Are Corticosteroid Injections Helpful in Plantar Heel Pain?

A review of randomized trials compared corticosteroid injection to other treatment strategies for plantar heel pain and found that while it outperforms “some comparators,” it “is not more effective than placebo injection for reducing pain or improving function.” The findings of the review were published in BMC Musculoskeletal Disorders.

“Plantar heel pain is a common foot condition that occurs in adults, with prevalence estimates between 4 and 7%,” the study authors wrote. “Several interventions are used to treat plantar heel pain, although there is limited evidence to suggest which interventions are more effective. Corticosteroid injection is often used to treat plantar heel pain but there is limited high-quality evidence to support its frequent use.”

The researchers searched MEDLINE, CINAHL, SPORTDiscus, Embase and the Cochrane Library on Dec. 1, 2016, and updated their search on April 17, 2019; randomized trials published in any language were eligible for inclusion. Google Scholar and trial registries were also queried. Primary outcomes were short- (zero to six weeks), medium- (seven to 12 weeks), and longer-term (13 to 52 weeks) pain and function.

Final analysis included 47 trials encompassing 2,989 patients. In improving short-term pain outcomes, corticosteroid injection was more effective than autologous blood injection (standardized mean difference [SMD] -0.56; 95% confidence interval [CI], − 0.86 to − 0.26) and foot orthoses (SMD -0.91; 95% CI, − 1.69 to − 0.13). No substantial evidence was found on medium-term outcomes. Corticosteroid injection was not as effective in the long-term as dry needling (SMD 1.45; 95% CI, 0.70 to 2.19) or platelet-rich plasma injection (SMD 0.61; 95% CI, 0.16 to 1.06). When comparing corticosteroid injection to placebo injection, there were no significant differences in pain reduction in the short (SMD -0.98; 95% CI, − 2.06, 0.11) and medium terms (SMD -0.86; 95% CI, − 1.90 to 0.19). In the short-term, corticosteroid injection more effectively improved function than physical therapy (SMD -0.69; 95% CI, − 1.31 to − 0.07).

“When trials considered to have high risk of bias were excluded, there were no significant findings,” the researchers noted.

The authors noted in their conclusion that much of the available evidence was low quality or very low quality. They wrote, “The impact of bias on these findings was assessed with a sensitivity analysis, which found that corticosteroid injection had similar effectiveness to placebo injection. Further trials that are of low risk of bias will strengthen this evidence.”