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Ruiz-Hernández IM, Gascó-Adrien J, Buen-Ruiz C, Perelló-Moreno L, Tornero-Prieto C, Barrantes-Delgado G, García-Gutiérrez M, Rapariz-González JM, Tejada-Gavela S. Botulinum toxin A versus platelet rich plasma ultrasound-guided injection in the treatment of plantar fasciitis: A randomised controlled trial. Foot Ankle Surg 2024; 30:117-122. [PMID: 37949704 DOI: 10.1016/j.fas.2023.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/14/2023] [Accepted: 10/13/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Platelet-rich plasma (PRP) and botulinum toxin type A (BTX-A) injections have proven effective in clinical trials for plantar fasciitis treatment but have not been directly compared. We aimed to compare clinical outcomes in patients undergoing PRP or BTX-A injections. METHODS We performed a randomised controlled trial (59 patients; 1-year follow-up) to assess efficacy, using pain and functional scales (VAS, AOFAS Hindfoot-scale and FAAM questionnaire) and fascia thickness reduction, in control and single ultrasound-guided BTX-A or PRP injection groups. RESULTS The BTX-A group showed better results at 1-month after treatment. Conversely, the PRP injection was more effective in the long-term, with significant pain reduction and functional improvement. Plantar fascia thickness significantly reduced from months 1 and 3 in the PRP and BTX-A groups, respectively. CONCLUSION PRP and BTX-A injections are effective in patients with plantar fasciitis with BTX-A achieving better short-term pain reduction and PRP better long-term results. LEVEL OF EVIDENCE Level I; Randomised Controlled Trial.
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Affiliation(s)
- Isabel M Ruiz-Hernández
- Department of Orthopaedics and Traumatology, Hospital Universitario Son Llàtzer, Carretera de Manacor, 07198 Palma, Baleares, Spain; Foot and Ankle Unit (Pieytobillo.es), Hospital Quironsalud Rotger, Calle Santiago Rusiñol, 9, 07012 Palma, Baleares, Spain.
| | - Javier Gascó-Adrien
- Department of Orthopaedics and Traumatology, Hospital Universitario Son Llàtzer, Carretera de Manacor, 07198 Palma, Baleares, Spain; Foot and Ankle Unit (Pieytobillo.es), Hospital Quironsalud Rotger, Calle Santiago Rusiñol, 9, 07012 Palma, Baleares, Spain
| | - Carmen Buen-Ruiz
- Department of Physical Therapy and Rehabilitation, Hospital Universitario Son Llàtzer, Carretera de Manacor, 07198 Palma, Baleares, Spain
| | - Laura Perelló-Moreno
- Department of Orthopaedics and Traumatology, Hospital Universitario Son Llàtzer, Carretera de Manacor, 07198 Palma, Baleares, Spain
| | - Carmen Tornero-Prieto
- Department of Orthopaedics and Traumatology, Hospital Universitario Son Llàtzer, Carretera de Manacor, 07198 Palma, Baleares, Spain
| | - Gonzalo Barrantes-Delgado
- Department of Orthopaedics and Traumatology, Hospital Universitario Son Llàtzer, Carretera de Manacor, 07198 Palma, Baleares, Spain; Foot and Ankle Unit (Pieytobillo.es), Hospital Quironsalud Rotger, Calle Santiago Rusiñol, 9, 07012 Palma, Baleares, Spain
| | - Mireia García-Gutiérrez
- Department of Physical Therapy and Rehabilitation, Hospital Universitario Son Llàtzer, Carretera de Manacor, 07198 Palma, Baleares, Spain
| | - J M Rapariz-González
- Department of Orthopaedics and Traumatology, Hospital Universitario Son Llàtzer, Carretera de Manacor, 07198 Palma, Baleares, Spain
| | - S Tejada-Gavela
- Department of Biology, Universitat de les Illes Balears, Cra. de Valldemossa, km 7.5, 07122 Palma, Baleares, Spain
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Treatment of "plantar fasciitis"/Plantar Heel Pain Syndrome with botulinum toxin - A novel injection paradigm pilot study. Foot (Edinb) 2020; 45:101711. [PMID: 33038660 DOI: 10.1016/j.foot.2020.101711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 05/26/2020] [Accepted: 07/03/2020] [Indexed: 02/04/2023]
Abstract
Randomized controlled trials over the last two decades, although promising with favorable results, have shown varied efficacy in treatment of "plantar fasciitis" with botulinum toxin injection1. One reason may be due to conflating the variabilities of plantar heel conditions solely as plantar fasciitis. Plantar Heel Pain Syndrome can be of one or more etiologies and symptoms which refutes the mistaken tendency to categorize all plantar heel pain singularly as either plantar fasciitis or fasciosis. Recognizing that there is likely an interplay of inflammatory, degenerative, and neuropathic etiologic conditions of this often-difficult malady to treat, a novel injection paradigm of botulinum toxin is explored in the treatment of 4 distinct presentations of Plantar Heel Pain Syndrome with encouraging results. Botulinum toxin injection into two intrinsic foot muscles; Abductor Hallucis and Quadratus Plantae at their origins with electrical stimulation is presented as novel method to treat four distinct etiologies of Plantar Heel Pain Syndrome. This method of botulinum toxin injection resulted in significant prolonged improvement of patient function and pain reduction in four variations of Plantar Heel Pain Syndrome. A precise injection paradigm facilitated with direct intrinsic muscle stimulation of the Abductor Hallucis and Quadratus Plantae at their origins may prove to be effective in reducing the disabilities of Plantar Heel Pain Syndrome and its associated pain.
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Mohammed W, Farah S, Nassiri M, McKenna J. Therapeutic efficacy of platelet-rich plasma injection compared to corticosteroid injection in plantar fasciitis: A systematic review and meta-analysis. J Orthop 2020; 22:124-134. [PMID: 32336895 PMCID: PMC7177161 DOI: 10.1016/j.jor.2020.03.053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 03/26/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND This study summarizes all literature assessing the long term effects of platelet-rich plasma (PRP) injection compared to corticosteroid injection to relieve pain and improve function in Plantar Fasciitis patients. MATERIALS AND METHODS This is a PRISMA compliant systematic review of 5 databases and include a meta-analysis of Randomized Controlled Trial data comparing the two injections. RESULTS Ten prospective trials were included with total number of 543 participants. The PRP group had significantly better pain scores at 3 months and 6 months follow-up. CONCLUSION PRP injections provide better pain relief, compared to corticosteroids, in patients with plantar fasciitis.
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Affiliation(s)
- Wafi Mohammed
- Tallaght University Hospital, Tallaght, Dublin 24, Ireland
| | - Salma Farah
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | | | - Johnny McKenna
- Tallaght University Hospital, Tallaght, Dublin 24, Ireland
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Abstract
BACKGROUND This study examined the effect of botulinum toxin upon plantar fasciitis through a randomized, controlled, and blinded trial. MATERIALS Between 2012 and 2015, 50 patients presented with plantar fasciitis. Twenty-five patients each randomly received an IncobotulinumtoxinA (IBTA) or saline injection of their affected foot. Pre- and postinjection function and pain were graded with the Foot and Ankle Ability Measures (FAAM) and visual analog scale (VAS), respectively. All 50 study patients who randomly received either placebo or IBTA presented at 6 and 12 months after injection. RESULTS At 6 months, the mean FAAM increased from 35.9 to 40.9 of 100, and the mean pain score decreased from 8.4 to 7.9 of 10 within the placebo group. At 6 months, the mean FAAM increased from 36.3 to 73.8 of 100, and mean pain score decreased from 7.2 to 3.6 of 10 within the IBTA group. These postinjection scores were significantly better than the placebo group ( P = .01). At 12 months after injection, the IBTA group maintained significantly better function and pain than the placebo group ( P < .05). By that time, 0 (0%) and 3 (12%) patients who received IBTA and saline, respectively, underwent surgery for recalcitrant plantar fasciitis ( P < .005). CONCLUSION Compared with placebo saline injection, using IBTA to treat plantar fasciitis resulted in significantly better improvement in foot function and pain. IBTA also lessened the need for operative treatment of plantar fasciitis. LEVEL OF EVIDENCE I, Randomized, double-blinded, placebo-controlled study.
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Affiliation(s)
- Jamal Ahmad
- 1 Orthopaedic Foot and Ankle Surgery, Rothman Institute Orthopaedics, Philadelphia, PA, USA
| | - Stacy H Ahmad
- 2 Department of Anatomy, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Kennis Jones
- 3 Rothman Institute Orthopaedics, Philadelphia, PA
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Abstract
Plantar fasciitis (PF) is a distressing condition experienced by many patients. Although self-limiting, it tends to become a chronic ailment if the precipitating factors are not addressed. One of the modality of treating PF is intra-lesional corticosteroid injection. This was done using palpation technique earlier but nowadays many specialists use ultrasound (US) imaging as a guide to give injection accurately instead of inadvertently damaging the plantar fascia or injecting into surrounding soft tissue, both of which can have serious implications. We did a literature search in Medline, Scopus, and Embase databases to find out articles describing US-guided corticosteroid injection for treating PF and whether guided injection was effective than injection given by palpation.
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Affiliation(s)
- A S Nair
- Department of Anesthesiology and Pain Management, Citizens Hospital, Hyderabad, Telangana, India
| | - R K Sahoo
- Department of Anesthesiology and Pain Management, Citizens Hospital, Hyderabad, Telangana, India
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Shah A, Best AJ, Rennie WJ. Percutaneous Ultrasound-Guided TOPAZ Radiofrequency Coblation: A Novel Coaxial Technique for the Treatment of Recalcitrant Plantar Fasciitis-Our Experience. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:1325-1331. [PMID: 27162283 DOI: 10.7863/ultra.15.06085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 09/28/2015] [Indexed: 06/05/2023]
Abstract
Various therapeutic options are available for treatment of recalcitrant plantar fasciitis. Studies using TOPAZ coblation (ArthroCare, Sunnyvale, CA) have had good early results. The current coblation technique involves a surgical incision or breach of the highly specialized plantar fat pad, which can be associated with risks. We describe a novel technique of ultrasound-guided percutaneous coblation with a lateral heel approach. Advantages include precise targeting of the plantar fascia by direct dynamic visualization of the coblation tip, a true percutaneous approach with a needle skin puncture (<5 mm), and preservation of the plantar fat pad by using a lateral heel approach.
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Affiliation(s)
- Amit Shah
- Department of Musculoskeletal Radiology, University Hospitals of Leicester National Health Service Trust, Leicester Royal Infirmary, Leicester, England
| | - Alistair J Best
- Department of Trauma and Orthopedics, University Hospitals of Leicester National Health Service Trust, Leicester Royal Infirmary, Leicester, England
| | - Winston J Rennie
- Department of Musculoskeletal Radiology, University Hospitals of Leicester National Health Service Trust, Leicester Royal Infirmary, Leicester, England
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