Comparative efficacy of corticosteroid injection and non-invasive treatments for plantar fasciitis: a systematic review and meta-analysis

Abstract

The first choice of treatment for patients with plantar fasciitis is non-invasive treatment, rather than corticosteroid injection (CSI). However, no comprehensive study has compared the effectiveness of CSI with non-invasive treatments for plantar fasciitis. We conducted a meta-analysis comparing CSI and non-invasive treatment effects on plantar fasciitis. The primary outcome was pain reduction. Nine randomized controlled trials comparing CSI with 4 non-invasive treatment types were included. A trend favoring CSI over non-invasive treatments was indicated regarding reduction in the visual analogue scale (VAS) score at 1-1.5 (mean difference (MD), 1.70; 95% confidence interval (CI) = 0.39-3.01; P = 0.01) and 2-3 months (MD, 1.67; 95% CI = 0.58-2.76; P = 0.003). At 1.5-month follow-up, CSI was associated with improved VAS score compared with physical therapy (PT) (MD, 2.5; 95% CI = 0.1-4.9; P = 0.04). No significant differences in the VAS score reduction were observed between CSI and shock wave therapy within 3 months. In summary, CSI tends to be more effective for pain reduction than non-invasive treatments within 3 months. Moreover, CSI provides significant pain relief at 1.5 months after treatment compared with PT. This study provides important clinical information for selecting therapeutics.

Figure 1

Flow diagram of the included studies.

Figure 2

Forest plot of comparisons of pain reduction between corticosteroid injection and non-invasive treatments. (A) VAS score reduction at 1–1.5 months. (B) VAS score reduction at 2–3 months. ^aIndicates the follow-up time point was 1.5 months. ^bIndicates the follow-up time point was 1 month. ^cIndicates the follow-up time point was 3 months. ^dIndicates the follow-up time point was 2 months. NI = non-invasive.