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

Yusuf Ziya Tatli, Sameer Kapasi, Yusuf Ziya Tatli, Sameer Kapasi

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.

Figures

Fig. 1
Fig. 1
From Buchbinder [4]. Used with permission from NEJM. Plantar and medial views of the foot demonstrating the origin and insertion of the plantar fascia and the location of nerves in proximity to the heel. The windlass mechanism, or bowstring effect, of the plantar fascia refers to its function in raising the arch of the foot during the push-off phase of walking

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