As a podiatrist clients often ask if they should get an injection for Plantar Fasciitis. So we thought it would be a good idea to bust a few myths and bring a bit of clarity to ‘Plantar Fasciitis’ and the use of cortisone and steroid injections.
Heel pain is one of the most common conditions that presents to a podiatrists office. Traditionally heel pain has been broadly diagnosed as Plantar Fasciitis.
But is your heel pain really Plantar Fasciitis?
The suffix 'itis' (as in Plantar Fasciitis) implies inflammation of the fascia. We now know that inflammation is often not the only the cause of pain or dysfunction in the plantar fascia.
So, according to the most recent research, we know that the using the term ‘Plantar Fasciitis’ for all plantar heel pain is, at best, likely misleading and, at worst, just incorrect.
A more accurate description of your heel pain symptoms would be either ‘Plantar Fasciopathy‘ or Plantar Heel Pain (PHP) to describe pain in the heel.
These terms encompasses a variety of pathological and anatomical features relating to heel pain. These include plantar fascia inflammation, degeneration or thickening, heel fat pad pathology, nerve irritation, and heel spurs.
Additionally, individuals with Plantar Heel Pain (PHP) may present with impairments in foot function, ankle or big toe range of motion and lower leg/foot muscle performance. Even factors like stress, depression and obesity can have impact.
Now heel pain will typically fall into two categories either reactive or degenerative.
REACTIVE implies an acute response to a stimulus such as changing your shoes, starting a new physical activity like boot-camp or joining the gym. This can be inflammatory. DEGENERATIVE refers to the slow breakdown of fascial tissue over time.
Now that we have a better understanding of what is actually happening in our fascia and heel pain, we can devise a plan to appropriately treat it.
Historically, cortisone has been used as a steroid injection to treat inflammation.
But does the science support this?
Well the results of 2 systematic reviews (here and here) failed to find any evidence showing any substantial clinical benefit of using cortisone (steroid injection) in patients with heel pain / plantar fasciitis.
Not only that, the potential harms associated with having a steroid injection weren’t great. Complications such as injection-site pain, infection, subcutaneous fat atrophy, skin pigmentation changes, plantar fascia rupture, peripheral nerve injury, and muscle damage were reported.
As a result any perceived benefit associated with cortisone injections for heel pain really does not offset the risk for adverse outcomes, including long-term disablement.
So where does this leave us?
Well since we know that Plantar Heel Pain is not always inflammatory AND the potential benefits of using cortisone don’t offset the risks then typically you should NOT have an injection in the vast majority of cases!