EFFICACY OF PHARMACOLOGICAL AND NON-PHARMACOLOGICAL THERAPIES ON PAIN AND DISABILITY IN PLANTAR FASCIITIS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Background

Plantar fasciitis (PF) is one of the most common musculoskeletal conditions of the foot. Estimates of lifetime prevalence are up to 34.7% of the general population. Most of the time, PF is self-limited, but the time for complete resolution of symptoms can take up to a year, impairing the quality of life of patients. Non-pharmacological therapies are the first-choice management option for PF, such as biomechanical support, stretching, and extracorporeal shock wave therapy [ESWT]. In addition, other pharmacologic options are commonly prescribed (e.g., nonsteroidal anti-inflammatory drugs [NSAIDs], botulinum toxin, platelet-rich plasma injections, corticosteroid injections). However, there is no consensus on the decision-making process because they are limited in scope and methodology. Current evidence also needs to be updated with the aim of providing reliable evidence for the management of PF, taking into account that some new types of pharmacological and non-pharmacological therapies are being investigated (e.g., orthoses, shoes).

Objective

To investigate the effects of pharmacological and non-pharmacological therapies on pain and disability in PF.

Methods

Systematic review of randomized controlled trials (RCTs). Data sources: AMED, MEDLINE, PEDro, COCHRANE, SPORTDISCUSS, CINAHL, EMBASE, and PsycINFO without language or date restrictions until February 3^rd, 2023. RCTs that evaluated the efficacy of any pharmacological and non-pharmacological therapies in comparison with control (placebo, sham, waiting list, or no intervention) on pain intensity and disability in people with PF were the eligibility criteria. Two reviewers independently screened eligible studies, extracted data, assessed the methodological quality of included studies, and assessed certainty of evidence using the Recommendations, Assessment, Development, and Reviews (GRADE) grading framework.

Results

Seventeen different therapies investigated in 28 studies were included in the quantitative analysis. Moderate certainty evidence showed short-term effects of custom orthoses on pain intensity when compared with control (MD, -12.0 [95% CI: -17.1 to -7.0) and that orthoses did not reduce long-term pain intensity (MD, -5.9 [95% CI: -21.2 to 9.5]). Low-certainty evidence showed short-term effects in favor of taping (MD, -21.3 [95% CI: -38.6 to 4.0]) on pain intensity. For disability, low-certainty evidence showed that high-quality studies are needed.

Conclusions

The results of this meta-analysis should be evaluated by clinicians, stakeholders, and researchers, taking into account that most investigated interventions currently have low or very low certainty. Our findings expose the need to develop new larger studies with high methodological quality. Clinical

Implications

Current evidence supports customized orthoses and taping on short-term pain intensity when compared with controls with moderate and low certainty evidence, respectively. PROSPERO: (CRD42021224416).