Both patients and doctors usually try to avoid the use of cortisone unless it is necessary to provide relief to the patient. Doctors are also looking for alternatives to cortisone injection.

Cortisone versus dry needling in treating the plantar fasciitis patient

A December 2021 study (2) wrote: “Corticosteroid injection and dry needling have been used in the treatment of musculoskeletal conditions, but it is unclear which intervention is the most effective.” To answer this question the study authors compared the effects of corticosteroid injection and dry needling for musculoskeletal conditions at short-, medium-, and long-term follow-up.

They found that there is very low-quality evidence that Corticosteroid injection is superior to dry needling for reducing heel pain (plantar fasciitis) at short- and medium-term follow-up.

Botox injections for plantar fasciitis

A February 2022 study (3) evaluated the efficacy of botulinum toxin A  for the treatment of plantar fasciitis. They found that botulinum toxin injections resulted in significant pain relief and functional improvement. A subanalysis indicated that pain relief was sustained at 12 months while functional improvement remained significant up to six months.

PRP treatment for plantar fasciitis

PRP treatments also called Platelet Plasma Therapy reinjects your own concentrated blood platelets into the plantar fascia area to stimulate healing and regeneration.

PRP treatment for plantar fasciitis compared to cortisone.

A 2019 study (4) noted previous research showing Platelet-rich plasma injections to be superior to corticosteroids for chronic plantar fasciitis and then set about their own research in 90 patients. They found both PRP and Cortisone are safe and effective treatment options for chronic plantar fasciitis. They suggested longer-term results of PRP makes it an attractive option versus corticosteroids injection.

References

1 Al-Siyabi Z, Karam M, Al-Hajri E, Alsaif A, Alazemi M, Aldubaikhi AA. Extracorporeal Shockwave Therapy Versus Ultrasound Therapy for Plantar Fasciitis: A Systematic Review and Meta-Analysis. Cureus. 2022 Jan 2;14(1).
2 Sousa Filho LF, Barbosa Santos MM, Dos Santos GH, da Silva Júnior WM. Corticosteroid injection or dry needling for musculoskeletal pain and disability? A systematic review and GRADE evidence synthesis. Chiropractic & manual therapies. 2021 Dec;29(1):1-4.
3 Acosta-Olivo C, Simental-Mendía LE, Vilchez-Cavazos F, Peña-Martínez VM, Elizondo-Rodíguez J, Simental-Mendía M. Clinical efficacy of botulinum toxin in the treatment of plantar fasciitis: a systematic review and meta-analysis of randomized controlled trials. Archives of physical medicine and rehabilitation. 2021 Oct 22.
4 Shetty SH, Dhond A, Arora M, Deore S. Platelet-Rich Plasma Has Better Long-Term Results Than Corticosteroids or Placebo for Chronic Plantar Fasciitis: Randomized Control Trial. The Journal of Foot and Ankle Surgery. 2019 Jan 1;58(1):42-6.

 

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