Autologous Blood Injection With Dry-Needling vs Dry-Needling Alone Treatment for Chronic Plantar Fasciitis: A Randomized Controlled Trial

Comparing dry needling or local acupuncture to various wet needling injection types for musculoskeletal pain and disability. A systematic review of randomized clinical trials

PURPOSE

Systematically evaluate the comparative effectiveness of dry needling (DN) or local acupuncture to various types of wet needling (WN) for musculoskeletal pain disorders (MPD).

METHODS

Seven databases (PubMed, PEDro, SPORTDiscus, CINAHL, Scopus, Embase, and Cochrane Central Register of Controlled Trials) were searched following PROSPERO registration. Randomized clinical trials were included if they compared DN or local acupuncture with WN for MPD. Primary outcomes were pain and/or disability. The Revised Cochrane Collaboration tool (RoB 2.0) assessed the risk of bias.

RESULTS

Twenty-six studies were selected. Wet Needling types included cortisone (CSI) (N = 5), platelet-rich plasma (PRP) (N = 6), Botox (BoT) (N = 3), and local anesthetic injection (LAI) (N = 12). Evidence was rated as low to moderate quality. Results indicate DN produces similar effects to CSI in the short-medium term and superior outcomes in the long term. In addition, DN produces similar outcomes compared to PRP in the short and long term and similar outcomes as BoT in the short and medium term; however, LAI produces better pain outcomes in the short term.

CONCLUSION

Evidence suggests the effectiveness of DN to WN injections is variable depending on the injection type, outcome time frame, and diagnosis. In addition, adverse event data were similar but inconsistently reported. PROSPERO Registration: 2019 CRD42019131826Implications for rehabilitationDry needling produces similar effects for pain and disability in the short and medium term compared to cortisone, Botox, and platelet-rich plasma injections. Local anesthetic injection may be more effective at reducing short-term pain.Long-term effects on pain and disability are similar between dry needling and platelet-rich plasma injections, but dry needling may produce better long-term outcomes than cortisone injections.The available adverse event data is similar between dry and wet needling.The conclusions from this study may be beneficial for patients and clinicians for considering risk and cost benefit analyses.

Effects of therapeutic interventions on pain due to plantar fasciitis: A systematic review and meta-analysis

OBJECTIVE

To determine the effects of different therapeutic interventions that have ever been evaluated in randomized controlled trials on pain due to plantar fasciitis.

METHODS

We searched different electronic databases until September 2022. Mean differences (MDs) and 95% confidence intervals (CIs) were calculated. The Grading of Recommendations Assessment, Development and Evaluation was used to evaluate the overall certainty evidence.

RESULTS

A total of 236 studies met the study criteria, including 15,401 patients. Botulinum toxin MD -2.14 (CI: -4.15, -0.14), micronized dehydrated human amnion/chorion membrane injection MD -3.31 (CI: -5.54, -1.08), dry needling MD -2.34 (CI: -4.64, -0.04), low-dye taping MD -3.60 (CI: -4.16, -3.03), low-level laser therapy MD -2.09 (CI: -2.28, -1.90), myofascial releases MD -1.79 (CI: -2.63, -0.94), platelet-rich plasma MD -2.40 (CI: -4.16, -0.63), radiofrequency MD -2.47 (CI: -4.65, -0.29), and stretching MD -1.14 (CI: -2.02, -0.26) resulted in being effective treatments for pain when compared to the control in the short term. In the medium and long term, only extracorporeal shock wave therapy MD -0.97 (CI: -1.13, -0.81)/MD -2.49 (CI: -3.17, -1.82) was effective for improving pain when compared to the control.

CONCLUSIONS

Considering the available studies, this systematic review and meta-analysis showed that different therapeutic interventions seem to be useful strategies for improving pain in patients with plantar fasciitis. In the medium and long term, only extracorporeal shock wave therapy was effective in improving pain when compared to the control.

Platelet-Rich Plasma vs Autologous Blood Injection to Treat Plantar Fasciitis: A Prospective Randomized, Double-Blinded, Controlled Trial

BACKGROUND

Plantar fasciitis (PF) is the most common cause of heel pain. Previous work has shown promising results regarding platelet-rich plasma (PRP) injections for the treatment of PF. The aim of this study is to prospectively compare the efficacy of PRP and autologous blood injections in a randomized anonymized patient group to treat PF.

METHODS

PF patients who failed at least 6 weeks of noninvasive conservative treatment aged between 40 and 65 years were recruited to be in the study. Patients were randomly assigned into group A (PRP) or group B (autologous blood). Injections were performed under ultrasonographic guidance in a double-anonymized manner. The groups were compared according to preinjection and postinjection health-related quality of life (HRQoL) scores measured with Foot and Ankle Disability Index (FADI) and visual analog scale (VAS). Intragroup comparative analysis was also performed at different time points. Independent t tests and repeated measures analyses of variance were used for statistical analysis, with P <.05 set for statistical significance.

RESULTS

Group A (PRP) included 30 (19 female, 11 male) patients with mean age 52.2 ±6.3; group B (ABI) included 30 (20 female, 10 male) patients with mean age 52.7 ± 6.5. Both groups had similar body mass index (P = .719). No injection-related complications were recorded. After treatment, both groups had improved FADI and VAS scores compared to the baseline. Although the mean HRQoL scores were higher in the PRP group, there was no significant difference between the 2 groups (P_VAS = .589; P_FADI = .742).

CONCLUSION

Participants with plantar fasciitis improved statistically significantly after either PRP or ABI injections compared with baseline HRQoL scores, with no significant differences seen between the groups.

LEVEL OF EVIDENCE

Level I, prospective randomized double-anonymized clinical comparative study.

Immunopathogenesis, early Detection, current therapies and prevention of plantar Fasciitis: A concise review

Plantar fasciitis or the inflammation of the fascial lining on the plantar aspect of the foot continues to be the leading cause of heel pain for many Americans. Common causes can range from anatomical deformities such as pes planus or flat foot, biomechanical etiology such as excessive pronation of the subtalar joint, or chronic diseases such as obesity and diabetes mellitus. The pathophysiology of plantar fasciitis can be either inflammatory due to vasodilation and immune system activation or non-inflammatory involving fibroblastic hypertrophy. Worsening pain of the inferior and medial heel after periods of prolonged rest and late in the day after hours of ambulation and weight-bearing activities is the most common symptom of plantar fasciitis. Common treatments for plantar fasciitis include plantar fascia stretching, physical therapy, orthotics, corticosteroid injections, and even surgery. Despite these treatment strategies, fasciitis remains a clinical problem and better treatment modalities are warranted. Late diagnosis is a common issue for prolonged and equivocal treatment and early diagnostic measures might be beneficial. In this concise review, we discussed the etiology, immunopathogenesis, current treatments of plantar fasciitis and potentially preventative measures prior to the onset of chronic treatment resistant condition.