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    Dextrose: Ryan et al 2009 Dextrose injection for chronic pain of Plantar fasciosis

    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 the content below.

    Objective: To report on the effectiveness of sonographically guided injections of hyperosmolar dextrose at reducing the pain associated with chronic plantar fasciitis.

    Design: Case series.

    Setting: 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.

    Results: 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.

    Conclusions: 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.