Comparative efficacy of six injection therapies for plantar fasciitis: a systematic review and network meta-analysis

Plantar fasciitis (PF) is the most common cause of heel pain, often causing significant disruptions to daily life due to severe discomfort. Multiple clinical investigations have attested to the efficacy of injection therapies. This network meta-analysis aimed to evaluate and compare the therapeutic effects of different injection treatments: placebo, corticosteroids (CS), platelet-rich plasma (PRP), dextrose prolotherapy, botulinum toxin A (BoNT-A), and autologous blood (AB). We systematically searched four databases (PubMed, Embase, Cochrane Library, and Web of Science) to identify controlled studies comparing the efficacy of the aforementioned six injection therapies for PF. The synthesis of outcome measures was performed using a Bayesian framework with Stata 15.1 software. The surface under the cumulative ranking curve was employed for treatment ranking. This study included 59 trials involving a total of 3833 patients. According to the Visual Analog Scale scores, in terms of short-term pain relief, BoNT-A demonstrated the best effect compared to the placebo [mean difference (MD): -4.16, 95% confidence interval (CI): -6.50 to -1.82]. CS, PRP, BoNT-A, and AB all performed better than the placebo in terms of long-term pain relief. Based on the America Orthopedic Foot and Ankle Society scores, BoNT-A showed significant differences compared to the placebo in the short-term (MD: 28.12, 95% CI: 4.49-51.76) and long-term effects (MD: 26.79, 95% CI: 18.24-35.34). For PF patients subjected to injection therapy, BoNT-A may be the optimal therapeutic agent, while PRP is a secondary choice.