Steroid injections for plantar fasciitis
Steroid injections have been used for many decades to treat conditions such as tennis elbow, Achilles tendinitis and plantar fasciitis. They are thought to have very powerful anti-inflammatory properties that can ease and settle the symptoms of plantar fasciitis.
What are the benefits?
Steroid injections can sometimes literally make the pain disappear overnight. For most however there is a good degree of pain relief experienced during the first couple of weeks following the injection. on occasion it can take six weeks for the benefits to kick in.
How long do the benefits last?
Studies would suggest the effects of steroid injections provide about a three-month window of relief. One such study compared outcomes for patients treated with steroid injections and those treated with PRP. The steroid group experienced a more rapid degree of relief however the relief wore off after three months. The patients in the PRP group experienced better outcomes when followed up at 12- and 24-months post injection.
What kind of patients select steroid injections for heel pain?
We see a lot of patients that are in so much pain on a day to day basis with their plantar fasciitis, that they are unable to fully engage with their exercises and rehab program. For such patients’ steroid injections are an excellent treatment choice, because the 3-month period of relief given by the injection allows the patient to re-engage with their rehab program. If you have a steroid injection and do nothing in the 3-month period of relief the symptoms are highly likely to return. You should see the 3-month period of grace, as an opportunity to rehab your plantar fascia…” Robin Weaver MSK Podiatrist at the Barn Clinic treatment centres
What are the risks?
Infection – Injections are given using a clean sterile technique. As such infections very rarely occur. The signs of infection include: pain redness, swelling, discharge. If you suspect infection seek medical treatment without delay.
Rupture of the plantar fascia – Steroid is thought to weaken collagen. Studies have suggested that collagen is indeed temporarily weakened, for a 2-3 weeks post injection, however by 6 weeks post injection, collagen has been shown to have completely recovered and remodelled. According to Mr Robin Weaver, “Another issue we warn patients about is the risk of suddenly overloading the plantar fascia. Sudden overloading of the plantar fascia will also lead to rupture. Overloading of the plantar fascia occurs when a patient finds him or herself suddenly pain free due to the effects of the steroid injection. Without pain inhibiting them patients often decide to return to running before the plantar fascia has had chance to fully recover.” To guard against this issue, we offer a plantar fascia health check prior to re-commencement of training. This check will involve an ultrasound scan that measures the thickness of the fascia, inflammation levels and levels of elasticity (elastography).
Loss of fat pad protection under the heel – A healthy adult will typically have 1cm of protective fat tissue cushioning the heel bone from the impact forces generated by walking running and jumping. As we get older, the fat pad thins. Some have feared that steroid injections for plantar fasciitis can cause fat pad atrophy (thinning). For such reasons we are keen for patients to avoid having too many injections over too shorter period of time. Prior to every injection for plantar fasciitis, we assess the fat pads via ultrasound imaging. Should we see signs of thinning we would advise against steroid injection. In our experience at the Barn Clinic treatment centres we have never seen patients develop such thinning following an ultrasound guided injection. Indeed, a recent study that pooled the data of numerous studies found that steroid injections have no real measurable effect on the fat pad thickness.
Discomfort – There is really no need to worry. At the Barn Clinic treatment centres we use very fine needles to get you numbed up with local anaesthetic prior to giving you the steroid injection. We also utilise ultrasound guidance to confirm correct needle placement, and to avoid the risk of accidentally injecting steroid into a nerve. A recent audit found that 100% of patients that have had a steroid injection as part of their heel pain treatment would recommend The Barn Clinic to others for the treatment of heel pain.
Post injection Flair – For reasons that are poorly understood, a small minority of patients experience a temporary sharp increase in pain lasting 24-48 hours. If this occurs, inform your clinician. You will generally be advised use pain killers and ice and elevate.
What should I do after my injection?
Have someone drive you home, rest and elevate the foot for 48 hours, avoid high impact sport and activity for between 2-6 weeks depending on the sport and the severity of your condition.