Study shows cortisone cost-effective for plantar fasciitis

[hhh]

Few points:
*pathethic p value
*very small study - no mention of this in the conclusion
*no mention of the standard deviation (for good reason!)
*a lot of evidence exists against the efficacy of ESWT, so they may as well compared cortisone with other sham like therapies like US.
*I'd take the results with a grain of salt, although it is easier preaching to the converted.

[sydunisportsmed]

With respect to the control group, this isn't an impressive study (the Porter one in CJSM), but the intervention part of the study was good with big numbers.

The difficulty is that most subjects improved and were substantially fixed, so it is difficult to get a difference at 12 months. The cortisone patients got better quicker though, although they were more tender (maybe due to a bit of fat pad atrophy, so it is easier to put a finger directly on the fascia origin).

The studies regarding efficicacy of ESWT aren't that impressive (some no difference, some showing postive results) but I'm not aware of any cases where the ESWT group does worse than the placebo. When the meta-analyses start getting down, I think the conclusions will be that ESWT is helpful, but perhaps number needed to treat to get a better result than placebo is pretty high for the cost of the machine.

Putting the results in perspective though, people with conditions like this (plantar fasciitis) need second line treatment options if orthotics and night splints don't work.

The surgeons basically don't bother doing RCTs - why would you when you are getting paid to do your surgery irrepsective of whether it is proven to benefit?

For newer treatments that must 'prove' their efficacy, it is obvious how difficult it is to show results using gold standard trials (which is what RCTs are).

[hhh]

Fair call on subject numbers, I read wrong. Would still like to see the standard deviations for the VAS as the range fro results appears to be massive. I also think that anyone who relies solely on night splints or orthotics to treat plantar fasciitis is also failing the patient. They should be used with a range of modalities with a unimodal treatment regime discouraged. Here lies the problem with RCTs as clinical practice favours a combined approach and perhaps RCTs should be designed around treatment protocol options.