Comparison of Injection Methods for the Treatment of Plantar Fasciitis: A Comparative Study.

Abstract

Plantar fasciitis (PF) is one of the most common causes of heel pain, and multiple injection-based treatments are used in practice; however, short-term comparative data remain limited. To compare the short-term clinical outcomes of four injection methods for PF-peppering alone, peppering combined with corticosteroid, corticosteroid alone, and autologous blood injection-using pain reduction measured by the Visual Analog Scale (VAS). Comparative cohort study. A total of 123 patients diagnosed with PF were screened, and 83 met the inclusion criteria (available VAS scores, completed third-week and third-month follow-ups, no prior foot surgery or fracture). Patients were allocated into four groups: peppering (n = 21), peppering with corticosteroid (n = 20), corticosteroid alone (n = 22), and autologous blood injection (n = 20). Pain severity was assessed using VAS at baseline, third week, and third month. Nonparametric tests were applied, including Mann-Whitney U and Kruskal-Wallis for independent comparisons and Wilcoxon or Friedman tests for repeated measures. Significant differences in VAS scores were observed among groups at both follow-ups. The peppering with corticosteroid and corticosteroid-alone groups demonstrated greater pain reduction than the peppering or autologous blood groups. Improvement in the peppering group appeared only at the third month, while the autologous blood group showed no significant short-term change. The combination of peppering and corticosteroid produced a more sustained reduction in pain than corticosteroid alone. Corticosteroid combined with the peppering technique was the most effective short-term option for reducing PF-related pain. Peppering alone may require longer follow-up to show meaningful benefit, whereas autologous blood injection demonstrated limited short-term efficacy.