Is prednisone (corticosteroid) effective for treating plantar fasciitis?

Prednisone Treatment for Plantar Fasciitis

Systemic prednisone is not recommended as a first-line or routine treatment for plantar fasciitis due to limited evidence supporting its efficacy and potential for adverse effects. Instead, local corticosteroid injections should be considered as a second-line treatment when conservative measures fail 1.

Treatment Algorithm for Plantar Fasciitis

First-Line Treatments

1. Patient-directed conservative measures:
   • Regular calf-muscle stretching
   • Cryotherapy (ice application)
   • Over-the-counter heel cushions/arch supports
   • Weight loss if indicated
   • Open-backed shoes and heel lifts
   • NSAIDs for pain control
   • Activity modification

Second-Line Treatments (if no improvement after 6 weeks)

1. Local corticosteroid injection:

   • More effective than oral NSAIDs for plantar fasciitis 2
   • Provides significant pain relief that can be sustained 3
   • Should be limited in number to avoid complications
   • Can be combined with controlled training for superior outcomes 3

2. Customized orthotic devices

3. Night splinting

Evidence for Corticosteroid Use in Plantar Fasciitis

Local Corticosteroid Injections

• Local corticosteroid injections have demonstrated significant effectiveness in treating plantar fasciitis 4
• In comparative studies, local injections of methylprednisolone (40mg) provided better pain relief than oral NSAIDs 2
• When combined with controlled training (strength training and stretching), corticosteroid injections show superior outcomes compared to either treatment alone 3
• The risk of plantar fascia rupture following corticosteroid injection is relatively low (2.4%) 5

Systemic Corticosteroids

• There is little evidence supporting long-term treatment with systemic glucocorticoids for plantar fasciitis 6, 1
• The American College of Rheumatology recommends local treatments rather than systemic steroids for plantar fasciitis 1
• In case reports of plantar fasciitis associated with spondyloarthritis, a 10-day course of oral corticosteroids did not provide sustained relief 6

Important Considerations and Precautions

• Risk factors for complications: Higher BMI (>30) and multiple injections may increase risk of plantar fascia rupture 5
• Injection technique: Proper technique and imaging guidance can improve outcomes and reduce complications
• Alternative treatments: For patients who fail to respond to corticosteroid injections, platelet-rich plasma (PRP) injections have shown promising results and may be as effective or more effective than corticosteroid injections 4

Special Populations

For plantar fasciitis associated with inflammatory conditions like spondyloarthritis:

• Local corticosteroid injections are still preferred over systemic treatment 6
• If plantar fasciitis is part of severe enthesitis in conditions like psoriatic arthritis that has failed NSAIDs and local treatments, TNF inhibitors may be considered rather than systemic corticosteroids 6

In summary, while oral prednisone is sometimes used in clinical practice, the evidence supports local corticosteroid injections as a more effective and safer approach for treating plantar fasciitis when conservative measures fail.