Effect of corticosteroids over plantar fascia thickness in plantar fasciitis: a systematic review and meta-analysis

Corticosteroid injections have been typically used for the management of plantar fasciitis with apparently good clinical outcomes; however, there is no information of the effect of corticosteroids on the thickness of the plantar fascia which is typically altered in this pathology. We aimed determine whether treatment with corticosteroid injections induces plantar fascia thickness changes in plantar fasciitis MEDLINE, Embase, Web of Science, and Scopus databases were searched for randomized controlled trials (RCT) reporting the use of corticosteroid injection to treat plantar fasciitis to July 2022. Studies must have reported plantar fascia thickness measurement. The risk of bias in all studies was assessed with the Cochrane Risk of Bias 2.0 tool. Meta-analysis was conducted using a random-effects model and the generic inverse variance method. Data from 17 RCT (including 1109 subjects) were collected. The follow-up period ranged from one to six months. Most studies measured the thickness of the plantar fascia at the insertion into the calcaneus using ultrasound. Pooled analysis revealed that corticosteroid injections had no significant effect on plantar fascia thickness (weighted mean differences [WMD], 0.06 mm [95% CI: −0.17, 0.29]; p = 0.61) or pain relief (WMD, 0.12 cm [95% CI: −0.36, 0.61]; p = 0.62) above active controls. Corticosteroid injections do not perform better than other common interventions in terms of a decrease of plantar fascia thickness and pain relief for plantar fasciitis.

糖皮质激素注射通常被用于跖筋膜炎（plantar fasciitis）的临床管理，既往报道其临床疗效尚可；然而目前尚无关于糖皮质激素对跖筋膜厚度影响的相关研究数据——而跖筋膜厚度在该病理状态下通常会发生改变。本研究旨在明确糖皮质激素注射治疗是否会引发跖筋膜炎患者的跖筋膜厚度变化。我们检索了截至2022年7月的MEDLINE、Embase、Web of Science及Scopus数据库，筛选出报道采用糖皮质激素注射治疗跖筋膜炎的随机对照试验（Randomized Controlled Trial, RCT）。纳入的研究均需报道跖筋膜厚度的测量数据。采用Cochrane偏倚风险2.0工具对所有研究的偏倚风险进行评估。本研究采用随机效应模型及通用逆方差法开展荟萃分析。最终共纳入17项RCT，涉及1109名研究对象，随访周期为1至6个月。多数研究采用超声（ultrasound）测量跟骨附着处的跖筋膜厚度。合并分析结果显示，相较于阳性对照组，糖皮质激素注射对跖筋膜厚度（加权均数差[weighted mean difference, WMD]：0.06 mm，95%置信区间[confidence interval, CI]：-0.17~0.29；p=0.61）及疼痛缓解（WMD：0.12 cm，95%CI：-0.36~0.61；p=0.62）均无显著改善作用。在跖筋膜炎的治疗中，糖皮质激素注射在降低跖筋膜厚度及缓解疼痛方面，并不优于其他常规干预手段。