Which is superior to local ozone injection or dextrose prolotheraphy injection in chronic plantar fasciitis?: a randomised controlled trial

Plantar fasciitis (PF) is a multifactorial pathology with unclear aetiology. Inflammation and/or degeneration have been blamed for the aetiology. Although it is common in athletic individuals, it also affects overweight women aged 40-60 years who are physically inactive. PF, impairs gait due to heel pain and may affect social and work life. The diagnosis is clinical. Ultrasonography (US) with a plantar fascia thickness of more than 4 mm supports the diagnosis. Conservative methods are primarily preferred in treatment. Despite conservative treatment, approximately %30 of patients become chronic. Dextrose prolotherapy and local ozone injection are recently popular regenerative treatment methods. This study was designed as a randomised single-blind controlled trial to compare the superiority of dextrose prolotherapy and local ozone injection to each other and to a control group in chronic PF. To our knowledge, there is no study comparing these two injection methods in chronic PF. Among the randomised groups; Group 1 received local ozone injection at doses of 10, 15, 20 μg/ml, and Group 2 received 15% dextrose prolotherapy injection into the plantar fascia 3 times with 2 weeks intervals at 0, 2, and 4 weeks, respectively, under USG guidance. Groups 1 and 2 were given home exercise programme in addition to injection. Group 3 was designed as a control group. Group 3 did not receive injection and only home exercise programme was given. Patients were evaluated with VAS-I, VAS-A and FFI questionnaire at 0, 2, 4 and 12 weeks. Plantar fascia thickness was measured by US at 0 and 12 weeks. Before treatment (at week 0), there was no difference between the groups in VAS-I, VAS-A, FFI pain, FFI disability, FFI activity limitation, FFI total and plantar fascia thickness parameters (p>0.05). The decrease in VAS-I and VAS-A was statistically significant in Group 1 compared to the other groups at week 2 (p<0.05). It was statistically significant in group 2 compared to the other groups at week 12 (p<0.05). At week 4, there was no statistically significant difference between the groups (p>0.05). The decrease in FFI pain score was statistically significant in Group 1 compared to the other groups at week 2 (p<0.05). At week 12, there was a statistically significant difference in Groups 1 and 2 compared to Group 3 (p<0.05). There was no statistically significant difference between Group 1 and Group 2 (p>0.05). At week 4, there was a statistically significant difference between Group 1 and Group 3 (p<0.05). However, there was no statistically significant difference between Group 2 and Group 3 (p>0.05). Decrease in FFI disability score; there was no statistically significant difference between the groups at all times (p>0.05). Decrease in FFI activity limitation score; there was a statistically significant difference between Group 1 and Group 2 at week 2 (p<0.05). At 4th and 12th weeks, there was no statistically significant difference between the groups (p>0.05). The decrease in FFI total score was statistically significant in Groups 1 and 2 compared to Group 3 at week 12 (p<0.05). There was no statistically significant difference between groups 1 and 2 (p>0.05). At the 2nd and 4th weeks, there was no statistically significant difference in FFI total score between the groups (p>0.05). The decrease in plantar fascia thickness measured by US was statistically significant in Group 2 compared to the other groups at 12 weeks (p<0.05). It was also statistically significant in Group 1 compared to Group 3 (p<0.05). The presence of side effects and complications; there was no statistically significant difference between the groups (p>0.05). As a result, local ozone injection is superior to prolotherapy injection in the early period (2nd week) in reducing pain scores in patients with chronic PF, while 15% dextrose prolotherapy injection is superior to local ozone injection in the 12th week. In the reduction of plantar fascia thickness, 15% dextrose prolotherapy injection is superior to local ozone injection. There was no difference between the two groups at week 12 in the increase of functionality, but both groups were superior to the control group. Both injection methods are effective and safe in chronic PF. However, randomised controlled trials with long-term follow-up are needed for the optimisation of the application method, frequency, dose and number of injections of local ozone and prolotherapy injections in chronic PF.