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Corticosteroid injection for plantar heel pain: a systematic review and meta-analysis
journal contributionposted on 17.01.2021, 22:54 by Glen Whittaker, Shannon Munteanu, Hylton Menz, Daniel Bonanno, James Gerrard, Karl Landorf
© 2019 The Author(s). Background: Corticosteroid 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. Methods: A 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). Results: A 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. Conclusions: Based 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. Registration: PROSPERO registration number CRD42016053216.
The review received no direct funding support. GAW is a recipient of an Australian Government Research Training Program scholarship. HBM is a National Health and Medical Research Senior Fellow (ID: 1135995).
JournalBMC Musculoskeletal Disorder
Article NumberARTN 378
Pagination22p. (p. 1-22)
Rights StatementThe Author reserves all moral rights over the deposited text and must be credited if any re-use occurs. Documents deposited in OPAL are the Open Access versions of outputs published elsewhere. Changes resulting from the publishing process may therefore not be reflected in this document. The final published version may be obtained via the publisher’s DOI. Please note that additional copyright and access restrictions may apply to the published version.
Science & TechnologyLife Sciences & BiomedicineOrthopedicsRheumatologyCorticosteroid injectionPlantar heel painPlantar fasciitisMeta-analysisSHOCK-WAVE THERAPYPLATELET-RICH PLASMASTEROID INJECTIONLATERAL EPICONDYLITISBLOOD INJECTIONLOCAL INJECTIONFASCIITISULTRASOUNDPHYSIOTHERAPYEFFICACYHeelHumansFasciitis, PlantarPlacebosGlucocorticoidsPain MeasurementTreatment OutcomeBlood Transfusion, AutologousInjections, IntralesionalRecovery of FunctionPlatelet-Rich PlasmaPain ManagementMusculoskeletal PainFoot Orthoses