From the Guidelines
Steroid injections are not recommended for the treatment of plantar fasciitis. When considering treatment options for plantar fasciitis, it is essential to prioritize morbidity, mortality, and quality of life as the outcome. According to the American College of Foot and Ankle Surgeons, as reported in the American Family Physician journal in 2002 1, initial treatment options may include open-backed shoes, heel lifts or orthoses, NSAIDs, decreased activity, stretching exercises, and weight loss.
Key Considerations
- The American College of Foot and Ankle Surgeons recommends against local injections of corticosteroids for plantar fasciitis treatment 1.
- Alternative treatment options, such as immobilization, may be considered in acute or refractory cases.
- If improvement occurs within six to eight weeks, treatments are continued until symptoms resolve.
Treatment Approach
- Focus on conservative measures, including open-backed shoes, heel lifts or orthoses, NSAIDs, decreased activity, stretching exercises, and weight loss (if indicated) 1.
- Immobilization may be considered in particularly acute or refractory cases.
- Treatment should be continued until symptoms resolve, with regular follow-up to assess progress and adjust the treatment plan as needed.
From the Research
Steroid Injection for Plantar Fasciitis
- Steroid injections are a common treatment for plantar fasciitis, but their effectiveness compared to other treatments is still being studied 2, 3, 4, 5, 6.
- A study published in 2022 found that platelet-rich plasma (PRP) injections were more effective than corticosteroid injections in treating chronic plantar fasciitis 2.
- Another study published in 2019 found that combining corticosteroid injections with controlled training was the most effective treatment for plantar fasciitis 3.
- A 2014 study found that PRP injections were more effective and durable than cortisone injections for treating chronic recalcitrant cases of plantar fasciitis 4.
- A 2015 study found that PRP injections were as effective as steroid injections at achieving symptom relief at 3 and 6 months, but were more effective at 12 months 5.
- A systematic review of randomized controlled trials published in 2020 found that PRP injections resulted in greater improvements in pain and functional outcomes compared to corticosteroid injections for patients with chronic plantar fasciitis 6.
Comparison of Treatment Outcomes
- The studies suggest that PRP injections may be a more effective and durable treatment for plantar fasciitis compared to corticosteroid injections 2, 4, 5, 6.
- However, the 2019 study found that combining corticosteroid injections with controlled training was the most effective treatment 3.
- The treatment outcomes measured in the studies included pain levels, functional outcomes, and patient satisfaction, with PRP injections generally resulting in better outcomes 2, 4, 5, 6.
Safety and Side Effects
- The studies reported some side effects and complications associated with both PRP and corticosteroid injections, including infection, skin depigmentation, and fat pad atrophy 2, 3, 4, 5.
- However, the side effects were generally mild and temporary, and the benefits of the treatments were found to outweigh the risks 2, 3, 4, 5, 6.