Injection therapies for plantar fasciopathy ('plantar fasciitis'): a systematic review and network meta-analysis of 22 randomised controlled trials.

OBJECTIVE: To compare the efficacy of different injection therapies for plantar fasciopathy (historically known as 'plantar fasciitis').

DESIGN: Systematic review and network meta-analysis.

DATA SOURCES: Electronic databases (MEDLINE, CENTRAL, Web of Science and Scopus) were searched up to 11 July 2015 for completed studies.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES: We considered randomised trials comparing various injection therapies in adults with plantar fasciopathy. The primary outcome was pain relief. Secondary outcomes included functional disability, composite and health-related outcomes. All outcomes were assessed (1) in the short term (up to 2 months), (2) the intermediate term (2-6 months) and (3) the medium term (more than 6 months to 2 years). Quality assessment was performed using the Cochrane risk of bias tool.

RESULTS: We included 22 trials comprising 1216 patients. Dehydrated amniotic membrane injections were significantly superior to corticosteroids in the short term in achieving the primary and composite outcomes (mean difference (MD) in visual analogue scale (VAS) was -7.32, 95% CIs -11.2 to -3.38; and MD in the foot health status questionnaire was 31.2, 95% CIs 13.9 to 48.6, respectively). For pain relief, botulinum toxin-A provided a significant short-term advantage over placebo, which was still present at 6 months (MD in VAS was -2.9, 95% CIs -4.44 to -1.39; and MD -4.34, 95% CIs -7.18 to -1.54, respectively).

SUMMARY: Although the dehydrated amniotic membrane provided significant clinical relief at 0-2 months, there were no data about this treatment at 2 months and beyond. Botulinum toxin-A injections significantly reduced pain intensity at 0-6 months.

SYSTEMATIC REVIEW REGISTRATION NUMBER: CRD42015017353.