CORTICOSTEROID INJECTION IS THE BEST TREATMENT IN PLANTAR FASCIITIS IF COMBINED WITH CONTROLLED TRAINING

Review written by Tom Goom info

BACKGROUND & OBJECTIVE

Plantar fasciitis is a common condition that can be challenging to treat. One study found that 46% of people were still symptomatic at 10 years post onset (Hansen et al. 2018). Although recent research has suggested that heavy, slow resistance training may be effective, there is a lack of evidence to guide clinical practice.

Corticosteroid injections (CSI) have been used in the treatment of plantar heel pain, but questions remain regarding their long-term effectiveness and safety. Risk of plantar fascial rupture has been reported to be 33 times higher following CSI (Lee et al. 2014). This study aimed to evaluate the treatment effect of three different strategies for plantar fasciitis – CSI, strength training, and CSI plus strength training combined – to determine the most effective treatment approach.

METHODS

90 subjects met the inclusion criteria and were randomised into one of three groups:

  • Corticosteroid injection only (CSI) - injections were administered once per month until plantar fascial thickness was less than 4mm as determined by ultrasound
  • Strength training only (ST) - heel raises and resisted toe flexion and ankle inversion (both done against resistance band) were combined with 3 stretches for the calf and plantar fascia.
  • Corticosteroid injection plus strength training (CSI and ST) - combined the two approaches above

The first 3 months were defined as the intervention period for both strength training and injections. During this period all subjects were instructed to reduce walking and refrain from running and jumping activities. They were also advised to use shoes with good shock absorption and to use standard insoles and low-dye taping.

Primary outcomes measures were average pain during function (VAS) and the Foot Function Index (FFI) at 6 months. These measures were taken alongside first step pain (VAS) at 3, 6, 12 and 24 months.

RESULTS

At the 6-month time point there were significant improvements in FFI and pain during function in all three groups. CSI and ST combined resulted in significantly greater improvements in both outcome measures.

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