Plantar heel fasciitis: steroid injection no better than placebo

  • Whittaker GA & al.
  • BMC Musculoskelet Disord
  • 17 Aug 2019

  • International Clinical Digest
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Takeaway

  • A meta-analysis finds that although corticosteroid injection is superior to some comparators in low-quality studies, it failed to be superior to placebo for pain in sensitivity analyses that excluded studies with high risk for bias.

Why this matters

  • High-quality randomized controlled trials are needed to demonstrate improvements in pain and function.

Study design

  • Meta-analysis of 47 randomized controlled trials (n=2989) identified from MEDLINE, CINAHL, SPORTDiscus, EMBASE, and Cochrane Library.
  • Funding: None.

Key findings

  • Pain reduction in the short term (0-6 weeks):
    • Corticosteroid was better than autologous blood injection (standardized mean difference [SMD], −0.56; 95% CI, −0.86 to −0.26) and foot orthoses (SMD, −0.91; 95% CI, −1.69 to −0.13).
    • Corticosteroid was similar to placebo (SMD, −0.98; −2.06 to 0.11).
  • Pain reduction in the medium term (7-12 weeks):
    • Corticosteroid was similar to placebo (SMD, −0.86; 95% CI, −1.90 to 0.19).
  • Pain reduction in the long term (13-52 weeks):
    • Corticosteroid injection was marginally less effective than dry needling (SMD, 1.45; 95% CI, 0.70-2.19) and platelet-rich plasma injection (SMD, 0.61; 95% CI, 0.16-1.06).
  • In sensitivity analyses, corticosteroid was similar to placebo for pain in the short term (SMD, −0.28; 95% CI, −0.71 to 0.16) and medium term (SMD, −0.23; 95% CI, −0.72 to 0.28).

Limitations

  • Lack of high-quality studies.
  • Low number of participants.

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