Bahrami MH, Raeissadat SA, Barchinejad M, et al. Local ozone (O2-O3) versus corticosteroid injection efficacy in plantar fasciitis treatment: a double-blinded RCT. J Pain Res. 2019 Jul 24;12:2251-2259. doi: 10.2147/JPR.S202045. eCollection 2019. (Original study)

Purpose: To compare the efficacy of local ozone injection versus corticosteroid in plantar fasciopathy treatment.

Patients and methods: This double-blinded randomized trial was performed on 44 adult patients with plantar fasciopathy. One group (23 patients) received local injection of 40 mg methylprednisolone, while a local injection of 3 cc oxygen-ozone solution was performed for the other group (21 subjects). Severity of pain, functional level, and pressure-pain threshold (PPT) were measured before treatment and 1, 4, and 12 weeks after injection using VAS, Foot and Ankle Ability Measure (FAAM) questionnaire, and algometer for PPT, respectively.

Results: The majority (65.9%) of the total 44 patients analyzed, were women. Both treatments efficiently relieved patients' pain and improved their functions at 1 and 3 months follow-up time-points. But one week after injection, the improvement in VAS (p<0.001) and FAAM (p<0.001) was significant only in the corticosteroid group. During the first month, VAS (p=0.35) and PPT (p=0.003) were still better in the corticosteroid group. However, FAAM revealed no remarkable difference between the two groups (p=0.083). Eventually, at the third month of follow-up, there was no remarkable preference between the treatments regarding any of the outcome measures (p>0.05). Nevertheless, both methods efficiently improved patients' symptoms, ie, over the 50% of pain reduction and 30% improvement in functional status.

Conclusion: The present results showed no remarkable superiority between the two groups. In other words, although ozone injection showed a slower efficacy than methylprednisolone, it could be used in plantar fasciitis management as an appropriate alternative.

Discipline Area Score
Physician 5 / 7
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Comments from MORE raters

Physician rater

Blindness was incomplete, so this added bias to the study results and might be resulted in incorrect conclusion.

Physician rater

The authors report a randomized clinical trial comparing methylprednisolone to ozone injection for plantar fasciitis. At 3 months, they found both to be effective for pain and function.
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