Ultrasound-guided collagen injections for treatment of plantar fasciopathy in runners: A pilot study and case series


  • Bruno Corrado Federico II University of Naples, Italy https://orcid.org/0000-0003-0990-3428
  • Ilenia Bonini Federico II University of Naples, Italy
  • Domiziano Tarantino Federico II University of Naples, Italy
  • Felice Sirico Federico II University of Naples, Italy


Plantar fasciitis, Plantar fasciopathy, Chronic plantar fasciitis, Athletes, Runners, Collagen injections


Background. Plantar fasciopathy is a frequent source of foot pain in athletes, and it is caused by the degeneration of the proximal insertion of the plantar fascia, usually triggered by repetitive microtrauma. Type I porcine collagen was shown to enhance tendon repair in vitro, and collagen injections are currently used to treat different tendinopathies. The aim of this study is to verify the effectiveness of collagen injections on pain and function in runners with plantar fasciopathy. Methods. Runners, who have been suffering from plantar fasciopathy for at least 6 months, were treated with a series of 4 ultrasound-guided type I porcine collagen injections, at weekly intervals. The Visual Analogue Scale, American Orthopedic Foot and Ankle Society-Ankle Hindfoot score and pressure algometry were used to verify the effects of collagen injections at 1-month and 3-month follow-up. Results. Compared to baseline, minor (p ≥ .05) and major (p ≤ .001) improvements on pain and function were registered at 1-month and 3-month follow-up, respectively. Conclusion. This is the first study that evaluates the effectiveness of collagen injections in the treatment of plantar fasciopathy in runners. Despite the limitations of this study, the positive findings could represent the starting point for further clinical trials.


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Ahmad, J., Ahmad, S. H., & Jones, K. (2017). Treatment of Plantar Fasciitis With Botulinum Toxin. Foot & Ankle International, 38(1), 1-7. https://doi.org/10.1177/1071100716666364

Akınoğlu, B., & Köse, N. (2018). A comparison of the acute effects of radial extracorporeal shockwave therapy, ultrasound therapy, and exercise therapy in plantar fasciitis. Journal of Exercise Rehabilitation, 14(2), 306-312. https://doi.org/10.12965/jer.1836048.024

Al-Ashhab, M. E., Elbegawy, H. E.-D. A., & Hasan, H. A. A. (2018). Endoscopic Plantar Fasciotomy Through Two Medial Portals for the Treatment of Recalcitrant Plantar Fasciopathy. The Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons, 57(2), 264-268. https://doi.org/10.1053/j.jfas.2017.09.004

Alrashidi, Y., Barg, A., Kampmann, M., & Valderrabano, V. (2016). Plantar Fasciitis in Sport. In V. Valderrabano & M. Easley (A c. Di), Foot and Ankle Sports Orthopaedics (pagg. 201-207). Springer International Publishing. https://doi.org/10.1007/978-3-319-15735-1_21

Bahrami, M. H., Raeissadat, S. A., Barchinejad, M., Elyaspour, D., & Rahimi-Dehgolan, S. (2019). Local ozone (O2-O3) versus corticosteroid injection efficacy in plantar fasciitis treatment: A double-blinded RCT. Journal of Pain Research, 12, 2251-2259. https://doi.org/10.2147/JPR.S202045

Bernhard, K., Ng, A., Kruse, D., & Stone, P. A. (2018). Surgical Treatment of Bone Marrow Lesion Associated with Recurrent Plantar Fasciitis: A Case Report Describing an Innovative Technique Using Subchondroplasty®. The Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons, 57(4), 811-815. https://doi.org/10.1053/j.jfas.2017.11.012

Celik, D., Kuş, G., & Sırma, S. Ö. (2016). Joint Mobilization and Stretching Exercise vs Steroid Injection in the Treatment of Plantar Fasciitis: A Randomized Controlled Study. Foot & Ankle International, 37(2), 150-156. https://doi.org/10.1177/1071100715607619

Chen, Y.-J., Wu, Y.-C., Tu, Y.-K., Cheng, J.-W., Tsai, W.-C., & Yu, T.-Y. (2019). Autologous Blood-Derived Products Compared With Corticosteroids for Treatment of Plantar Fasciopathy: A Systematic Review and Meta-Analysis. American Journal of Physical Medicine & Rehabilitation, 98(5), 343-352. https://doi.org/10.1097/PHM.0000000000001070

Cinar, E., Saxena, S., & Uygur, F. (2018). Combination Therapy Versus Exercise and Orthotic Support in the Management of Pain in Plantar Fasciitis: A Randomized Controlled Trial. Foot & Ankle International, 39(4), 406-414. https://doi.org/10.1177/1071100717747590

Corrado, B., Albano, M., Caprio, M. G., Di Luise, C., Sansone, M., Servodidio, V., Russo, S., Vallone, G., Vola, E. A., & Iammarrone, C. S. (2019). Usefulness of point shear wave elastography to assess the effects of extracorporeal shockwaves on spastic muscles in children with cerebral palsy: An uncontrolled experimental study. Muscles, Ligaments & Tendons Journal (MLTJ), 9(1), 124-130. https://doi.org/10.32098/mltj.01.2019.04

Corrado, B, Bonini, I., Chirico, V., Filippini, E., Liguori, L., Magliulo, G., Mazzuoccolo, G., Rosano, N., & Gisonni, P. (2020). Ultrasound-guided collagen injections in the treatment of supraspinatus tendinopathy: A case series pilot study. Journal of Biological Regulators and Homeostatic Agents, 34(3-S2), 33-39.

Corrado, B., Mazzuoccolo, G., Liguori, L., Chirico, V. A., Costanzo, M., Bonini, I., Bove, G., & Curci, L. (2019). Treatment of Lateral Epicondylitis with Collagen Injections: A Pilot Study. Muscle Ligaments and Tendons Journal, 09(04), 584. https://doi.org/10.32098/mltj.04.2019.14

Corrado, Bruno, Ciardi, G., Fortunato, L., & Iammarrone, C. S. (2019). Burnout syndrome among Italian physiotherapists: A cross-sectional study. European Journal of Physiotherapy, 21(4), 240-245. https://doi.org/10.1080/21679169.2018.1536765

Corrado, Bruno, Di Luise Carla, & Servodio Iammarrone Clemente. (2019). Management of Muscle Spasticity in Children with Cerebral Palsy by Means of Extracorporeal Shockwave Therapy: A Systematic Review of the Literature. 1-7-7. https://doi.org/10.1080/17518423.2019.1683908

Crawford, F., & Thomson, C. (2003). Interventions for treating plantar heel pain. The Cochrane Database of Systematic Reviews, 3, CD000416. https://doi.org/10.1002/14651858.CD000416

David, J. A., Sankarapandian, V., Christopher, P. R., Chatterjee, A., & Macaden, A. S. (2017). Injected corticosteroids for treating plantar heel pain in adults. The Cochrane Database of Systematic Reviews, 6, CD009348. https://doi.org/10.1002/14651858.CD009348.pub2

De Garceau, D., Dean, D., Requejo, S. M., & Thordarson, D. B. (2003). The association between diagnosis of plantar fasciitis and Windlass test results. Foot & Ankle International, 24(3), 251-255. https://doi.org/10.1177/107110070302400309

Eftekharsadat, B., Babaei-Ghazani, A., & Zeinolabedinzadeh, V. (2016). Dry needling in patients with chronic heel pain due to plantar fasciitis: A single-blinded randomized clinical trial. Medical Journal of the Islamic Republic of Iran, 30, 401.

Elias, D. A., Carne, A., Bethapudi, S., Engebretsen, L., Budgett, R., & O'Connor, P. (2013). Imaging of plantar fascia and Achilles injuries undertaken at the London 2012 Olympics. Skeletal Radiology, 42(12), 1645-1655. https://doi.org/10.1007/s00256-013-1689-1

Franceschi, F., Papalia, R., Franceschetti, E., Paciotti, M., Maffulli, N., & Denaro, V. (2014). Platelet-rich plasma injections for chronic plantar fasciopathy: A systematic review. British Medical Bulletin, 112(1), 83-95. https://doi.org/10.1093/bmb/ldu025

Frank, L., McLaughlin, P., & Vaughan, B. (2013). The repeatability of pressure algometry in asymptomatic individuals over consecutive days. International Journal of Osteopathic Medicine, 16(3), 143-152. https://doi.org/10.1016/j.ijosm.2012.10.004

Goff, J. D., & Crawford, R. (2011). Diagnosis and Treatment of Plantar Fasciitis. American Family Physician, 84(6), 676-682.

Gurcay, E., Kara, M., Karaahmet, O. Z., Ata, A. M., Onat, Ş. Ş., & Özçakar, L. (2017). Shall We Inject Superficial or Deep to the Plantar Fascia? An Ultrasound Study of the Treatment of Chronic Plantar Fasciitis. The Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons, 56(4), 783-787. https://doi.org/10.1053/j.jfas.2017.03.004

Hall, M. M. (2013). The accuracy and efficacy of palpation versus image-guided peripheral injections in sports medicine. Current Sports Medicine Reports, 12(5), 296-303. https://doi.org/10.1097/01.CSMR.0000434103.32478.36

Hanselman, A. E., Tidwell, J. E., & Santrock, R. D. (2015). Cryopreserved human amniotic membrane injection for plantar fasciitis: A randomized, controlled, double-blind pilot study. Foot & Ankle International, 36(2), 151-158. https://doi.org/10.1177/1071100714552824

Hay, E. D. (1981). Extracellular matrix. The Journal of Cell Biology, 91(3 Pt 2), 205s-223s. https://doi.org/10.1083/jcb.91.3.205s

Hoffman, M. D., & Krishnan, E. (2014). Health and Exercise-Related Medical Issues among 1,212 Ultramarathon Runners: Baseline Findings from the Ultrarunners Longitudinal TRAcking (ULTRA) Study. PLoS ONE, 9(1). https://doi.org/10.1371/journal.pone.0083867

Hormozi, J., Lee, S., & Hong, D. K. (2011). Minimal invasive percutaneous bipolar radiofrequency for plantar fasciotomy: A retrospective study. The Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons, 50(3), 283-286. https://doi.org/10.1053/j.jfas.2011.02.007

Hsu, W.-H., Yu, P.-A., Lai, L.-J., Chen, C.-L., Kuo, L.-T., & Fan, C.-H. (2018). Effect of Extracorporeal Shockwave Therapy on Passive Ankle Stiffness in Patients With Plantar Fasciopathy. The Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons, 57(1), 15-18. https://doi.org/10.1053/j.jfas.2017.05.038

Huffer, D., Hing, W., Newton, R., & Clair, M. (2017). Strength training for plantar fasciitis and the intrinsic foot musculature: A systematic review. Physical Therapy in Sport: Official Journal of the Association of Chartered Physiotherapists in Sports Medicine, 24, 44-52. https://doi.org/10.1016/j.ptsp.2016.08.008

Irving, D. B., Cook, J. L., Young, M. A., & Menz, H. B. (2008). Impact of chronic plantar heel pain on health-related quality of life. Journal of the American Podiatric Medical Association, 98(4), 283-289. https://doi.org/10.7547/0980283

Jain, K., Murphy, P. N., & Clough, T. M. (2015). Platelet rich plasma versus corticosteroid injection for plantar fasciitis: A comparative study. Foot (Edinburgh, Scotland), 25(4), 235-237. https://doi.org/10.1016/j.foot.2015.08.006

Kim, E., & Lee, J. H. (2014). Autologous platelet-rich plasma versus dextrose prolotherapy for the treatment of chronic recalcitrant plantar fasciitis. PM & R: The Journal of Injury, Function, and Rehabilitation, 6(2), 152-158. https://doi.org/10.1016/j.pmrj.2013.07.003

Kim, M., Choi, Y. S., You, M.-W., Kim, J. S., & Young, K. W. (2016). Sonoelastography in the Evaluation of Plantar Fasciitis Treatment: 3-Month Follow-Up After Collagen Injection. Ultrasound Quarterly, 32(4), 327-332. https://doi.org/10.1097/RUQ.0000000000000233

Kiter, E., Celikbas, E., Akkaya, S., Demirkan, F., & Kiliç, B. A. (2006). Comparison of injection modalities in the treatment of plantar heel pain: A randomized controlled trial. Journal of the American Podiatric Medical Association, 96(4), 293-296. https://doi.org/10.7547/0960293

Kumai, T., Samoto, N., Hasegawa, A., Noguchi, H., Shiranita, A., Shiraishi, M., Ikeda, S., Sugimoto, K., Tanaka, Y., & Takakura, Y. (2018). Short-term efficacy and safety of hyaluronic acid injection for plantar fasciopathy. Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA, 26(3), 903-911. https://doi.org/10.1007/s00167-017-4467-0

Leigheb, M., Janicka, P., Andorno, S., Marcuzzi, A., Magnani, C., & Grassi, F. (2016). Italian translation, cultural adaptation and validation of the «American Orthopaedic Foot and Ankle Society's (AOFAS) ankle-hindfoot scale». Acta Bio-Medica: Atenei Parmensis, 87(1), 38-45.

Lim, A. T., How, C. H., & Tan, B. (2016). Management of plantar fasciitis in the outpatient setting. Singapore Medical Journal, 57(4), 168-171. https://doi.org/10.11622/smedj.2016069

Lopes, A. D., Hespanhol Júnior, L. C., Yeung, S. S., & Costa, L. O. P. (2012). What are the main running-related musculoskeletal injuries? A Systematic Review. Sports Medicine (Auckland, N.Z.), 42(10), 891-905. https://doi.org/10.1007/BF03262301

Mahindra, P., Yamin, M., Selhi, H. S., Singla, S., & Soni, A. (2016). Chronic Plantar Fasciitis: Effect of Platelet-Rich Plasma, Corticosteroid, and Placebo. Orthopedics, 39(2), e285-289. https://doi.org/10.3928/01477447-20160222-01

Meyer, N. B., Jacobson, J. A., Kalia, V., & Kim, S. M. (2018). Musculoskeletal ultrasound: Athletic injuries of the lower extremity. Ultrasonography (Seoul, Korea), 37(3), 175-189. https://doi.org/10.14366/usg.18013

Monteagudo, M., de Albornoz, P. M., Gutierrez, B., Tabuenca, J., & Álvarez, I. (2018). Plantar fasciopathy: A current concepts review. EFORT Open Reviews, 3(8), 485-493. https://doi.org/10.1302/2058-5241.3.170080

Montesano, P., Daniele, M., Maurizio Di Silvestro, Giulia, C., Tafuri, D., & Mazzeo, F. (2020). Effects of combined training program, controlled diet and drugs on middle-distance amateur runners: A Pilot Study. 13(1), 17-22.

Monto, R. R. (2013). Platelet-rich plasma and plantar fasciitis. Sports Medicine and Arthroscopy Review, 21(4), 220-224. https://doi.org/10.1097/JSA.0b013e318297fa8d

Neufeld, S. K., & Cerrato, R. (2008). Plantar fasciitis: Evaluation and treatment. The Journal of the American Academy of Orthopaedic Surgeons, 16(6), 338-346. https://doi.org/10.5435/00124635-200806000-00006

Nielsen, R. O., Rønnow, L., Rasmussen, S., & Lind, M. (2014). A prospective study on time to recovery in 254 injured novice runners. PloS One, 9(6), e99877. https://doi.org/10.1371/journal.pone.0099877

Oliva, F., Piccirilli, E., Tarantino, U., & Maffulli, N. (2017). Percutaneous release of the plantar fascia. New surgical procedure. Muscles, Ligaments and Tendons Journal, 7(2), 338-340. https://doi.org/10.11138/mltj/2017.7.2.338

Orchard, J. (2012). Plantar fasciitis. BMJ (Clinical Research Ed.), 345, e6603. https://doi.org/10.1136/bmj.e6603

Ozan, F., Koyuncu, Ş., Gürbüz, K., Öncel, E. S., & Altay, T. (2017). Radiofrequency Thermal Lesioning and Extracorporeal Shockwave Therapy: A Comparison of Two Methods in the Treatment of Plantar Fasciitis. Foot & Ankle Specialist, 10(3), 204-209. https://doi.org/10.1177/1938640016675408

Palermi, S., Sacco, A. M., Belviso, I., Romano, V., Montesano, P., Corrado, B., & Sirico, F. (2020). Guidelines for Physical Activity-A Cross-Sectional Study to Assess Their Application in the General Population. Have We Achieved Our Goal? International Journal of Environmental Research and Public Health, 17(11). https://doi.org/10.3390/ijerph17113980

Petraglia, F., Ramazzina, I., & Costantino, C. (2017). Plantar fasciitis in athletes: Diagnostic and treatment strategies. A systematic review. Muscles, Ligaments and Tendons Journal, 7(1), 107-118. https://doi.org/10.11138/mltj/2017.7.1.107

Randelli, F., Menon, A., Giai Via, A., Mazzoleni, M. G., Sciancalepore, F., Brioschi, M., & Gagliano, N. (2018). Effect of a Collagen-Based Compound on Morpho-Functional Properties of Cultured Human Tenocytes. Cells, 7(12). https://doi.org/10.3390/cells7120246

Reilly, J. M., Bluman, E., & Tenforde, A. S. (2018). Effect of Shockwave Treatment for Management of Upper and Lower Extremity Musculoskeletal Conditions: A Narrative Review. PM & R: The Journal of Injury, Function, and Rehabilitation, 10(12), 1385-1403. https://doi.org/10.1016/j.pmrj.2018.05.007

Riddle, D. L., Pulisic, M., Pidcoe, P., & Johnson, R. E. (2003). Risk factors for Plantar fasciitis: A matched case-control study. The Journal of Bone and Joint Surgery. American Volume, 85(5), 872-877. https://doi.org/10.2106/00004623-200305000-00015

Riddle, D. L., & Schappert, S. M. (2004). Volume of ambulatory care visits and patterns of care for patients diagnosed with plantar fasciitis: A national study of medical doctors. Foot & Ankle International, 25(5), 303-310. https://doi.org/10.1177/107110070402500505

Rompe, J. D. (2009). Plantar fasciopathy. Sports Medicine and Arthroscopy Review, 17(2), 100-104. https://doi.org/10.1097/JSA.0b013e3181a3d60e

Ryan, M. B., Wong, A. D., Gillies, J. H., Wong, J., & Taunton, J. E. (2009). Sonographically guided intratendinous injections of hyperosmolar dextrose/lidocaine: A pilot study for the treatment of chronic plantar fasciitis. British Journal of Sports Medicine, 43(4), 303-306. https://doi.org/10.1136/bjsm.2008.050021

Say, F., Gürler, D., İnkaya, E., & Bülbül, M. (2014). Comparison of platelet-rich plasma and steroid injection in the treatment of plantar fasciitis. Acta Orthopaedica Et Traumatologica Turcica, 48(6), 667-672. https://doi.org/10.3944/AOTT.2014.13.0142

Schillizzi, G., Alviti, F., D'Ercole, C., Elia, D., Agostini, F., Mangone, M., Paoloni, M., Bernetti, A., Pacini, P., Polti, G., Minafra, P., & Cantisani, V. (2020). Evaluation of plantar fasciopathy shear wave elastography: A comparison between patients and healthy subjects. Journal of Ultrasound. https://doi.org/10.1007/s40477-020-00474-7

Singh, P., Madanipour, S., Bhamra, J. S., & Gill, I. (2017). A systematic review and meta-analysis of platelet-rich plasma versus corticosteroid injections for plantar fasciopathy. International Orthopaedics, 41(6), 1169-1181. https://doi.org/10.1007/s00264-017-3470-x

Sirico, F., Miressi, S., Castaldo, C., Spera, R., Montagnani, S., Di Meglio, F., & Nurzynska, D. (2018). Habits and beliefs related to food supplements: Results of a survey among Italian students of different education fields and levels. PloS One, 13(1), e0191424. https://doi.org/10.1371/journal.pone.0191424

Sirico, F., Ricca, F., DI Meglio, F., Nurzynska, D., Castaldo, C., Spera, R., & Montagnani, S. (2017). Local corticosteroid versus autologous blood injections in lateral epicondylitis: Meta-analysis of randomized controlled trials. European Journal of Physical and Rehabilitation Medicine, 53(3), 483-491. https://doi.org/10.23736/S1973-9087.16.04252-0

Sobhani, S., Dekker, R., Postema, K., & Dijkstra, P. U. (2013). Epidemiology of ankle and foot overuse injuries in sports: A systematic review. Scandinavian Journal of Medicine & Science in Sports, 23(6), 669-686. https://doi.org/10.1111/j.1600-0838.2012.01509.x

Soraganvi, P., Nagakiran, K. V., Raghavendra-Raju, R. P., Anilkumar, D., Wooly, S., Basti, B. D., & Janakiraman, P. (2019). Is Platelet-rich Plasma Injection more Effective than Steroid Injection in the Treatment of Chronic Plantar Fasciitis in Achieving Long-term Relief? Malaysian Orthopaedic Journal, 13(3), 8-14. https://doi.org/10.5704/MOJ.1911.002

Tatli, Y. Z., & Kapasi, S. (2009). The real risks of steroid injection for plantar fasciitis, with a review of conservative therapies. Current Reviews in Musculoskeletal Medicine, 2(1), 3-9. https://doi.org/10.1007/s12178-008-9036-1

Taunton, J. E., Ryan, M. B., Clement, D. B., McKenzie, D. C., Lloyd-Smith, D. R., & Zumbo, B. D. (2002). A retrospective case-control analysis of 2002 running injuries. British Journal of Sports Medicine, 36(2), 95-101. https://doi.org/10.1136/bjsm.36.2.95

Tenforde, A. S., Yin, A., & Hunt, K. J. (2016). Foot and Ankle Injuries in Runners. Physical Medicine and Rehabilitation Clinics of North America, 27(1), 121-137. https://doi.org/10.1016/j.pmr.2015.08.007

Vola, E. A., Albano, M., Di Luise, C., Servodidio, V., Sansone, M., Russo, S., Corrado, B., Servodio Iammarrone, C., Caprio, M. G., & Vallone, G. (2018). Use of ultrasound shear wave to measure muscle stiffness in children with cerebral palsy. Journal of Ultrasound, 21(3), 241-247. https://doi.org/10.1007/s40477-018-0313-6

Walton, D. M., Macdermid, J. C., Nielson, W., Teasell, R. W., Chiasson, M., & Brown, L. (2011). Reliability, standard error, and minimum detectable change of clinical pressure pain threshold testing in people with and without acute neck pain. The Journal of Orthopaedic and Sports Physical Therapy, 41(9), 644-650. https://doi.org/10.2519/jospt.2011.3666

Ylinen, J., Nykänen, M., Kautiainen, H., & Häkkinen, A. (2007). Evaluation of repeatability of pressure algometry on the neck muscles for clinical use. Manual Therapy, 12(2), 192-197. https://doi.org/10.1016/j.math.2006.06.010



How to Cite

Corrado, B., Bonini, I., Tarantino, D., & Sirico, F. (2020). Ultrasound-guided collagen injections for treatment of plantar fasciopathy in runners: A pilot study and case series. Journal of Human Sport and Exercise, 15(3proc), S793-S805. Retrieved from https://www.jhse.ua.es/article/view/2020-v15-n3-proc-ultrasound-guided-collagen-injections-treatment

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