Does a corticosteroid injection plus exercise or exercise alone add to the effect of patient advice and a heel cup for patients with plantar fasciopathy? A randomised clinical trial

Review written by Ian Griffiths info

Key Points

  1. Exercise prescription may not be essential for people suffering with plantar fasciopathy.
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BACKGROUND & OBJECTIVE

Plantar fasciopathy (frequently also referred to as plantar fasciitis or plantar heel pain) is the most common overuse issue affecting the foot (1) but despite this no firm conclusions exist regarding which treatments are most effective (2).

A best practice guide was recently developed by Morrissey et al (3) and acknowledged the lack of robust RCTs that had been performed with regard to corticosteroid injection and strength/resistance exercises, despite them often being used clinically. There were also no published papers of high enough quality regarding resistance/strength training to be included in the systematic review of the Morrissey et al paper.

Despite this, an entire generation of clinicians prescribe high load strength training for plantar fasciopathy sufferers, seemingly off the back of one key paper which suggested that there were superior outcomes in the foot function index after three months of strength training compared to stretching (with both groups also getting a heel cup) (4). However, this was quite a small study (n = 48) and it should be noted that there were no differences between the groups at later time points of 6 months and 12 months.

The aim of this current study was to identify if strength training was a worthy addendum to advice and a heel cup for patients with plantar fasciopathy, and then to also investigate if there was further benefit in adding a corticosteroid injection on top of all three of these interventions.

Plantar fasciopathy is accepted as being the most common overuse issue affecting the foot.
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Patient education and advice is important, and this is in keeping with the best practice guide for plantar heel pain which also suggests it should be individualized.

METHODS

This study was a randomized trial with three groups (detailed below) and was single blinded in design (as it was not possible to blind the patients). Individuals with ultrasound confirmed plantar fasciopathy were recruited (n = 180) and randomized into

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