ArticleFoot & ankle orthopaedics2026
Peppering Injection for Plantar Heel Pain: A Double-Blind Randomized Feasibility Study (a Short Report).
Article in Foot & ankle orthopaedics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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6 authors.
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Abstract
Background: Plantar heel pain affects up to 10% of individuals and often limits activity. Corticosteroid injections provide short-term relief, though emerging evidence suggests that benefits may derive from mechanical stimulation rather than pharmacologic effect. This pilot study evaluated the feasibility of a double-blind randomized trial comparing corticosteroid vs saline delivered via a standardized infracalcaneal peppering (fenestration) technique. Exploratory outcomes included short-term changes in Foot Function Index (FFI) and visual analog scale (VAS) pain scores. Methods: A total of 495 adults were identified via electronic health record queries, research registries, and targeted outreach; 76 were screened (assessed for eligibility) and 41 were enrolled and randomized (21 corticosteroid; 20 saline). Feasibility metrics included recruitment yield, visit completion, protocol adherence, and data completeness. Exploratory analyses used unadjusted linear mixed effects models. Results: Feasibility was demonstrated through adequate recruitment, 76% study completion (31/41), high protocol adherence, and low missingness of scheduled outcome measurements (3%). Baseline characteristics were comparable. Exploratory unadjusted estimates favored saline: FFI change -3.2 points (95% CI: -6.1, -0.4), VAS First-Step Pain change -6.6 mm (95% CI: -10.7, -2.4), and VAS General Pain change -3.0 mm (95% CI: -6.6, 0.7); between-group differences were below published minimal important difference (MID) thresholds (≈7 points for FFI Total; ≈9 mm for VAS). Conclusion: A randomized peppering-injection trial was feasible, and early unadjusted signals are consistent with a mechanically mediated effect independent of corticosteroid pharmacology. Larger, longer-term trials-including non-injection controls-are required to evaluate clinical effectiveness. Level of Evidence: Level II, pilot feasibility study.
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