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Meta-Analysis
. 2018 Dec;97(50):e13687.
doi: 10.1097/MD.0000000000013687.

Clinical effects of extracorporeal shock-wave therapy and ultrasound-guided local corticosteroid injections for plantar fasciitis in adults: A meta-analysis of randomized controlled trials

Shuxiang Li  1 , Kun Wang, Han Sun, Xiaomin Luo, Peng Wang, Sheng Fang, Haifeng Chen, Xiaoliang Sun
Affiliations
Meta-Analysis

Clinical effects of extracorporeal shock-wave therapy and ultrasound-guided local corticosteroid injections for plantar fasciitis in adults: A meta-analysis of randomized controlled trials

Shuxiang Li et al. Medicine (Baltimore). 2018 Dec.

Abstract

Background: The argument on whether extracorporeal shock-wave therapy (ESWT) and corticosteroid injections (CSIs) exert an equivalent pain control or which is the better treatment for plantar fasciitis (PF) in adults remains to be resolved. It is important and necessary to conduct a meta-analysis to make a relatively more credible and overall assessment about which treatment method performs better pain control in treatment of PF in adults.

Methods: From the inception to July 2018, the Embase, PubMed, Web of Science, and Cochrane Library electronic databases were searched for all relevant studies. Only randomized controlled trials (RCTs) focusing on comparing ESWT and CSI therapies in PF cases in adults were included. The primary outcome measure was visual analog scale (VAS) reduction, whereas the secondary outcomes included treatment success rate, recurrence rate, function scores, and adverse events.

Results: Nine RCTs involving 658 cases were included in this meta-analysis. In the present study, meta-analysis showed that high-intensity ESWT had superior pain relief and success rates relative to the CSI group within 3 months, but the ESWT with low intensity was slightly inferior to CSI for efficacy within 3 months. In addition, patients with CSI may tend to increase the need for the analgesic and more adverse events may be associated with the ESWT. However, the ESWT and CSI present similar recurrent rate and functional outcomes.

Conclusion: Our analysis showed that the pain relief and success rates were related to energy intensity levels, with the high-intensity ESWT had the highest probability of being the best treatment within 3 months, followed by CSI, and low-intensity ESWT. More high-quality RCTs with long-term follow-up time are needed to further compare the differences of CSI and ESWT for adults with PF.

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Conflict of interest statement

The authors report no conflicts of interest.

Figures

Figure 1
Figure 1
Flow diagram showing details of literature search.
Figure 2
Figure 2
(A) Forest plots of visual analog scale (VAS) reduction in low-intensity extracorporeal shock-wave therapy (ESWT) group and corticosteroid injection (CSI) groups within 3 months. (B) Forest plots of VAS reduction in high-intensity ESWT group and CSI groups within 3 months. (C) Forest plots of VAS reduction in ESWT group and CSI groups at 12 months.
Figure 3
Figure 3
(A) Forest plots of treatment success rate in low-intensity extracorporeal shock-wave therapy (ESWT) group and corticosteroid injection (CSI) groups. (B) Forest plots of treatment success rate in high-intensity ESWT group and CSI groups.
Figure 4
Figure 4
Forest plot of recurrent rate in extracorporeal shock-wave therapy group and corticosteroid injection groups.
Figure 5
Figure 5
(A) Forest plot of required analgesia in extracorporeal shock-wave therapy (ESWT) group and corticosteroid injection (CSI) groups. (B) Forest plot of throbbing pain and erythema in ESWT group and CSI groups.
Figure 6
Figure 6
Funnel plots of visual analog scale reduction in high-intensity extracorporeal shock-wave therapy group and corticosteroid injection groups.
See this image and copyright information in PMC

References

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