Comparative effectiveness of minimally invasive therapies for plantar fasciitis: a systematic review and network meta-analysis

Plantar fasciitis is a common and often disabling condition that affects both general and athletic populations, with chronic cases significantly impairing function and quality of life. Although a wide range of conservative and non-invasive, and minimally invasive treatments are available, the absence of direct comparative evidence has limited clarity about which interventions offer the most durable benefits. We conducted a systematic review and network meta-analysis of 63 randomized controlled trials including 4170 participants to evaluate extracorporeal shock wave therapy, prolotherapy, and injection-based therapies including platelet-rich plasma, botulinum toxin A, corticosteroids, autologous blood, and local anaesthetics. Across short-, mid-, and long-term follow- up, botulinum toxin A provided the greatest short-term improvements in pain and plantar fascia thickness, where prolotherapy was most effective for sustained pain relief. Corticosteroids injection yielded the largest short-term function gains, while platelet-rich plasma supported the long-term improvements in both function and plantar fascia thickness. Extracorporeal shock wave therapy demonstrated broad efficacy across all domains and timepoints. These findings provide updated comparative evidence to guide clinical decision-making, suggesting that treatment strategies for plantar fasciitis should be tailored to symptom duration and therapeutic goals rather than defaulting to one intervention alone. Systematic review registration: PROSPERO CRD420250641285.