Corticosteroid Injection for Calcaneal Spur
Yes, methylprednisolone and other corticosteroids can be injected into the area of a calcaneal (heel) spur, specifically targeting the plantar fascia attachment at the medial tubercle of the calcaneal tuberosity, though the injection is technically treating the associated plantar fasciitis rather than the spur itself. 1, 2
Understanding the Target
The calcaneal spur is a bony outgrowth that commonly appears with plantar fasciitis, but the spur itself is not the primary pain generator—it's the inflamed plantar fascia attachment and adjacent calcaneal periostitis that cause symptoms. 3, 4 The injection targets this soft tissue inflammation at the fascia's insertion point, not the bone spur directly. 2
When to Consider Injection
Corticosteroid injection is appropriate when: 1
- Conservative therapy (NSAIDs, physical therapy, stretching exercises, orthoses, heel lifts) has been tried for 2-3 months without adequate improvement 1
- Pain intensity is greater than 4/10 and has been present for more than one month 1
- The patient has focal tenderness beneath the calcaneum at the plantar fascia insertion 1, 2
Injection Technique Considerations
Accurate localization is essential for successful symptom resolution. 2 The injection should target the attachment of the plantar fascia to the medial tubercle of the calcaneal tuberosity, which can be guided using lateral radiographs of the foot. 2
Important Caveats and Contraindications
Local corticosteroid injections are NOT recommended for insertional Achilles tendonitis (posterior heel pain), as injection near the Achilles tendon risks tendon rupture. 1 This is a critical distinction—anterior/plantar heel pain from plantar fasciitis can be injected, but posterior heel pain at the Achilles insertion should not be. 1
For bursitis associated with Haglund's deformity (posterior lateral heel), corticosteroid injections may be considered but must carefully avoid the Achilles tendon. 1
Expected Outcomes and Limitations
Corticosteroid injections provide relatively short-lived benefit, typically lasting 1-4 weeks, though some patients may experience relief up to 12 weeks. 1, 5 This is similar to the evidence base for knee osteoarthritis injections, where benefits diminish by 12-24 weeks. 1
If symptoms persist despite injection and continued conservative measures for 6-8 months total, referral to a podiatric foot and ankle surgeon for consideration of plantar fasciotomy or other surgical interventions is appropriate. 1, 3, 4
Frequency Limitations
While specific guidelines for heel injections are not as well-established as for knee injections, the general principle of limiting corticosteroid injections to no more than 3-4 per year in the same area applies to minimize risks of tissue atrophy and other complications. 6