Marc Darrow, MD, JD. Joint Rehab Los Angeles
Prolotherapy is the injection of a mild irritant, often dextrose (a simple sugar), into a specific area of the body that is arthritic, worn down, or injured.
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A meta-analysis published in March 2026 (1) examined five randomized controlled trials and two cohort studies, which included a total of 567 patients diagnosed with plantar fasciitis. The primary objective was to assess and compare the effectiveness of corticosteroid (CS) injections versus dextrose prolotherapy in alleviating pain and enhancing foot function. The findings revealed that, at the one-month follow-up, corticosteroid injections were more effective than dextrose prolotherapy in pain reduction, as indicated by the Visual Analog Scale (VAS). Specifically, patients who received CS injections reported more significant decreases in overall VAS pain scores, VAS pain scores for the first step in the morning, and VAS pain scores during walking. Moreover, corticosteroid injections resulted in a notably greater decrease in the Foot Function Index (FFI) score and plantar fascia thickness when compared to dextrose prolotherapy.
At the three-month follow-up, the analysis showed a significant enhancement in the Foot Function Index score for patients treated with dextrose prolotherapy relative to those who received corticosteroid injections. In conclusion, corticosteroid injections offered more substantial short-term pain relief and improved foot function for patients with plantar fasciitis compared to dextrose prolotherapy. Over the mid-term follow-up period, the effectiveness of both treatments appeared to converge, with dextrose prolotherapy demonstrating better results in terms of foot function.
A November 2023 paper (2) the compared the use of dextrose prolotherapy for plantar fasciopathy versus normal saline and corticosteroid. “Low certainty evidence (insufficient data numbers or lack of controlled testing procedure) demonstrated that dextrose prolotherapy was superior to normal saline injections in reducing pain and improving function in the medium term, but moderate certainty evidence showed that dextrose prolotherapy was inferior to corticosteroid in reducing pain in the short term.”
A 2014 study (3) compared Prolotherapy to PRP for chronic recalcitrant plantar fasciitis. The researchers found all patients in both the Prolotherapy group and the PRP group showed significant improvements. They concluded: “PRP treatment also may lead to better initial improvement in function compared with dextrose Prolotherapy treatment.”
An August 2021 study (4) compared the effectiveness of ultrasound-guided dextrose Prolotherapy with radial extracorporeal shock wave therapy (ESWT) for chronic plantar fasciitis.
- 59 patients were divided into two groups receiving three sessions of radial ESWT (29 patients) vs. two sessions of ultrasound-guided interfacial 2 cc dextrose 20% injection (30 patients).
- At six and 12 weeks after treatment, pain, disability and plantar fascia thickness were monitored.
- Pain and disability patient reported outcomes showed significant improvements in pain and function in both study groups 6 weeks and 12 weeks after the treatments.
- A significant reduction was also seen in plantar fascia thickness at these intervals.
- Dextrose Prolotherapy is comparable to radial ESWT in reducing pain, daily-life functional limitation, and plantar fascia thickness in patients with plantar fasciitis.
A research study carried out in December 2024 (5) looked into how effective ultrasound-guided corticosteroid injections are when compared to ultrasound-guided dextrose prolotherapy for patients suffering from plantar fasciitis. The study involved 38 patients diagnosed with plantar fasciitis, which included 24 females and 14 males, with an average age of 48 years. In the group receiving corticosteroid injections, participants were given methylprednisolone, while those in the prolotherapy group received dextrose. Throughout the procedure, ultrasound guidance was used to ensure both accuracy and safety. Patients were monitored and assessed at two follow-up points: one month (short term) and three months (middle term) after treatment. The main outcomes measured were pain severity and foot function. Both treatment groups showed significant improvements in pain severity and foot function index by the middle term. The improvement was slightly more pronounced in the dextrose prolotherapy group. On the other hand, in the corticosteroid injection group, the effectiveness of the treatment seemed to decrease over time.
In a study published in February 2026 (6) data from 63 randomized controlled trials with a total of 4,170 participant assessed how effective extracorporeal shock wave therapy, prolotherapy, and different injection-based treatments are for plantar fasciitis patients. The injection therapies looked at were platelet-rich plasma, botulinum toxin A, corticosteroids, autologous blood, and local anesthetics.
- Botulinum Toxin A: This treatment showed the most significant short-term improvements in pain relief and in reducing the thickness of the plantar fascia.
- Prolotherapy: Out of all the treatments, prolotherapy was the best for providing long-lasting pain relief during the mid- and long-term follow-ups.
- Corticosteroid Injection: Using corticosteroids led to the biggest short-term improvements in how well patients could function.
- Platelet-Rich Plasma: This treatment showed significant long-term benefits in both functional ability and the thickness of the plantar fascia.
- Extracorporeal Shock Wave Therapy: This method proved to be effective across all areas we evaluated and showed positive results at every follow-up time.
In Summary a March 2026 research (7) writes: “dextrose prolotherapy has been shown to be effective in reducing pain in the short and medium term, proving superior to placebo or isolated conservative therapies, and emerging as a valid cost-effective alternative.”
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References
1 Qafesha RM, Ishreiteh HA, Nassourah AL, Tawil OI, Mashaly D. Efficacy and Safety of Dextrose Prolotherapy Versus Corticosteroid Injections in Plantar Fasciitis: A Systematic Review and Meta-Analysis. Journal of foot and ankle research. 2026 Mar;19(1):e70135.
2 Fong HP, Zhu MT, Rabago DP, Reeves KD, Chung VC, Sit RW. Effectiveness of hypertonic dextrose injection (prolotherapy) in plantar fasciopathy: A systematic review and meta-analysis of randomized controlled trials. Archives of Physical Medicine and Rehabilitation. 2023 Apr 23.
3 Kim E, Lee JH. Autologous platelet-rich plasma versus dextrose prolotherapy for the treatment of chronic recalcitrant plantar fasciitis. PM&R. 2014 Feb 28;6(2):152-8.
4 Asheghan M, Hashemi SE, Hollisaz MT, Roumizade P, Hosseini SM, Ghanjal A. Dextrose prolotherapy versus radial extracorporeal shock wave therapy in the treatment of chronic plantar fasciitis: A randomized, controlled clinical trial. Foot and Ankle Surgery. 2020 Aug 25.
5 Teymouri A, Alaei F, Fakheri M, Nasiri A. Ultrasound-guided prolotherapy versus corticosteroid injections for the treatment of patients with plantar fasciitis: A randomized controlled trial. TURKISH JOURNAL OF PHYSICAL MEDICINE AND REHABILITATION. 2024 Dec 6.
6 Tien CH, Chiu MC, Shen YL, Ko YC, Lee JJ. Comparative effectiveness of minimally invasive therapies for plantar fasciitis: a systematic review and network meta-analysis. Scientific Reports. 2026 Feb 14.
7 Távara-Vidalón P, Lloret-González JM, Alcalá-Cruz M. Diagnosis and current therapeutic management of chronic plantar fasciitis. Med Clin (Barc). 2026 Mar 3;166(5):107375. English, Spanish. doi: 10.1016/j.medcli.2026.107375. Epub ahead of print. PMID: 41780307.