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Date of Award
Spring 2020
Degree Name
Other
Master of Medical Science
Department
Physician Assistant; College of Health Sciences
First Advisor
Kimberly Erikson, PA-C
Abstract
Abstract
Introduction: Plantar fasciitis is the most common cause of heel pain which affects approximately one percent of adults in the United States. Current mainstay treatment options include non-steroidal anti-inflammatory drugs, splints, orthotics, physical therapy, corticosteroid injections and surgery. NSAIDs carry the risk of GI bleed and renal damage, physical therapy can be expensive, and corticosteroid injections carry the risk of tendon rupture. Additionally, long lasting relief is variable. Therefore, this review analyzes the efficacy and duration of pain relief with the use of botulinum toxin A injections or extracorporeal shockwave therapy compared to corticosteroid injections in adults with chronic plantar fasciitis.
Methods: A literature search was conducted through PubMedand Clinical Key/Medlineon November 18, 2018. Seven articles were selected based on study design, research question, interventions used and age of the participants.
Results: Upon review of the literature, promising data was found to support the efficacy and long-term effects of BTX-A injections and ESWT. One study demonstrated longer improvement of pain with BTX-A when compared to CS injections. Another study demonstrated longer improvement of pain with ESWT when compared to CS. Additionally, another study demonstrated superiority of ESWT over BTX-A. However, one studied also found that there was a greater chance to be nonresponsive to ESWT and recurrence rates were also higher when compared to CS.
Discussion: Ultimately, each study found statistically significant improvement in at least one outcome measure within the experimental group. However, the sample sizes were not large enough and only one study followed up with the participants beyond 6 months post treatment. Additionally, the variability in ESWT regimen between each of the studies does not allow for fair comparison of the results. Therefore, while all of the studies found statistically significant improvement with ESWT or BTX-A further research is still needed.
Conclusion: At this time there is not enough evidence to suggest one modality is better than the other and therefore a suggestion to change from current mainstay treatment cannot be made. However, there is enough evidence to support the necessity of further investigation in the subject. Presently, use of BTX-A and ESWT appears to be promising for long term control of plantar fasciitis but due to the deficiencies of the studies it has not yet been clearly established which is superior or which provides the longest improvement of pain management.
Recommended Citation
Chavez, Evelyn, "Duration of Pain Relief with Botulinum Injections or Extracorporeal Shockwave Therapy Compared to Corticosteroid Injections in Adult Patients with Chronic Plantar Fasciitis" (2020). Capstone Showcase. 33.
https://scholarworks.arcadia.edu/showcase/2020/pa/33
Duration of Pain Relief with Botulinum Injections or Extracorporeal Shockwave Therapy Compared to Corticosteroid Injections in Adult Patients with Chronic Plantar Fasciitis
Abstract
Introduction: Plantar fasciitis is the most common cause of heel pain which affects approximately one percent of adults in the United States. Current mainstay treatment options include non-steroidal anti-inflammatory drugs, splints, orthotics, physical therapy, corticosteroid injections and surgery. NSAIDs carry the risk of GI bleed and renal damage, physical therapy can be expensive, and corticosteroid injections carry the risk of tendon rupture. Additionally, long lasting relief is variable. Therefore, this review analyzes the efficacy and duration of pain relief with the use of botulinum toxin A injections or extracorporeal shockwave therapy compared to corticosteroid injections in adults with chronic plantar fasciitis.
Methods: A literature search was conducted through PubMedand Clinical Key/Medlineon November 18, 2018. Seven articles were selected based on study design, research question, interventions used and age of the participants.
Results: Upon review of the literature, promising data was found to support the efficacy and long-term effects of BTX-A injections and ESWT. One study demonstrated longer improvement of pain with BTX-A when compared to CS injections. Another study demonstrated longer improvement of pain with ESWT when compared to CS. Additionally, another study demonstrated superiority of ESWT over BTX-A. However, one studied also found that there was a greater chance to be nonresponsive to ESWT and recurrence rates were also higher when compared to CS.
Discussion: Ultimately, each study found statistically significant improvement in at least one outcome measure within the experimental group. However, the sample sizes were not large enough and only one study followed up with the participants beyond 6 months post treatment. Additionally, the variability in ESWT regimen between each of the studies does not allow for fair comparison of the results. Therefore, while all of the studies found statistically significant improvement with ESWT or BTX-A further research is still needed.
Conclusion: At this time there is not enough evidence to suggest one modality is better than the other and therefore a suggestion to change from current mainstay treatment cannot be made. However, there is enough evidence to support the necessity of further investigation in the subject. Presently, use of BTX-A and ESWT appears to be promising for long term control of plantar fasciitis but due to the deficiencies of the studies it has not yet been clearly established which is superior or which provides the longest improvement of pain management.