Is hypertonic dextrose injection effective in the treatment of plantar fasciitis: A clinical randomized study

Abstract

Objectives: We aimed to assess the efficacy of hypertonic dextrose injection (prolotherapy; PT) in the treatment of patients with plantar fasciitis (PFs).
Material and methods: In this single-blind, randomized, controlled study, 30 PFs patients were randomly assigned into 2 groups. Group 1 (PT group) received 3 injections of 3 ml 15% dextrose into plantar fascia at an interval of 3 weeks and PFs exercise treatment;
meanwhile Group 2 (control group) received 3 injections of 3 ml saline and PFs exercise treatment. Clinical assessments included measurement of pain intensity (VAS score), foot function index (FFI), RolesMoudsley Scoring, and American Orthopedic Foot
and Ankle Society (AOFAS) ankle-hindfoot scores. Assessments were performed before the first and after the last injections. All patients completed the study without any complication.
Results: Significant improvements were observed in post-treatment VAS, FFI, AOFAS (pain, function, total) and Roles-Moudsley scores in both groups, however VAS, FFI and Roles-Moudsley score improvements were greater in the PT group when compared with the control group (p<0.001).
Conclusion: PT improved pain and functional outcomes, and seems to be effective in the treatment of PFs. Further studies including larger number of patients and longer follow-up periods are needed to validate these results.
Keywords: Plantar fasciitis, dextrose, prolotherapy, saline

Full text

102
Elif Umay Altas* 0002 4877 5871
Ayhan Askin
Aliye Tosun *0003 2827 6255
1 M.D., Department of Physical Medicine and Reha-
bilitaon, Kap Celebi University Ataturk Educaon
and Research Hospital, Izmir, Turkey
Correspondence: Elif Umay Altas, MD.
Department of Physical Medicine and Rehabilitaon,
Kap Celebi University Ataturk Educaon and Rese-
arch Hospital, 35360, Izmir, Turkey
E-mail: elifumayaslan@hotmail.com
Abstract
Objecves: We aimed to assess the ecacy of hyper-
tonic dextrose injecon (prolotherapy; PT) in the tre-
atment of paents with plantar fasciis (PFs).
Material and methods: In this single-blind, randomi-
zed, controlled study, 30 PFs paents were randomly
assigned into 2 groups. Group 1 (PT group) received
3 injecons of 3 ml 15% dextrose into plantar fascia
at an interval of 3 weeks and PFs exercise treatment;
meanwhile Group 2 (control group) received 3 in-
jecons of 3 ml saline and PFs exercise treatment.
Clinical assessments included measurement of pain
intensity (VAS score), foot funcon index (FFI), Roles-
Moudsley Scoring, and American Orthopedic Foot
and Ankle Society (AOFAS) ankle-hindfoot scores. As-
sessments were performed before the rst and aer
the last injecons. All paents completed the study
without any complicaon.
Results: Signicant improvements were observed in
post-treatment VAS, FFI, AOFAS (pain, funcon, total)
and Roles-Moudsley scores in both groups, however
VAS, FFI and Roles-Moudsley score improvements
were greater in the PT group when compared with
the control group (p<0.001).
Conclusion: PT improved pain and funconal outco-
mes, and seems to be eecve in the treatment of
PFs. Further studies including larger number of pa-
ents and longer follow-up periods are needed to va-
lidate these results.
Keywords: Plantar fasciis, dextrose, prolotherapy,
saline
Öz
Amaç: Plantar fasiitli (PF) hastalarda hipertonik deks-
troz enjeksiyonunun (proloterapi; PT) etkinliğini de-
ğerlendirmeyi amaçladık.
Materyal Metod: Değerlendiricinin kör olduğu ran-
domize kontrollü olarak tasarlanan bu çalışmada
PFs tanılı 30 hasta 2 gruba ayrıldı. 1. Gruba (PT grup)
%15’lik dextroz PT ve egzersiz, 2.gruba(kontrol grup)
salin enjeksiyonu ve egzersiz verildi. Enjeksiyonlar
3’er haa arayla 3 kez yapıldı. Klinik değerlendirmede
ağrı yoğunluğu (VAS skoru), ayak fonksiyon indeksi
(FFI), Roles-Moudsley skorlaması, Amerikan orto-
pedik ayak ve ayak bileği topluluğu ayak bileği arka
ayak skoru (AOFAS) kullanıldı. Değerlendirmeler ilk
KLİNİK ÇALIŞMA / CLINICAL TRIAL
Is hypertonic dextrose injecon eecve in the tre-
atment of plantar fasciis: A clinical randomized
study
Plantar fasiit tedavisinde hipertonik dekstroz en-
jeksiyonu etkili midir: Klinik randomize çalışma
Geliş Tarihi: 01/08/2018
Kabul Tarihi: 27/09/2018
Ege Klin Tıp Derg 2018; 56 (3): 102-108

103
enjeksiyon öncesi ve son enjeksiyonlardan sonra ger-
çekleşrildi. Tüm hastalar herhangi bir komplikasyon
olmaksızın çalışmayı tamamladı.
Bulgular: Her iki grupta da tedavi sonrası VAS, FFI,
AOFAS (pain, funcon, total) ve Roles-Moudsley skor-
larında anlamlı düzelme oldu. Ancak kontrol grubuna
göre VAS, FFI ve Roles-Moudsley skorundaki iyileş-
meler PT grubunda daha fazlaydı (p <0.001).
Sonuç: PFs tedavisinde PT, ağrı ve fonksiyonel so-
nuçlar üzerine etkili bir yöntem olmakla birlikte, bu
sonuçları doğrulamak için daha fazla sayıda hasta ve
uzun takip süreleri de dahil olmak üzere daha ileri ça-
lışmalara ihyaç vardır.
Anahtar Kelimeler: Plantar fasiit, dextroz, prolotera-
pi, salin
1. Introducon
Plantar fasciis (PFs) is a degenerave syndrome in
which repeang microtraumas cause tracon perios-
s on central band’s inseron point of plantar fascia
and microtears [1]. As a result, a sharp pain develops
just below the heel or on medial collateral tubercle
which increases by pressure. Some addional comp-
laints also include snging and intense pain that radi-
ates below the heel towards lower leg. This condion
might aect the mobility and movement capability of
the paent signicantly [2].
Since PFs is a self-liming clinical condion, most of
the paents show improvement with a conservave
treatment [3]. The paents who do not show impro-
vement with conservave measures such as stretc-
hing, orthoses, physical therapy, nighme splints
and immobilizaon might be treated with alternave
methods such as extracorporeal shock wave therapy
(ESWT), steroid injecons, prolotherapy, platelet-rich
plasma (PRP) injecons and in most severe cases,
surgery [4].
Hypertonic dextrose injecon (prolotherapy) is a
method in which an irritant soluon is injected to the
damaged ligament or tendon structures in order to
increase the new cell proliferaon on those structu-
res, therefore strengthening them [5, 6]. The main
goal of prolotherapy (PT) is to strengthen bro-osse-
ous inseron points of ligaments, tendons and joint
capsules by creang a ght and thick brous ssue
[7]. PT is thought to create a curave cascade by ca-
using a therapeuc trauma, characterized by increa-
sing cellular stress on the weakened ligament or ten-
don area and causing mild inammaon on injecon
site. This cascade includes granulaon ssue forma-
on, matrix formaon and remodeling of the ssue
[8, 9]. Macrophages clean out dead cells and fore-
ign materials by phagocytosis meanwhile broblasts
help new cell producon and development in addi-
on to collagen synthesis by increasing DNA synthe-
sis and protein by growth factor exposure. New cells
and matrix stack up with organizaon in the aected
area. Remodeling occurs weeks later. Contemporary
theory says that PT mimics the natural healing pro-
cess of the body [10-12].
PT was rst standardized by Hacke in 1950’s, and
hypertonic dextrose in addion to morrhuate sodium
is the most commonly used soluon today [13, 14].
Although its indicaon is usually reported as chronic
back pain, some studies reported successful results
when used in the treatment of thoracic and cervical
pain syndromes, whiplash injuries, lateral and medial
epicondylis, rotator cu or bicipital tendinosis, PFs,
coccygodynia and osteoarthris [15]. When all evi-
dence-based studies on PT were reviewed, evidence
level was classied as A in lateral epicondylis [13],
and B in Achilles’ tendinopathy [16], PFs [17] and os-
teoarthris [18].
To our knowledge, only two studies evaluated the ef-
cacy of PT in paents with PFs in English literature.
Ryan et al reported a good clinical response to dext-
rose injecons in 20 paents with PFs [17]. Kim et
al compared the ecacy of PT versus PRP on 20 PFs
paents, and reported that both treatments seemed
to be eecve, however PRP led to a beer inial
improvement in funcon [19]. In this study, our
main objecve is to assess the ecacy of PT treat-
ment on pain and funconal status in paents with
PFs.
2. Material and Methods
Our study design was designed as a prospecve,
single-blind, randomized, controlled study. All par-
cipants were informed about the study and their
informed consents were obtained. Ethical approval
was obtained from our hospital’s local ethics com-
miee.
2.1.Parcipants
Paents with a clinical diagnosis of PFs (pain during
rst few minutes in the morning with walking and
with pain by pressure on calcaneal tubercle when
the foot was on passive dorsiexion) and with uni-
lateral symptoms ongoing for at least 2 months and
had minimal pain levels of 4 on VAS were included in
the study.
Paents were excluded if they used nonsteroidal an-
-inammatory drugs (NSAIDs) in the last 2 weeks,
received physical therapy for PFs in last 3 months, re-
ceived previous injecons, had history of foot, ankle
or heel surgical intervenons or haddetected anato-
mical anomalies such as pes planus or pes cavus on
x-rays. They were also excluded if theyhad infecons
on injecon site, coagulaon disorders / ancoagu-
Is hypertonic dextrose injecon eecve in the treatment of plantar fasciis: A
clinical randomized study
Plantar fasiit tedavisinde hipertonik dekstroz enjeksiyonu etkili midir: Klinik ran-
domize çalışma

104
lant treatments, pregnancy or nursing, peripheral ne-
uropathies or lower extremity paresis or paraplegia.
2.2.Intervenons
Paents were randomly divided into 2 groups by
a stascal soware. Group 1 received PT and PFs
exercise treatment; while Group 2 received saline in-
jecons and PFs exercise treatment.
Exercise programmes: Exercise programmes presc-
ribed to the paents included plantar fascial stretc-
hing, towel carrying using toes, rolling solid objects
with the sole, dorsiexion against resistance, resis-
tant plantar exion, inversion and eversion. Exercises
were iniated 72 hours following the inial injecons
and were demonstrated to the paents on their rst
sessions. Paents were instructed to connue to the
home-based exercise programmes for 3 months (one
session per day with a duraon of 10 minutes).
Prolotherapy injecons: Group 1 (PT group) received
3 injecons of 3 ml 15% dextrose into the plantar
fascia-bone inseron point at an interval of 3 weeks
under sterile condions. The applicaon was done
under asepc condions using a 22-gauge needle
with a single skin entry on the fascia ligament-bone
inseron point with peppering technique which con-
tained 5 penetraons.
Saline injecons: Group 2 (control group) received
3 injecons of 3 ml saline at an interval of 3 weeks
under asepc condions with the same peppering
technique.
Following injecons, the injecon area was exposed
to surface heat for 10 minutes and paents were as-
ked to remain in a sing posion for 30 minutes and
instructed to apply heat to the injecon surface 3 -
mes for 10 minutes for 3 days. Paents were warned
that their pain might worsen during that period and
were told not to take any NSAIDs during the treat-
ment, but can take acetaminophen for pain if neces-
sary. They were also adviced to avoid heavy loading
acvies and to begin exercises 72 hours aer the
injecons. None of the paents were given foot ort-
hoses.
2.3.Assessments
Clinical assessments were done prior to treatment
and on the 3rd month of the treatment by an asses-
sor who was blind to the treatments. Clinical assess-
ments included the measurement of pain intensity
(VAS score), foot funcon index (FFI), Roles-Mouds-
ley scores, and American Orthopedic Foot and Ankle
Society (AOFAS) ankle-hindfoot scores.
FFI is a funconal index that reviews the eect foot
pain has on the daily life of the paent. It is made of
23 quesons with pain, disability and acvity limita-
on subscales. Pain and disability subscales have 9
and acvity limitaon subscale has 5 quesons. The
paent scores each queson from 0 (no pain) to 10
(worst pain ever) [22].
Roles-Moudsley Scoring measures the relaonship
between pain in the extremity with acvity. It is gra-
ded as 1 point for asymptomac paent, 2 points
for paents with transient symptoms that respond
well to treatment, 3 points for paents with mild-
to-moderate pain following acvity and 4 points for
paents with no improvement in the symptoms [21].
AOFAS is a scoring system developed for measuring
the pain, limitaon in acvity, walking distance and
disorders, foot mobility, stability and alignment of
the foot [22].
At the follow up of the paents 3 months aer the
rst injecons; clinical assessments were repeated
by the same invesgator.
2.4.Stascal Analysis
All stascal analyses were performed by using SPSS
22.0 (IBM Corporaon, Armonk, New York, United
States) and Medcalc 14 (Acacialaan 22, B-8400 Os-
tend, Belgium) soware. Normality assessment was
made with Shapiro-Wilk test. Comparison of two in-
dependent groups was performed with independent
samples t-test and Mann Whitney U (Exact) test.
Wilcoxon’s signed-rank test were performed to de-
termine dierences within groups. Comparison for
categorical variables was made with Pearson Chi-
Square test and Monte Carlo simulaon technique
was applied. Variables were analyzed at 95% con-
dence level, and a p-value of less than 0.05 was ac-
cepted as signicant.
3. Results
Thirthy PFs paents were included in the study. No
signicant dierence was seen in baseline demog-
raphical and clinical values between the groups. The
demographical and clinical properes of the paents
were shown on Table 1.
Table 1. Demographic and clinical characteris-
cs of the paents in both groups.
Altas ve ark. Altas et al.

105
A signicant dierence was seen between Group 1
and 2 on VAS scores prior to treatment, with higher
VAS scores in Group 1 (p = 0.007). Similarly, acvity
limitaon (subscale of FFI) was signicantly dierent,
with higher values on Group 1 (p = 0.039). When
pre- and post-treatment results were compared,
signicant improvements were seen in both groups
on VAS, AOFAS (pain, funcon, total), FFI (pain, di-
sability, acvity limitaon, total) and Roles-Maudsley
scores. In addion, there was a signicantly higher
improvement in Group 1 compared to Group 2 in
terms of VAS, AOFAS (pain, funcon, total), FFI (pain,
disability, acvity limitaon, total) and Roles-Mauds-
ley scores in post-treatment results. Intergroup and
intragroup pre- and post-treatment improvement re-
sults were summarized on Table 2.
Table 2. Baseline / posntervenon comparisons in
outcome measures within and between the groups.
In intergroup improvement dierences, Group 1 had
signicantly beer outcomes except AOFAS (Align-
ment) parameter compared to Group 2. The die-
rences in improvement measures were shown on
Table 3.
Table 3. Comparison of median dierences in outco-
me measuresfrom baseline.
4. Discussion
Our study results revealed that PT treatment is more
eecve in improving pain and funconal outcomes
when compared to saline injecons. No signicant
improvement was seen in AOFAS – Alignment sub-
score in both groups. When groups were compared
in terms of improvement in all other scores, paents
who received PT revealed signicant improvements
compared to saline injecons. To the best of our
knowledge, our study is the rst randomized, cont-
rolled study that compared PT ecacy with saline in
PFs treatment.
PFs is a common disease without a clear eology
which causes pain and tenderness of the foot soles
with a wide clinical spectrum that might even cause
disability in some paents [23]. The underlying pat-
hology is thought to be the degenerave ssue on
the area where plantar fascia originates on the me-
dial tuberosity of calcaneus [24]. Structural deformi-
es, excessive foot pronaon, forefoot varus defor-
mity and weakness of bialis posterior muscle are all
though to be parts of eology [25]. The most frequ-
ently used conservave measures include changing
daily acvies, using orthoses, stretching exercises
and treatment with NSAIDs [26]. In more severe ca-
ses, extracorporeal shockwave treatment (ESWT),
Is hypertonic dextrose injecon eecve in the treatment of plantar fasciis: A
clinical randomized study
Plantar fasiit tedavisinde hipertonik dekstroz enjeksiyonu etkili midir: Klinik ran-
domize çalışma

106
laser therapy, acupuncture, dry needling and ion-
tophoresis can also be used [27, 29]. As those treat-
ments are thought to be eecve in almost 90% of all
cases, some authors argue that PFs is a self-liming
condion and that there is not enough evidence for
treatment ecacy, about 10% of more severe cases
might need more aggressive treatment intervenons
such as surgery [17, 29].
In placebo-controlled studies, corcosteroid (CS) tre-
atment was found to be eecve on the pain, but the
treatment eect is relavely short-lasng; between
4-12 weeks [30]. In addion, treatment complica-
ons such as fat pad atrophy, skin atrophy, plantar fas-
cia ruptures and osteomyelis in calcaneus limit the
usage of this treatment method [20]. PRP increases
rejuvenaon process by starng the inammatory
process which was interrupted by conservave treat-
ment of PFs by growth factors contained within [32].
PT is used for treang most of the musculoskeletal
paintypes including tendinopathies. PT works by cre-
ang a hypertonic environment which causes cell
rupture and up-regulang thrombocyte-rich growth
factor expression. Cellular shiing and increased
growth factors develop a healing cascade on the in-
jury. Fibroblasts’ exposure to growth factors increase
DNA synthesis and proteins, therefore causing new
cell growth and reproducon and collagen deposits
[33]. In the previous studies done on PT, Robago et
al, Distel and Best, Vara et al and Hauser et al all re-
ported successful results in majority of the cases,
however they did not have randomizaon or control
groups [18, 34]. In this perspecve, our study stands
out by its single-blind, prospecve randomized cont-
rolled study design. Rabago et al’s study done on 32
lateral epicondylis cases reported PT to be eecve
in improving pain and funcon in those paents [35].
Another study done on 61 paents with chondro-
malacia patella reported that PT caused a long-term
pain modicaon and could be a rst line of choice
in conservave treatment opons [36]. Yet another
randomized study done on 73 paents with chronic
shoulder pain caused by rotator cu tendinopathy
compared saline injecons with PT and reported PT
to be eecve on pain management [37]. A study
done on knee osteoarthris showed that PT caused
signicantly beer outcomes compared to saline
injecon and exercise; but warned that the results
showed heterogeneity and said that further studies
with wider paent series were necessary [38]. Again,
another study done on knee osteoarthris showed
that PT showed beer improvement compared to
local anesthec and CS injecons in 6-month term
and that there was no dierence in hand and knee
osteoarthris results [39]. A review done on lower
extremity tendinopathy and fasciopathy reported PT
to be benecial in Achilles’ tendinopathy, PFs and
Osgood-Schlaer disease, however more randomi-
zed controlled wider studies were necessary on this
subject [40]. Ryan et al’s study in which they made
3 PT injecons guided by USG with 6-week periods
reported that there was a signicant decrease in pain
severity during resng and acvity aer 18 months
[19]. There is only one randomized controlled study
done on PFs in the literature. Kim et al’s study with
20 PFs paents compared the ecacy of PRP and PT
by 2 injecons 2 weeks apart. The paents were fol-
lowed for 6 months and both methods were found to
be eecve. During inial period, PRP showed beer
outcomes in funconal improvement [19]. In accor-
dance with the previous results in the literature, we
also found out that PT treatment to be more eec-
ve in our study with 30 PFs paents. Our study’s main
advantages are the inclusion of larger number of pa-
ents, presence of control group and its randomized
and single-blind design. Therefore, we think that our
study, being a rst in this eld for the reasons stated
above, will make an extra contribuon to the litera-
ture on PFs.
No severe side-eects were reported on PT treat-
ments used on musculoskeletal system [29]. Dext-
rose is generally recognized as a safe proliferang
agent for injecon as it is a natural component of
blood biochemistry. The side eects which might
develop with the treatment are similar to other in-
jecon techniques and is mainly caused by injecon
technique rather than the agents injected [18]. No
adverse eects were seen in any of our paents du-
ring the study.
The main limitaon of our study is the short follow-
up period. As this was designed as a pilot study, alt-
hough the period was kept short, PT’s ecacy on PFs
treatment was proven. However, we sll need furt-
her randomized single-blind studies with longer pa-
ent series and longer follow-up periods to support
our results.
5.Conclusions
Prolotheraphy improved pain and funconal outco-
mes, and seems to be eecve in the treatment of
paents with PFs. It may be considered as a new tre-
atment opon for PFs. Further studies including lar-
ger number of paents and longer follow-up periods
are needed to validate these results.
Abbreviaons
PFs: Plantar fasciis; VAS score: Clinical assessments
included measurement of pain intensity, FFI: foot
funcon index, AOFAS: American Orthopedic Foot
Altas ve ark. Altas et al.

107
and Ankle Society; ESWT: extracorporeal shock
wave therapy, PRP: steroid injecons, prolotherapy,
platelet-rich plasma; PT: prolotherapy; NSAIDs: nons-
teroidal an-inammatory drugs; CS: corcosteroid
Funding
No nancial support was received for this project.
Availability of data and materials
The datasets analyzed during the current study are
available from the corresponding author on reaso-
nable request.
Compeng interests
The authors declare they have no compeng inte-
rests.
Consent for publicaon
Not applicable.
Ethics approval and consent to parcipate
Ethics approval was granted for this study by the
instute’s Ethics Commiee of Izmir Kap Celebi Uni-
versity, School of Medicine (21 July 2016, No. 124).
Informed consent was provided by all parcipants.
References
1. Irving DB, Cook JL, Menz HB. Factors associated with
chronic plantar heel pain: a systemac review. J Sci Med
Sport 2006;9:11-22.
2. Yuzer S, Sever A, Gurcay E, Unlu E, Çakci A. Comparison
of the Eecveness of Laser Therapy and Steroid Injecon
in Epin Calcanei. Turk J Phys Med Rehab 2006;52:68-71.
3. Michelsson O, Konnen YT, Paavolainen P, Santavirta
S.Plantar heel pain and its 3-mode 4-stage treatment. Mod
Rheumatol 2005;15:307-14.
4. Roxas M. Plantar fasciis: diagnosis and therapeuc
consideraons. Altern Med Rev 2005;10:83-93.
5. Rabago D, Kijowski R, Woods M, Paerson JJ, Mundt
M, Zgierska A, et al. Associaon between disease-specic
quality-of-life and magnec resonance imaging outcomes
in a clinical trial of prolotherapy for knee osteoarthris
Arch Phys Med Rehabil 2013;94:2075-2082.
6. Dagenais S, Mayer J, Haldeman S, Borg-Stein J. Eviden-
ce-informed management of chronic low back pain with
prolotherapy. Spine J 2008;8:203-212.
7. Cusi M, Saunders J, Hungerford B, Wisbey-Roth T, Lucas
P, Wilson S. The use of prolotherapy in the sacroiliac joint.
Br J Sports Med 2010;44:100-104.
8. Slaengren AH, Christensen T, Prasad S, Jones K. PURLs:
Prolotherapy: a nontradional approach to knee oateoart-
hris. J Fam Pract 2014;63:206-208.
9. Sanderson LM, Bryant A. Eecveness and safety of pro-
lotherapy injecons for management of lower limb tendi-
nopathy and fasciopathy: a systemac review. J Foot Ankle
Res 2015;8:57.
10. Linetsky FS, Manchikan L. Regenerave injecon
therapy for axial pain. Tech Reg Anesth Pain Manage
2005;9:40–49.
11. Goswami A. Prolotherapy. J Pain Palliat Care Pharma-
cother 2012;26:376–378.
12. DeChellis DM, Cortazzo MH. Regenerave medicine in
the eld of pain medicine: prolotherapy, platelet-rich plas-
ma therapy, and stem cell therapy-theory and evidence.
Tech Reg Anesth Pain Manag 2011;15:74–80.
13. Scarpone M, Rabago DP, Zgierska A, Arbogast G, Snell
E. The ecacy of prolotherapy for lateral epicondylosis: a
pilot study. Clin J Sport Med 2008;18:248- 254.
14. Dagenais S, Haldeman S, Wooley JR. Intraligamentous
injecon of sclerosing soluons (prolotherapy) for spinal
pain: a crical review of the literature. Spine J 2005;5:310-
328.
15. Alderman D. Prolotherapy for musculoskeletal pain.
Praccal Pain Management 2007;1:10-15.
16. Maxwell NJ, Ryan MB, Taunton JE, Gillies JH, Wong
AD. Sonographically guided intratendinous injecon of
hyperosmolar dextrose to treat chronic tendinosis of
the Achilles tendon: a pilot study. AJR Am J Roentgenol
2007;189:215-220.
17. Ryan MB, Wong AD, Gillies JH, Wong J, Taunton JE. So-
nographically guided intratendinous injecons of hyperos-
molar dextrose/lidocaine: a pilot study for the treatment
of chronic plantar fasciis. Br J Sports Med 2009;43:303-
306.
18. Rabago D, Paerson JJ, Mundt M, Kijowski R, Gree
J, Segal NA, et al. Dextrose prolotherapy for knee osteo-
arthris: a randomized controlled trial. Ann Fam Med
2013;11:229-237.
19. Kim E, Lee JH. Autologous platelet-rich plasma versus
dextrose prolotherapy for the treatment of chronic recal-
citrant plantar fasciis. PMR 2014;6:152-158.
20. Budiman-Mak E, Conrad KJ, Roach KE.The Foot Func-
on Index: A measure of foot pain and disability.J Clin Epide-
miol 1991:561-570.
21. Roles NC, Maudsley RH.Radial tunnel syndrom: resis-
tant tennis elbow as a nerve entropment. J Bone Joint Surg
Br 1972;54:499-508.
22. Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myer-
son MS, Sanders M. Clinical rang systems for the ank-
le-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle
Int.994;15:349-353.
23. Díaz-Llopis IV, Rodríguez-Ruíz CM, Mulet-Perry S,
Mondéjar Gómez FJ, Climent-Barberá JM, Cholbi-Llobel
F. Randomized controlled study of the ecacy of the in-
jecon of botulinum toxin type A versus corcosteroids in
chronic plantar fasciis: Results at one and six months. Clin
Rehabil 2012;26:594-606.
24. Buchbinder R. Clinical pracce. Plantar fasciis. N Engl
J Med 2004; 350:2159-66.
25. Bolgla LA, Malone TR. Plantar fasciis and the windlass
mechanism: a biomechanical link to clinical pracce. J Athl
Train 2004;39:77–82.
26. Lim AT, How CH, Tan B. Management of plantar fas-
ciis in the outpaent seng. J Orthop Sports Phys Ther
2016;6:1–101.
27. Eslamian F, Shakouri SK, Jahanjoo F, Hajialiloo M, Notg-
hi F. Extra corporeal shock wave therapy versus local cor-
costeroid injecon in the treatment of chronic plantar fas-
ciis, a single blinded randomized clinical trial. Pain Med
Is hypertonic dextrose injecon eecve in the treatment of plantar fasciis: A
clinical randomized study
Plantar fasiit tedavisinde hipertonik dekstroz enjeksiyonu etkili midir: Klinik ran-
domize çalışma

108
2016;17:1722–1731.
28. Cox J, Varatharajan S, Côté P. J. Eecveness of acu-
puncture therapies to manage musculoskeletal disorders
of the extremies: a systemac review. Orthop Sports Phys
Ther 2016;46:409–429.
29. Scioli MW. Platelet-rich plasma injecon for proximal
plantar fasciis. Tech Foot Ankle 2011;10:7-10.
30. Hsiao MY, Hung CY, Chang KV, Chien KL, Tu YK, Wang
TG. Comparave eecveness of autologous blood-deri-
ved products, shock-wave therapy and corcosteroids for
treatment of plantar fasciis: a network meta-analysis.
Rheumatology (Oxford) 2015;54:1735–1743.
31. Karimzadeh A, Raeissadat SA, Erfani Fam S, Sedighi-
pour L, Babaei-Ghazani A. Autologous whole blood versus
corcosteroid local injecon in treatment of plantar fasci-
is: A randomized, controlled mulcenter clinical trial.Clin
Rheumatol 2016 Dec 12. [Epub ahead of print]
32. Ragab EM, Othman AM.Platelets rich plasma for treat-
ment of chronic plantar fasciis. Arch Orthop Trauma Surg
2012;132:1065-1070.
33. Rabago D, Wilson JJ, Zgierska A. Platelet-rich plasma for
treatment of achilles tendinopathy. JAMA 2010;303:1696-
1697.
34. Vora A, Borg-Stein J, Nguyen RT. Regenerave injecon
therapy for osteoarthris:fundamental concepts and evi-
dence-based review. PMR 2012:4;104-109.
35. Rabago D, Lee KS, Ryan M, Chourasia AO, Sesto ME,
Zgierska A, et al. Hypertonic dextrose and morrhuate sodi-
um injecons (prolotherapy) for lateral epicondylosis (ten-
nis elbow): results of a single-blind, pilot-level, randomized
controlled trial. Am J Phys Med Rehabil 2013;92:587-596.
36. Hauser RA, Sprague IS. Outcomes of prolotherapy in
chondromalacia patella paents: improvements in pain le-
vel and funcon. Clin Med Insights Arthris Musculoskelet
Disord 2014;7:13-20.
37. Bertrand H, Reeves KD, Benne CJ, Bicknell S, Cheng
AL. Dextrose Prolotherapy Versus Control Injecons in Pa-
inful Rotator Cu Tendinopathy. Arch Phys Med Rehabil
2016;97:17-25.
38. Sit RW, Chung VCh, Reeves KD, Rabago D, Chan KK.
Hypertonic dextrose injecons (prolotherapy) in the tre-
atment of symptomac knee osteoarthris: A systemac
review and meta-analysis. Sci Rep 2016;6:25247.
39. Hung CY, Hsiao MY, Chang KV, Han DS, Wang TG. Com-
parave eecveness of dextrose prolotherapy versus
control injecons and exercise in the management of os-
teoarthris pain: a systemac review and meta-analysis. J
Pain Res 2016;9:847-857.
40. Sanderson LM, Bryant A. Eecveness and safety of
prolotherapy injecons for management of lower limb
tendinopathy and fasciopathy: a systemac review.J Foot
Ankle Res 2015;8:57.
Altas ve ark. Altas et al.

Cilt / No: 56  Sayı/No: 3 Aralık/December 2018
İÇİNDEKİLER/CONTENTS
KLİNİKÇALIŞMALAR/CLINICALTRIALS
•DeneyselİrritablBağırsakSendromununİntesnalYüzeyEpitelindeBulunanDopaminerjikYolaklar
ÜzerindekiEtkisi
Fatma ŞİMŞEK ve Ark.
•Ishypertonicdextroseinjeconeecveinthetreatmentofplantarfasciis:Aclinicalrandomizedstudy
Elif Umay ALTAS ve Ark.
•FarklıHastaGruplarındakiTedaviSürecindeYaşamKalitesininDeğerlendirilmesi
Ayşe Gülsün AKSÜT ve Ark.
•EsansiyelTremorHastalarındaYüzDuyguTanıma
Yıldızhan ŞENGÜL ve Ark.
•AtrokVaginitTedavisindeUzunDönemDüşükDoz17-βEstradiol
VaginalTabletUygulamalarının;KlinikEtkinliğiİveEndometrialSonuçları
Dilek UYSAL ve Ark.
•PremenstrüelSendromluOlgulardaTiroidFonksiyonTestleri
Hakan ÇÖKMEZ ve Ark.
•AcilServisteAkutAortDiseksiyonuTanısıAlanHastalarınGeriyeDönükAnalizi
Erkan DOĞAN ve Ark.
OLGUSUNUMLARI/CASEREPORTS
•AmniyonSıvıEmbolisiNedenliBirÖlümOlgusu
Yasemin BALCI ve Ark.
•UlnarSinirPalsisininNadirBirNedeni:RadiusDistalUçKırığıSonucuUlnarSinirinDorsalDeplasmanı
Gürkan YILDIZ ve Ark.
•LaparoskopiSonrasıUmbilicalTrokarYeriHernisi
Eren AKBABA
•TheConcurrencethreedierentbeningnpathologiesinonenose
Ozan GÖKDOĞAN ve Ark.
DERLEME/REVIEW
•ÇocuklardaIgEAracılıOlmayanBesinAlerjileri
İrem TURGAY YAMUR ve Ark.

90

95
İÇİNDEKİLER / CONTENTS
KLİNİK ÇALIŞMALAR/ CLINICAL TRIALS
Deneysel İrritabl Bağırsak Sendromunun İntesnal Yüzey Epitelinde
Bulunan Dopaminerjik Yolaklar Üzerindeki Etkisi
The Eects of Experimental Irritable Bowel Syndrome on Dopaminergic Pathways in Intesnal Surface Epithelium
Fatma ŞİMŞEK, Selen BAHÇECİ
Is hypertonic dextrose injecon eecve in the treatment of plantar fasciis:
A clinical randomized study
Plantar fasiit tedavisinde hipertonik dekstroz enjeksiyonu etkili midir: Klinik randomize çalışma
Elif Umay ALTAS, Ayhan ASKIN, Aliye TOSUN
Farklı Hasta Gruplarındaki Tedavi Sürecinde Yaşam Kalitesinin Değerlendirilmesi
Evaluaon of Quality of Life in The Treatment Process in Dierent Paent Groups
Ayşe Gülsün AKSÜT, Nazlı SOYSAL, Umut Gök BALCI, Kurtuluş ÖNGEL
Esansiyel Tremor Hastalarında Yüz Duygu Tanıma
Facial Emoon Recognion in the Paents With Essenal
Yıldızhan ŞENGÜL, Abdulkadir TUNÇ, Onur YILMAZ, Ahmet ÖZTÜRK
Atrok Vaginit Tedavisinde Uzun Dönem Düşük Doz 17-β Estradiol
Vaginal Tablet Uygulamalarının; Klinik Etkinliğiİ ve Endometrial Sonuçları
The Clinical Ecacy and Endometrial Outcome of Long-term Low-dose
17-β Estradiol Vaginal Tablet Applicaons in the Treatment of Atrophic Vaginis
Dilek UYSAL, Ali BALOĞLU
Premenstrüel Sendromlu Olgularda Tiroid Fonksiyon Testleri
Thyroid Funcon Tests in Cases With Premenstrual Ssyndrome
Hakan ÇÖKMEZ, Ayşegül GÜLBAHAR
Acil Serviste Akut Aort Diseksiyonu Tanısı Alan Hastaların Geriye Dönük Analizi
Retrospecve Analysis of Paents Diagnosed as Acute Aorc Dissecon in Emergency Department
Erkan DOĞAN, Akkan AVCI, Müge GÜLEN, Ertan CÖMERTPAY, Begüm Şeyda AVCİ, Salim SATAR
OLGU SUNUMLARI/ CASE REPORTS
Amniyon Sıvı Embolisi Nedenli Bir Ölüm Olgusu
Amnioc Fluid Embolism as a Cause of Death: A Case Report
Yasemin BALCI, Ümit Ünüvar GÖÇEOĞLU
Ulnar Sinir Palsisinin Nadir Bir Nedeni: Radius Distal Uç Kırığı Sonucu Ulnar Sinirin Dorsal Deplasmanı
A Very Rare Cause Of Ulnar Nerve Palsy: Dorsal Shi of the Ulnar Nerve Aer Distal Radius Fracture
Gürkan YILDIZ, Mesut TAHTA, Eyüp Çağatay ZENGİN, Ahmet SAVRAN
Laparoskopi Sonrası Umbilical Trokar Yeri Hernisi
Umbilical Port Hernia Following Laparoscopic Surgery
Eren AKBABA
The Concurrence three dierent beningn pathologies in one nose
Bir burunda 3 farklı iyi huylu patolojinin es zamanlı bulunması
Ozan GÖKDOĞAN, Harun ÜÇÜNCÜ
DERLEME/ REVIEW
Çocuklarda IgE Aracılı Olmayan Besin Alerjileri
Non IgE Mediated Food Allergies in Children
İrem TURGAY YAMUR, Özge YILMAZ TOPAL, Emine DİBEK MISIRLIOĞLU
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89