Corticosteroid Injections Versus Extracorporeal Shockwave Therapy for the Treatment of Plantar Heel Pain
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Presenter(s)
Molly Dring, Payton Hansen
Abstract
Clinical Scenario: Heel pain, particularly due to plantar fasciitis, can be managed through various treatment options. Among these, extracorporeal shock wave therapy (ESWT) and corticosteroid injections (CSI) are commonly used interventions. This appraisal examines the outcomes of ESWT and CSI to determine which treatment is more beneficial for adults experiencing plantar heel pain.
Clinical Question: In adults with plantar heel pain, does CSI provide better results than ESWT for decreasing pain?
Search Strategy: Eight articles were included in the appraisal from a literature search of the PubMed database and Google Scholar search engine. Key search words included: RCT, corticosteroid injections, extracorporeal shockwave therapy, plantar heel, and plantar fasciitis. Inclusion criteria consisted of patients aged 18 and above undergoing CSI or ESWT for plantar heel pain, with pain assessment based on patient-reported outcomes. Exclusion criteria included patients utilizing injection types other than CSI, those undergoing treatment areas other than plantar heel pain, and studies lasting less than eight weeks.
Evidence and Assessment: The quality of the eight articles was assessed using the PEDro scale, with scores ranging from 5/10 to 7/10. Seven of eight articles scored a Level 2a on The Oxford Level of Evidence scale with one article scoring a Level 4 as a case series.
Results and Summary of Search: The key outcome measured in this analysis included the Visual Analogue Pain Scores (VAS). Four of eight studies concluded that both ESWT and CSI are equally effective in treating heel pain (p<.001). Three studies found that CSI is more effective than ESWT with one linking the presence of edema as a factor (p<.001). Two studies concluded that ESWT is more effective than CSI with one noting that obese subjects prefer ESWT (p<.001). Weaknesses of the appraisal included small sample sizes, variability in patient populations, and the subject nature of pain, which may have influenced the results.
Clinical Bottom Line: Our findings were inconclusive in favoring one treatment, as both CSI and ESWT were found to effectively treat plantar heel pain. Our research received a Strength of Recommendation Taxonomy (SORT) score of Level B, indicating inconsistent or limited quality patient-orientated evidence.
Implications: Currently, no single treatment is considered the "gold standard" for heel pain. Our findings suggest that both CSI and ESWT are effective treatments for plantar heel pain. Educating patients on these choices allows them to select the best fit for their needs. Future research should include larger, more diverse sample sizes to improve accuracy and applicability, as some studies were limited to specific populations. Expanding research with broader interventions will help produce clearer, more definitive results.
College
College of Nursing & Health Sciences
Department
Health, Exercise & Rehabilitative Sciences
Campus
Winona
First Advisor/Mentor
Brandon Donahue, DAT, LAT, ATC
Second Advisor/Mentor
Nora Kraemer, PhD, LAT, ATC, CSCS
Presentation Type
Oral Presentation
Format of Presentation or Performance
Pre-Recorded Video
Metadata Creation Responsibility
Molly Dring
Corticosteroid Injections Versus Extracorporeal Shockwave Therapy for the Treatment of Plantar Heel Pain
Clinical Scenario: Heel pain, particularly due to plantar fasciitis, can be managed through various treatment options. Among these, extracorporeal shock wave therapy (ESWT) and corticosteroid injections (CSI) are commonly used interventions. This appraisal examines the outcomes of ESWT and CSI to determine which treatment is more beneficial for adults experiencing plantar heel pain.
Clinical Question: In adults with plantar heel pain, does CSI provide better results than ESWT for decreasing pain?
Search Strategy: Eight articles were included in the appraisal from a literature search of the PubMed database and Google Scholar search engine. Key search words included: RCT, corticosteroid injections, extracorporeal shockwave therapy, plantar heel, and plantar fasciitis. Inclusion criteria consisted of patients aged 18 and above undergoing CSI or ESWT for plantar heel pain, with pain assessment based on patient-reported outcomes. Exclusion criteria included patients utilizing injection types other than CSI, those undergoing treatment areas other than plantar heel pain, and studies lasting less than eight weeks.
Evidence and Assessment: The quality of the eight articles was assessed using the PEDro scale, with scores ranging from 5/10 to 7/10. Seven of eight articles scored a Level 2a on The Oxford Level of Evidence scale with one article scoring a Level 4 as a case series.
Results and Summary of Search: The key outcome measured in this analysis included the Visual Analogue Pain Scores (VAS). Four of eight studies concluded that both ESWT and CSI are equally effective in treating heel pain (p<.001). Three studies found that CSI is more effective than ESWT with one linking the presence of edema as a factor (p<.001). Two studies concluded that ESWT is more effective than CSI with one noting that obese subjects prefer ESWT (p<.001). Weaknesses of the appraisal included small sample sizes, variability in patient populations, and the subject nature of pain, which may have influenced the results.
Clinical Bottom Line: Our findings were inconclusive in favoring one treatment, as both CSI and ESWT were found to effectively treat plantar heel pain. Our research received a Strength of Recommendation Taxonomy (SORT) score of Level B, indicating inconsistent or limited quality patient-orientated evidence.
Implications: Currently, no single treatment is considered the "gold standard" for heel pain. Our findings suggest that both CSI and ESWT are effective treatments for plantar heel pain. Educating patients on these choices allows them to select the best fit for their needs. Future research should include larger, more diverse sample sizes to improve accuracy and applicability, as some studies were limited to specific populations. Expanding research with broader interventions will help produce clearer, more definitive results.
