• Pain physician · Nov 2021

    Meta Analysis

    Comparative Effectiveness of Minimally Invasive Nonsurgical Treatments for Plantar Fasciitis: A Network Meta-analysis of 30 Randomized Controlled Trials.

    • Rui Gao, Jianfeng Sun, Li Zhang, Shu Chen, Wei Dong, Hui Yu, Bin Han, Mingsheng Tan, and Xian Li.
    • Institute of Clinical Pharmacology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China.
    • Pain Physician. 2021 Nov 1; 24 (7): E955-E971.

    BackgroundSeveral minimally invasive nonsurgical treatments have been widely applied for plantar fasciitis (PF). To date, controversy still exists regarding the effectiveness of these approaches for treating PF.ObjectiveThe purpose of this study was to perform a comprehensive comparison of the currently available invasive nonsurgical treatments for PF regarding short- and mid-term reductions in pain using a network meta-analysis (NMA).Study DesignNMA of randomized controlled trials (RCTs) for minimally invasive nonsurgical treatments of PF.MethodsThe EMBASE, PubMed, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched for eligible studies. Patients were adults age >= 18 years with PF. The outcome measures were the visual analog scale (VAS) scores at 3-6 weeks and 4-6 months. Pairwise meta-analysis and NMA based on a Bayesian analysis were performed, and all potential comparisons and rank of probabilities were calculated.ResultsThirty RCTs were included in the NMA. The trials investigated 20 treatments or combined treatments, including autologous whole blood, botulinum toxin A (BTA), ultrasound-guided gastrocnemius injection of botulinum toxin (BTA in the gastrocnemius), corticosteroid (CS), miniscalpel-needle (MSN), placebo, platelet-rich plasma (PRP), and the ultrasound-guided technique and peppering technique (PEP). The MSN treatment may be the best choice.LimitationsSome treatments were investigated in only one study or at one follow-up period and were separated from the network at 4-6 months. Other limitations include the inconformity of the treatment schedule and dose.ConclusionsThe MSN treatment should be recommended as the best therapy, followed by BTA in the gastrocnemius and BTA. CS and PRP are common medications that remain valuable in clinical practice. PEP can be performed after the injection of medication.

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