Abstract
Research Type:
Level 1 - Randomized controlled trial (RCT), Meta-analysis of randomized trials with homogeneous results
Introduction/Purpose:
Plantar fasciitis (PF) is one of the most common causes of heel pain, affecting both athletes and the general population. While numerous non-surgical treatments are utilized in clinical practice, their comparative effectiveness remains uncertain. Interventions such as extracorporeal shockwave therapy (ESWT), platelet-rich plasma (PRP), corticosteroid injections (CSI), prolotherapy, dry needling, and various physiotherapy modalities have shown promise, but the degree of pain relief and functional improvement varies across studies. This systematic review evaluates the current evidence regarding the efficacy of non-surgical treatments for PF, synthesizing findings from recent randomized controlled trials (RCTs).
Methods:
This review was conducted following the PRISMA guidelines. A comprehensive literature search was performed to identify RCTs published between January 2023 and January 2025 that investigated non-surgical treatments for PF. Inclusion criteria required studies to be randomized controlled trials with at least 20 participants, involving adults (≥18 years) with a clinical diagnosis of PF or related terminology (e.g., fasciosis, heel pain). Eligible interventions included ESWT, PRP, CSI, prolotherapy, dry needling, and other invasive non-surgical modalities. Studies were excluded if they involved surgical procedures, pharmacological oral agents or topical ointments, animal models, or populations with significant comorbidities such as diabetes, neuropathy, or rheumatoid arthritis. Non-English publications and RCTs scoring below 5 on the PEDro scale were also excluded. Data extraction focused on primary outcomes, including pain reduction (VAS, NRS), functional improvement (FAOS, AOFA, FFI), structural changes in plantar fascia thickness (PFT), and patient-reported quality of life measures (PGIC, SF-36).
Results:
A total of 18 RCTs met the inclusion criteria, evaluating a range of non-surgical interventions for PF. ESWT and PRP demonstrated the most consistent long-term benefits, with PRP exhibiting sustained improvements in pain and function beyond six months. Corticosteroid injections (CSI) provided rapid short-term pain relief but were associated with higher recurrence rates compared to regenerative therapies. Prolotherapy emerged as a promising alternative, with results comparable to CSI but with fewer side effects. Dry needling demonstrated moderate effectiveness, particularly when combined with additional rehabilitation strategies. Physiotherapy-based approaches, including taping, stretching, manual therapy, and peloidotherapy, proved beneficial as adjuncts, especially for patients preferring non-invasive options. Plantar fascia thickness (PFT) was significantly reduced in studies evaluating PRP and ESWT, correlating with pain improvement.
Conclusion:
This systematic review highlights the diversity and effectiveness of non-surgical treatments for PF and underscores the importance of individualized treatment selection. PRP and ESWT appear to provide superior long-term outcomes, while CSI remains effective for short-term relief but has a higher likelihood of symptom recurrence. Prolotherapy and dry needling offer viable, minimally invasive alternatives with favorable safety profiles. Physiotherapy-based interventions can be effective adjuncts to enhance functional recovery. Given the variability in treatment response, future high-quality comparative trials with longer follow-up periods are needed to refine clinical guidelines and optimize patient outcomes.
The interventions analyzed include platelet-rich plasma (PRP), extracorporeal shockwave therapy (ESWT), corticosteroid injections (CSI), prolotherapy, dry needling, and physiotherapy-based treatments. Outcome measures include pain assessments such as the Visual Analog Scale (VAS) and Numeric Rating Scale (NRS), as well as functional assessments including the Foot and Ankle Outcome Score (FAOS), American Orthopaedic Foot & Ankle Score (AOFA), and Foot Function Index (FFI). Structural outcomes were evaluated using Plantar Fascia Thickness (PFT), often measured via ultrasound. Patient-reported outcome measures such as the Patient Global Impression of Change (PGIC) and Short Form Health Survey (SF-36) were used to assess perceived improvements in quality of life.