Placental-derived injectable products for chronic plantar fasciitis: A systematic review and meta-analysis.

Abstract

Background: Plantar fasciitis may persist despite prolonged conservative treatment, and placental-derived injectable orthobiologics have emerged as potential regenerative therapies. However, their clinical efficacy and safety remain uncertain.

Purpose: To systematically evaluate the current evidence on placental-derived injectable products for chronic plantar fasciitis.

Study design: Systematic review and meta-analysis.

Methods: Literature search was conducted through PubMed, Science Direct, Google Scholar, Cochrane, and ProQuest following PRISMA 2020. The primary outcome was pain reduction. Pain outcomes were harmonized to a 0-10 scale and pooled using mean difference (MD). Functional outcomes and adverse events were synthesized narratively. Certainty of evidence was evaluated using GRADE.

Results: Six studies involving 324 adults with plantar fasciitis were included. Among placebo-controlled randomized trials, placental-derived injections were associated with greater pain reduction than control (MD 3.37 points; 95% CI, 1.13-5.60; p = 0.003; I² = 92%). Non-randomized comparative studies also favored placental-derived treatment (MD 1.91 points; 95% CI, 0.80-3.03; I² = 9%; p < 0.001). The exploratory cross-design estimate was MD 2.77 points (95% CI, 1.29-4.25; I² = 85%). Functional outcomes generally improved, although heterogeneous instruments precluded quantitative pooling. No serious treatment-related adverse events were reported. Certainty of evidence was low to very low.

Conclusions: Placental-derived injectable products may be associated with pain improvement in chronic plantar fasciitis; however, the certainty of evidence remains limited by small sample sizes, substantial heterogeneity, and variation in product formulation and treatment protocols. Further standardized randomized trials are required before routine clinical use can be recommended.