Ultrasound- versus palpation-guided injection of corticosteroid for plantar fasciitis: a meta-analysis

Zonghuan Li, Chengyan Xia, Aixi Yu, Baiwen Qi, Zonghuan Li, Chengyan Xia, Aixi Yu, Baiwen Qi

Abstract

Background: It is controversial whether ultrasound-guided injection of corticosteroid is superior to palpation-guided injection for plantar fasciitis. This meta-analysis was performed to compare the effectiveness of ultrasound-guided and palpation-guided injection of corticosteroid for the treatment of plantar fasciitis.

Methods: Databases (MEDLINE, Cochrane library and EMBASE) and reference lists were searched from their establishment to August 30, 2013 for randomized controlled trials (RCTs) comparing ultrasound-guided with palpation-guided injection for plantar fasciitis. The Cochrane risk of bias (ROB) tool was used to assess the methodological quality. Outcome measurements were visual analogue scale (VAS), tenderness threshold (TT), heel tenderness index (HTI), response rate, plantar fascia thickness (PFT), hypoechogenicity and heel pad thickness (HPT). The statistical analysis was performed with software RevMan 5.2 and Stata 12.0. When I2<50%, the fixed-effects model was adopted. Otherwise the randomized-effects model was adopted. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to assess the quality of evidence.

Results: Five RCTs with 149 patients were identified and analyzed. Compared with palpation-guided injection, ultrasound-guided injection was superior with regard to VAS, TT, response rate, PFT and hypoechogenicity. However, there was no statistical significance between the two groups for HPT and HTI.

Conclusion: Ultrasound-guided injection of corticosteroid tends to be more effective than palpation-guided injection. However, it needs to be confirmed by further research.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Flow diagram of the process…
Figure 1. Flow diagram of the process of literature screening.
Figure 2. Forest plot for VAS score…
Figure 2. Forest plot for VAS score between ultrasound-guided injection and palpation-guided injection.
Figure 3. Forest plot for tenderness threshold…
Figure 3. Forest plot for tenderness threshold between ultrasound-guided injection and palpation-guided injection.
Figure 4. Forest plot for heel tenderness…
Figure 4. Forest plot for heel tenderness index between ultrasound-guided injection and palpation-guided injection.
Figure 5. Forest plot for response rate…
Figure 5. Forest plot for response rate between ultrasound-guided injection and palpation-guided injection.
Figure 6. Forest plot for plantar fascia…
Figure 6. Forest plot for plantar fascia thickness between ultrasound-guided injection and palpation-guided injection.
Figure 7. Forest plot for hypoechogenicity between…
Figure 7. Forest plot for hypoechogenicity between ultrasound-guided injection and palpation-guided injection.
Figure 8. Forest plot for heel pad…
Figure 8. Forest plot for heel pad thickness between ultrasound-guided injection and palpation-guided injection.

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