Comparative Effectiveness of Extracorporeal Shock Wave Therapy, Local Corticosteroid Injection and Dextrose Prolotherapy in Treatment of Chronic Plantar Fasciitis: A Randomized Controlled Study.

Document Type : Original Article

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Department of Rheumatology, Rehabilitation and Physical medicine - Faculty of medicine—Banha University.

Abstract

Background: Assess the effectiveness of extracorporeal shockwave therapy (ESWT), corticosteroid injections, and dextrose prolotherapy in lessening pain, decreasing the plantar fascia's thickness, plus improving foot function in chronic plantar fasciitis cases. Patients & Methods: 75 plantar fasciitis cases have been classified into three groups: Group I: 25 patients got three ESWT sessions. Group II: 25 patients got one local injection of 40 mg/ml methylprednisolone acetate. Group III: 25 patients received three dextrose prolotherapy injections of 3.6 milliliters dextrose (25%) with 0.4 milliliters lidocaine. The primary outcomes included the visual analogue scale (VAS) and the foot function index (FFI), while the secondary outcome involved the assessment of plantar fascia thickness (PFT) through musculoskeletal ultrasonography. Results: A significant decrease in VAS across all groups at one month follow-up (P<0.001). At three months, VAS decreased in all groups, with Group I (77.9%) having the highest reduction. At one month, FFI decreased significantly in all groups (P=0.01). FFI reduced in all groups after three months, with Group I (41.7%) decreasing the most. PFT decreased significantly across all groups at one-month interval (P=0.004). During the three-month follow-up, PFT reduced in all groups, with Group I (27.5%) having the highest drop, followed by Group II (20%) and Group III (17.2%) with groups I and II differing significantly (P1=0.002). Conclusion: ESWT, corticosteroid injection, and dextrose prolotherapy greatly reduce chronic plantar fasciitis pain and fasciopathy thickness. Short-term and unfavorable effects of corticosteroid injections make ESWT and dextrose prolotherapy better over time.

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