The real risks of steroid injection for plantar fasciitis, with a review of conservative therapies

Abstract

This article presents a review of conservative therapies for plantar fasciitis pain reduction with a discussion of steroid therapy risks. The therapies reviewed include orthoses, stretching, extracorporeal shockwave, BTX-A, and corticosteroid injection/iontophoresis. These modes were included based on the availability of double blinded randomized controlled trials. We noted the following findings. Orthoses, regardless of type, can improve pain levels. Plantar stretching shows limited short-term benefit (1 month), but can reflect significant long-term improvement (10 months). Extracorporeal shockwave therapy shows equivocal benefit with some studies showing significant improvement and others showing none. Although BTX-A injections were the least studied, significant pain improvement was demonstrated in the short and long term. Steroid injection/iontophoresis showed significant improvement in the short term (1 month). Steroid therapy, when coupled with plantar stretching, can provide efficacious pain relief; however, steroid injections should be combined with ultrasound monitoring to reduce complications.

Corticosteroid versus placebo injection for plantar fasciitis: A meta-analysis of randomized controlled trials

“…Corticosteroid injection is believed to provide only short-term pain relief or even no benefit (3,4). Furthermore, the patient may suffer from an increased risk of plantar fascia rupture following the treatment (6).…”

Plantar fasciitis treatment: What is better, oral nonsteroidal anti-inflammatory agents or locally injectable steroid?

“…[2] Long-term use of oral NSAIDs can cause serious systemic side effects like gastritis, peptic ulcer, esophagitis, gastrointestinal (GI) bleeding, interstitial nephritis, Na + and water retention, thrombocytopenia, bleeding, pruritus, central nervous system, and hepatic complications 5 , whereas in case of steroid injections chances of systemic side effects are very rare as it is injected locally, but steroid injection for plantar fasciitis is often associated with local site erythema, plantar fascia rupture, and fat pad atrophy. [14,15] In our study the group I patients had a high complication rate, 18 patients had complaints of gastritis, 3 cases had pruritis, 1 case was diagnosed with esophagitis, these complications are commonly seen in other studies with NSAIDs. In group II, one patient had plantar fascia rupture (3.33%), and one patient each had injection site erythema and infection.…”

Comparative Study of: Non-Invasive Conservative Treatments with Local Steroid Injection in the Management of Planter Fasciitis

“…Because of the recent availability and facility of ultrasound to improve needle placement accuracy in clinical practice, enhanced therapeutic response rates have been reflected in some of the studies. Further limiting the number and frequency of steroid injections and educating patients on reduction of aggressive physical activity during a 2-wk post injection period has been suggested [14]. In our patients apprehension was noted for the adverse effects and also for further increase in pain after local steroid injections.…”