From the Guidelines
If your plantar fasciitis pain has returned after steroid treatment, you should restart conservative treatments including rest, ice application, and over-the-counter NSAIDs, as the recurrence is common due to the temporary nature of steroid relief. The provided evidence, although primarily focused on knee osteoarthritis and general heel pain, supports the use of conservative measures for managing plantar fasciitis, especially when steroid injections provide only temporary relief 1.
Conservative Treatments
- Rest and avoid activities that aggravate the condition
- Ice application for 15-20 minutes several times daily
- Over-the-counter NSAIDs like ibuprofen (400-600mg three times daily with food) or naproxen (220-440mg twice daily with food)
- Continue stretching exercises, focusing on calf and plantar fascia stretches, holding each for 30 seconds and repeating 3-5 times, several times daily
- Wear supportive shoes with good arch support and consider over-the-counter orthotic inserts
- Night splints can help prevent morning pain by keeping the fascia stretched overnight
The evidence from studies on osteoarthritis, such as the one published in 2009 1, and the EULAR recommendations from 2003 1, although not directly addressing plantar fasciitis, highlight the short-term benefits of corticosteroid injections for pain relief, which is relevant when considering the management of plantar fasciitis pain that has returned after such treatment.
Next Steps
If pain persists beyond 2-3 weeks despite these conservative measures, it is advisable to return to your healthcare provider for further evaluation and potential additional treatments, which may include physical therapy, custom orthotics, or possibly another steroid injection, though repeated injections are generally limited due to potential tissue weakening 1.
From the Research
Plantar Fasciitis Treatment with Steroid Injections
- The effectiveness of steroid injections for plantar fasciitis is a topic of ongoing research, with studies yielding mixed results 2, 3, 4, 5.
- A study published in 2022 compared the efficacy of platelet-rich plasma (PRP) injections and corticosteroid injections in patients with chronic plantar fasciitis, finding that PRP injections may be a superior alternative to corticosteroid injections 2.
- Another study published in 2017 found that steroid injections may lead to lower heel pain scores in the short-term, but this benefit is diminished over time 3.
- A review of conservative therapies for plantar fasciitis published in 2009 noted that steroid injection/iontophoresis can provide significant pain relief in the short-term, but should be combined with ultrasound monitoring to reduce complications 4.
- A 2020 evaluation of the treatment of chronic plantar fasciitis noted that corticosteroid injections can temporarily relieve pain, but may increase the risk of plantar fascia rupture and fat pad atrophy 5.
Risks and Complications of Steroid Injections
- Steroid injections can cause complications such as plantar fascia rupture, fat pad atrophy, and nerve injury 3, 5, 6.
- A case study published in 2005 reported a lateral plantar nerve injury following a steroid injection for plantar fasciitis, highlighting the importance of proper injection technique 6.
- The available evidence suggests that steroid injections may not provide long-term relief for plantar fasciitis, and may be associated with significant risks and complications 2, 3, 4, 5.
Recurrence of Pain after Steroid Injection
- The available evidence suggests that the pain-relieving effects of steroid injections for plantar fasciitis may be short-lived, with pain often recurring over time 2, 3, 4, 5.
- A study published in 2017 found that steroid injections may not provide significant pain relief beyond one month 3.
- As a result, patients who experience initial improvement with steroid injections may still experience recurrent pain, highlighting the need for ongoing management and treatment of plantar fasciitis 2, 3, 4, 5.