Corticosteroid injections are a common treatment for plantar fasciitis. They are usually injected at the source of pain, the attachment of the plantar fascia to the heel bone. The aim of a corticosteroid injection is to reduce inflammation and thickening of the fascia and pain. Historically, corticosteroid injections have been used very frequently, however more and more health professionals are beginning to question the appropriateness of corticosteroid injections due to our current understanding of the pathological process of plantar fasciitis.
Up until the early 2000's plantar fasciitis has been considered an inflammatory condition, however research has demonstrated that there is a lack of inflammation involved in the disease process. The consensus among health professionals is that plantar fascitiis is not an inflammatory condition but a degenerative condition. Corticosteroid is a potent anti-inflammatory drug, however if there is lack of inflammation involved in plantar fasciits, is a corticosteroid injection really a wise option?
Are Corticosteroid Injections Effective?
As corticosteroid injections have been used extensively for a very long time for a wide range of musculoskeletal conditions, including plantar fasciitis, there is actually a lot of published research investigating their effectiveness. With specific reference to plantar heel pain, overall, the majority of the research indicates that corticosteroid injections are mildly effective in the short term (0-3 months), but ineffective in the long term (>3 months) as in most cases the heel pain recurs.
Are Corticosteroid Injections Safe?
Steroid injections come with their risks. The most concerning risk is a subsequent rupture of the plantar fascia. According to studies, the rupture risk following a single corticosteroid injection appears to be to between 5%-10% and the risk of rupture increases with repeated injections. Another significant risk is thinning of the fat pad of the heel, which means the heel has less fat pad available to aid in shock absorption.
If you haven't guessed by now, I am not a fan of corticosteroid injections for the treatment of plantar fasciitis. One of the top priorities when treating patients is to do no harm to the patient. There are many safer and more effective alternative treatment options available, that I find it hard to justify recommending this treatment option to my patients. In light of research inidicating that plantar fasciitis is more accurately defined as plantar fasciosis, which is a degenerative condition as opposed to an inflammatory condition the indication of a corticosteroid injection which is a potent anti-inflammatory agent is questionable. Although corticosteroid injections can help with pain relief in the short term, they do not address the underlying cause of the problem and if used, should therefore, always be an adjunctive treatment along with other treatments such as exercise prescription, night splints, orthoses, suitable footwear and weight loss.