Table.
GRADE evaluation of interventions for plantar heel pain and fasciitis
| Important outcomes | Pain relief, functional improvement, quality of life, adverse effects | ||||||||
| Number of studies (participants) | Outcome | Comparison | Type of evidence | Quality | Consistency | Directness | Effect size | GRADE | Comment |
| What are the effects of treatments for plantar heel pain? | |||||||||
| 1 (91) | Functional improvement | Casted orthoses v placebo/no treatment | 4 | –1 | 0 | 0 | 0 | Moderate | Quality point deducted for sparse data |
| 1 (91) | Pain relief | Casted orthoses v placebo/no treatment | 4 | –1 | 0 | 0 | 0 | Moderate | Quality point deducted for sparse data |
| 1 (89) | Pain relief | Casted orthoses v prefabricated orthoses | 4 | –1 | 0 | 0 | 0 | Moderate | Quality point deducted for sparse data |
| 1 (89) | Functional improvement | Casted orthoses v prefabricated orthoses | 4 | –1 | 0 | 0 | 0 | Moderate | Quality point deducted for sparse data |
| 1 (103) | Pain relief | Casted orthoses plus pad plus taping v heel pad plus pain medication | 4 | –2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and no intention-to-treat analysis |
| 1 (236) | Pain relief | Casted orthoses plus stretching exercises v heel pad plus stretching exercises | 4 | –1 | 0 | 0 | 0 | Moderate | Quality point deducted for incomplete reporting of results |
| 1(222) | Pain relief | Casted orthoses v night splints | 4 | –2 | 0 | –1 | 0 | Very low | Quality points deducted for incomplete reporting of results and uncertainty about intention-to-treat analysis. Directness points deducted for differences in withdrawal rates between groups |
| 1 (43) | Pain relief | Casted orthoses v orthosis plus night splints | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for sparse data, incomplete reporting of results and lack of blinding |
| 1 (91) | Pain relief | Corticosteroid injection plus local anaesthesia v local anaesthetic (short term) | 4 | –3 | 0 | –2 | 0 | Very low | Quality points deducted for sparse data, lack of placebo controls, no intention-to-treat analysis and poor follow-up. Directness points deducted for uncertainty of clinical relevance and heterogeneity between interventions |
| 2 (97) | Pain relief | Corticosteroid injection plus local anaesthesia v heel pad alone | 4 | –3 | –1 | –1 | 0 | Very low | Quality points deducted for sparse data, lack of placebo controls, no intention-to-treat analysis and poor follow-up. Consistency point deducted for different results at different endpoints. Directness point deducted for heterogeneity between interventions |
| 1 (80) | Pain relief | Corticosteroid injection plus local anaesthesia v corticosteroid plus local anaesthetic plus heel pad | 4 | –3 | 0 | –2 | 0 | Very low | Quality points deducted for sparse data, lack of placebo controls, no intention-to-treat analysis and poor follow-up. Directness points deducted for uncertainty of clinical relevance and heterogeneity between interventions |
| 1 (80) | Pain relief | Corticosteroid injection plus local anaesthesia plus heel pad v heel pad | 4 | –3 | 0 | –1 | 0 | Very low | Quality points deducted for sparse data, lack of placebo controls, no intention-to-treat analysis and poor follow-up. Directness point deducted for heterogeneity between interventions |
| 1 (91) | Pain relief | Corticosteroid injection plus local anaesthesia v local anaesthetic (medium term) | 4 | –3 | 0 | –2 | 0 | Very low | Quality points deducted for sparse data, lack of placebo controls, no intention-to-treat analysis and poor follow-up. Directness points deducted for uncertainty of clinical relevance and heterogeneity between interventions |
| 1 (80) | Pain relief | Corticosteroid injection plus local anaesthesia v heel pad alone | 4 | –3 | 0 | –1 | 0 | Very low | Quality points deducted for sparse data, lack of placebo controls, no intention-to-treat analysis and poor follow-up. Directness point deducted for heterogeneity between interventions |
| 1 (80) | Pain relief | Corticosteroid injection plus local anaesthesia v corticosteroid plus local anaesthetic plus heel pad | 4 | –3 | –1 | –2 | 0 | Very low | Quality points deducted for sparse data, lack of placebo controls, no intention-to-treat analysis and poor follow-up. Consistency point deducted for different results at different endpoints. Directness points deducted for uncertainty of clinical relevance and heterogeneity between interventions |
| 1 (103) | Pain relief | Corticosteroid injection plus local anaesthesia plus NSAIDs v heel pad plus paracetamol | 4 | –3 | 0 | –2 | 0 | Very low | Quality points deducted for sparse data, lack of placebo controls, no intention-to-treat analysis and poor follow-up. Directness point deducted for heterogeneity between interventions |
| 1 (103) | Pain relief | Corticosteroid injection plus local anaesthesia plus NSAIDs v pad plus taping plus orthoses | 4 | –3 | 0 | –2 | 0 | Very low | Quality points deducted for sparse data, lack of placebo controls, no intention-to-treat analysis and poor follow-up. Directness point deducted for heterogeneity between interventions |
| 8 (1183) | Pain relief | Extracorporeal shock wave therapy v placebo | 4 | –1 | –1 | –1 | 0 | Very low | Quality point deducted for incomplete reporting of results. Consistency point deducted for conflicting results. Directness point deducted for uncertainty of clinical relevance of effect |
| 1 (32) | Pain relief | Lasers v placebo | 4 | –2 | 0 | –1 | 0 | Very low | Quality points deducted for sparse data and incomplete reporting of results. Directness point deducted for uncertainty about outcome measured |
| 2 (133) | Pain relief | Taping v placebo/no treatment | 4 | –1 | 0 | 0 | 0 | Moderate | Quality point deducted for sparse data |
| 1 (92) | Functional improvement | Taping v placebo/no treatment | 4 | –1 | 0 | 0 | 0 | Moderate | Quality point deducted for sparse data |
| 1 (116) | Pain relief | Night splints plus NSAIDs v NSAIDs | 4 | –2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and incomplete reporting of results |
| 1 (236) | Pain relief | Stretching exercises v orthoses plus stretching exercises | 4 | –1 | 0 | 0 | 0 | Moderate | Quality point deducted for incomplete reporting of results |
| 1 (166) | Pain relief | Stretching exercises v heel pad plus stretching exercises | 4 | –1 | 0 | 0 | 0 | Moderate | Quality point deducted for sparse data |
| 1 (101) | Pain relief | Plantar fascia stretching plus heel pad v Achilles tendon stretching plus heel pad | 4 | –2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and for not reporting treatment adherence rates |
| 1 (19) | Pain relief | Ultrasound v sham ultrasound | 4 | –1 | 0 | 0 | 0 | Moderate | Quality point deducted for sparse data |
Type of evidence: 4 = RCT; 2 = Observational; 1 = Non-analytical/expert opinion. Consistency: similarity of results across studies Directness: generaliseability of population or outcomes Effect size: based on relative risk or odds ratio