Ryan MB, Wong AD, Gillies JH, Wong J, Traunton JE Sonographically guided intratendinous injections of hyperosmolar dextrose/lidocaine: a pilot study for the treatment of chronic plantar fasciitis. Br J Sports Med 2009;43 :303–306.
DR. REEVES’ NOTES:
The is an article about injection of 25% dextrose in 20 consecutive patients with pain in the feet imitated by pressure over the plantar fascia. Injections were given under ultrasound guidance. These were chronic cases with pain from 7 to 228 months (mean 21 months). Follow-up was for 6-20 months (mean 11.8) months from the final treatment. Three to 12 sessions (mean 3) were given at 2 week intervals. 16 out of 20 had good to excellent results.
My impression is that there were apparently no dropouts which is somewhat unusual in a study with foot injection every 2 weeks. This speaks well of the technique of the authors. However, the every 2 week frequency may have not allowed enough time in between to really determine the number of treatments needed with full healing intervals. There is always a balance between desire to move treatment along in an athlete and the desire to keep the number of treatments minimal. It is notable that, although ultrasound was used for injection there were no post treatment ultrasound results reported. Therefore there were no objective post treatment measures. There also was not a group comparing blind injections to ultrasound guided.
A copy of the abstract on Dextrose Injection is available here, with a copy of the content below.
To report on the effectiveness of sonographically guided injections of hyperosmolar dextrose at reducing the pain associated with chronic plantar fasciitis.
Ultrasound division of St Paul’s Hospital. Patients: 20 referrals (3 men, 17 women; age 51 (SD 13) years) from local sports medicine primary care practitioners who had failed previous conservative treatments. Interventions: A 27-gauge needle administered a 25% dextrose/lidocaine solution under sonographic guidance at 6 week intervals returning for a median of three consultations.
MAIN OUTCOME MEASURES:
Visual analogue scale (VAS) items for pain levels at rest (VAS1), activities of daily living (VAS2), and during or after physical activity (VAS3) were recorded at baseline and at the final treatment consultation (post-test). A telephone interview conducted an average of 11.8 months after the post-test consultation provided a measure of long-term follow-up.
16 patients reported a good to excellent outcome, while the symptoms in 4 patients were unchanged. There was a significant decrease (p,0.001) in all mean VAS items from pre-test to post-test: VAS1 (36.8 (SD 25.6) to 10.3 (10.9)), VAS2 (74.7 (20.8) to 25.0 (27.7)) and VAS3 (91.6 (9.2) to 38.7 (35.1)) and there were no apparent changes after the follow-up interview.
Sonographically guided dextrose injections showed a good clinical response in patients with chronic plantar fasciitis insofar as pain was reduced during rest and activity. Further studies including a control group are needed to validate these outcomes.
Kiter E; Celikbas E; Akkaya S; Demirkan F; Kilic BA Comparison of injection modalities in the treatment of plantar heel pain: a randomized controlled trial. J Am Podiatr Med Assoc (United States), Jul-Aug 2006, 96(4) p293-6
DR. REEVES’ NOTES:
It is important to note that these were feet that had not been injected before. In feet without previous injection exposed to steroid X 1, blood X1, or traumatic needling with anesthetic only, each group as a whole did much better with one treatment at 6 months follow-up. Clinical experience has indicated that the first injection with steroid is usually helpful but subsequent injections are less so. Thus these results are not those expected from chronic feet pain that have failed injection. It is interesting to note that results were very similar between 15 or more traumatic redirections of an 18 gauge needle and a single injection of autologous blood with such trauma being required. Also notable was a severity of 6.4 in the needling group and 7.6 in the blood group, which may have been significant if the groups had been larger in size (15 in each group)
A copy of the abstract on Whole Blood Kiter is available here, with a copy of the content below.
In a prospective randomized study of plantar heel pain, 44 patients were treated with injection of 1 mL of 2% prilocaine using the peppering technique, 1 mL of 2% prilocaine combined with 2 mL of autologous blood, or 1 mL of 2% prilocaine mixed with 40 mg of methylprednisolone acetate. At 6-month follow-up, clinical improvement was evaluated by using a 10-cm visual analog scale and the rearfoot score of the American Orthopaedic Foot and Ankle Society. Results were analyzed using sample t-tests within groups and repeated-measures analyses of variance between groups. Mean +/- SD visual analog scale scores in the peppering technique, autologous blood injection, and corticosteroid injection groups improved from 6.4 +/- 1.1, 7.6 +/- 1.3, and 7.28 +/- 1.2 to 2.0 +/- 2.2 (P < .001), 2.4 +/- 1.8 (P < .001), and 2.57 +/- 2.9 (P < .001), respectively. Mean +/- SD rearfoot scores in the same groups improved from 64.1 +/- 15.1, 71.6 +/- 1, and 65.7 +/- 12.7 to 78.2 +/- 12.4 (P = .018), 80.9 +/- 13.9 (P = .025), and 80.07 +/- 17.5 (P = .030), respectively. There were no statistically significant differences among the groups. Good outcomes have been documented using the peppering technique and autologous blood injection for the treatment of lateral epicondylitis. Although the curative mechanisms of both injection modalities are based on a hypothesis, they seem to be good alternatives to corticosteroid injection for the treatment of plantar heel pain.