From the Guidelines
Steroid injections are not recommended for the treatment of plantar fasciitis and partial tear to peroneus brevis due to the potential deleterious effects on the tendon and lack of evidence-based guidelines supporting their use. The use of steroid injections for these conditions is a topic of debate, and more research is needed to determine their optimal use 1. While steroid injections may provide temporary pain relief, they do not address the underlying biomechanical issues and may weaken the tendon, predisposing it to spontaneous rupture 1.
For plantar fasciitis, initial treatment options may include open-backed shoes, heel lifts or orthoses, NSAIDs, decreased activity, stretching exercises, and weight loss (if indicated) 1. For a partial peroneus brevis tear, treatment should focus on relative rest, icing, and eccentric strengthening exercises 1. Additional treatments for plantar fasciitis may include night splints and supportive footwear, while physical therapy focusing on strengthening and proprioception is crucial for peroneus brevis tears 1.
It is essential to approach the treatment of these conditions with caution and consider the potential risks and benefits of steroid injections. A comprehensive treatment plan that addresses the underlying biomechanical issues and promotes tissue healing is crucial for optimal outcomes.
Key considerations for treatment include:
- Avoiding steroid injections due to potential deleterious effects on the tendon
- Focusing on relative rest, icing, and eccentric strengthening exercises for peroneus brevis tears
- Using open-backed shoes, heel lifts or orthoses, NSAIDs, decreased activity, stretching exercises, and weight loss (if indicated) for plantar fasciitis
- Incorporating night splints and supportive footwear for plantar fasciitis
- Implementing physical therapy focusing on strengthening and proprioception for peroneus brevis tears.
From the Research
Treatment Options for Plantar Fasciitis and Partial Tear to Peroneus Brevis
- The use of steroid injections for plantar fasciitis has been studied, with some research suggesting that it can be an effective treatment option when combined with controlled training 2.
- A study published in 2019 found that combining corticosteroid injection and physical training (strength training and stretching) resulted in a superior effect compared to each treatment separately 2.
- Another study compared the effects of local platelet-rich plasma, corticosteroid, and placebo injections in the treatment of chronic plantar fasciitis, and found that both platelet-rich plasma and corticosteroid injections were effective treatment options 3.
- A 2014 study found that platelet-rich plasma injection was more effective and durable than corticosteroid injection for the treatment of chronic recalcitrant cases of plantar fasciitis 4.
Partial Tear to Peroneus Brevis
- There is limited research available on the treatment of partial tears to the peroneus brevis, but a study on plantar fasciitis found that partial tears of the plantar fascia in the insertional region presented a favorable prognosis with complete recovery, both clinically and anatomically, when managed with a conservative approach 5.
- The same study suggested that coupling clinical findings with sonohistologic pattern is a valuable approach to plan the most suitable treatment for patients with spontaneous plantar fascia tear 5.
Steroid Injection for Plantar Fasciitis
- A study published in 2019 found that corticosteroid injections combined with controlled training are recommended as first-line treatment in patients with plantar fasciitis 2.
- Another study found that local injection of platelet-rich plasma or corticosteroid is an effective treatment option for chronic plantar fasciitis, with platelet-rich plasma injection being as effective as or more effective than corticosteroid injection 3.