Ultrasound guided corticosteroid injection for plantar fasciitis: randomised controlled trial
BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e3260 (Published 22 May 2012) Cite this as: BMJ 2012;344:e3260
- Andrew M McMillan, PhD candidate1,
- Karl B Landorf, senior lecturer1,
- Mark F Gilheany, lecturer1,
- Adam R Bird, senior lecturer1,
- Adam D Morrow, associate lecturer1,
- Hylton B Menz, professor2
- 1Department of Podiatry, Faculty of Health Sciences, La Trobe University, Vic 3086, Australia
- 2Musculoskeletal Research Centre, Faculty of Health Sciences, La Trobe University
- Correspondence to: A M McMillan a.mcmillan{at}latrobe.edu.au
- Accepted 22 March 2012
Abstract
Objective To investigate the effectiveness of ultrasound guided corticosteroid injection in the treatment of plantar fasciitis.
Design Randomised, investigator and participant blinded, placebo controlled trial.
Setting University clinic in Melbourne, Australia.
Participants 82 people with a clinical and ultrasound diagnosis of plantar fasciitis unrelated to systemic inflammatory disease.
Interventions Participants were randomly allocated to ultrasound guided injection of the plantar fascia with either 1 mL of 4 mg/mL dexamethasone sodium phosphate (experimental group) or 1 mL normal saline (placebo). Before injection the participants were given an ultrasound guided posterior tibial nerve block with 2% lidocaine (lignocaine).
Main outcome measures Primary outcomes were pain, as measured by the foot health status questionnaire (0-100 point scale), and plantar fascia thickness, measured by ultrasound at 4, 8, and 12 weeks.
Results Reduction in pain at four weeks favoured the dexamethasone group by 10.9 points (95% confidence interval 1.4 to 20.4, P=0.03). Between group differences for pain scores at eight and 12 weeks were not statistically significant. Plantar fascia thickness measured at four weeks favoured the dexamethasone group by −0.35 mm (95% confidence interval −0.67 to −0.03, P=0.03). At eight and 12 weeks, between group differences for plantar fascia thickness also favoured dexamethasone, at −0.39 mm (−0.73 to −0.05, P=0.02) and −0.43 mm (−0.85 to −0.01, P=0.04), respectively. The number needed to treat with dexamethasone for one successful outcome for pain at four weeks was 2.93 (95% confidence interval 2.76 to 3.12). There were no reported adverse events associated with the intervention.
Conclusion A single ultrasound guided dexamethasone injection is a safe and effective short term treatment for plantar fasciitis. It provides greater pain relief than placebo at four weeks and reduces abnormal swelling of the plantar fascia for up to three months. However, clinicians offering this treatment should also note that significant pain relief did not continue beyond four weeks.
Trial registration Australian New Zealand Clinical Trials Registry ACTRN12610000239066.
Footnotes
Contributors: AMcM and KBL designed the trial protocol and obtained project funding. MFG, ARB, and HBM assisted in designing the trial protocol. AMcM screened participants (including ultrasound examination), carried out ultrasound guided injection procedures, measured treatment outcomes, analysed data, and drafted the manuscript. KBL assisted with data analysis and drafting of the manuscript. MFG provided clinical supervision and ADM assisted with clinical procedures. MFG, ARB, ADM, and HBM commented on the manuscript. All authors read and approved the final manuscript before submission. AMcM and KBL accept full responsibility for this work and act as guarantors for the study.
Funding: This study was funded by the Australian Podiatry Education and Research Foundation. AMcM has received an Australian Postgraduate Award scholarship. HBM is a National Health and Medical Research Council senior research fellow (ID: 1020925). Briggate Medical (Victoria, Australia) donated medical consumables used in the trial.
Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare that AMcM, KBL, MFG, ARB, ADM, and HBM have no relationships with companies that might have an interest in the submitted work in the previous three years; and AMcM, KBL, MFG, ARB, ADM, and HBM have no non-financial interests that may be relevant to the submitted work.
Ethical approval: This study was approved by the La Trobe University human ethics committee.
Data sharing: The dataset is available from the corresponding author at a.mcmillan{at}latrobe.edu.au.
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