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Cortisone Shots for Plantar Fasciitis:  Pros & Cons of a Foot Steroid Injection

Plantar fasciitis can be incredibly painful to live with. It can cause chronic heel and arch pain in the foot.  

Do cortisone shots for plantar fasciitis actually work? 

Cortisone injections for plantar fasciitis are effective in reducing pain. However, they typically provide short-term pain relief ranging from 3 months to 6 months. A combination of cortisone injections and other conservative treatment options is effective in relieving pain associated with plantar fasciitis.

Cortisone shots come with both benefits and risks. 

In this article, we’ll discuss the pros and cons of cortisone shots for plantar fasciitis.

heel pain

What Is Plantar Fasciitis?

Plantar fasciitis has been reported as one of the most common causes of heel pain and arch pain, estimating 11-15% of all foot problems requiring care (1)

It occurs when the plantar fascia, a thick band of tissue that runs along the bottom of the foot, becomes inflamed or irritated. 

The plantar fascia connects the heel bone to the toes and supports the arch of the foot. When it becomes inflamed,  heel pain and arch pain may be present throughout the day. 

The pain is often described as sharp or stabbing and can be severe enough to limit daily activities. 

It can be caused by a variety of factors, including overuse, improper footwear, obesity, and certain medical conditions. 

Treatment for heel pain associated with plantar fasciitis include rest, ice, stretching exercises, orthotics, physical therapy, and in some cases, cortisone injections.

How Does a Cortisone Shot for Plantar Fasciitis Work?

A cortisone shot for plantar fasciitis works by reducing inflammation in the affected area. Plantar fasciitis is caused by inflammation and degeneration of the plantar fascia. This inflammation can cause pain and discomfort, especially in the heel area.

Cortisone is a synthetic form of cortisol, a hormone that is present in your body. Cortisone shots contain a concentrated dose of this hormone, which is injected directly into the plantar fascia. 

The cortisone works by reducing inflammation and swelling in the plantar fascia. This will result in pain relief. 

steroid

Pros and Cons of a Steroid Shot for Plantar Fasciitis in the Foot

Pros

Cortisone Shots in the Foot  Provide Short-Term Relief for Heel Pain

Cortisone injections in the plantar fascia can be effective in reducing the pain and inflammation, but the effects are short-term. 

The cortisone works by reducing the inflammation in the affected area, which will provide immediate relief from pain and discomfort.

However, the underlying cause of the inflammation, such as overuse or a structural issue with the foot, may need to be addressed for long-term relief.

Abnormal foot biomechanics can make plantar fasciitis worse. If you have flatfeet and roll inwards as you walk (pronate), you may strain the fascia excessively, making the condition worse. 

You can also develop plantar fasciitis if you have an excessively high arch and place a lot of pressure on the heel when walking. 

A tight calf muscle is a major cause of plantar fasciitis. The two calf muscles (gastrocnemius and soleus muscle) make up the Achilles tendon. When the Achilles tendon becomes tight, this can cause the plantar fascia to hurt when walking.

To address these structure foot changes, treatment for plantar fasciitis should include a combination of stretching, physical therapy, and orthotics. The cortisone shot cannot correct foot mechanics.

Cons

It Is Not a Long-Term Solution for Fasciitis Pain

How Long Does a Cortisone Shot for Plantar Fasciitis Last?

A study done by A. Shinde in the International Journal Of Orthopaedic Sciences studied 75 patients to see how they responded to three types of treatments for plantar fasciitis: ultrasound therapy, steroid injection therapy, and stretching therapy (2). They followed up with these patients at 1 month, 3 months, and 6 months after their treatment. 

In this review, they found that although all three groups achieved a reduction in heel pain, the patients who received steroid injections had the most pain relief at 1 month, and maintained pain relief at 3 months. However, the benefits of the corticosteroid had reduced at 6 months. 

This suggests that steroids are effective in reducing pain, but not for prolonged periods.

A Plantar Fascia Injection Can Be Expensive

A plantar fascia injection can be expensive. The cost of the injection can vary depending on factors such as the type of injection, and how many injections are needed. 

The cost for a single plantar fascia injection can vary from $100-$300. These costs can add up and make the treatment less accessible for some patients.

In some cases, insurance may cover the injection. However, some insurances do not, leaving patients to pay out of pocket.

A Corticosteroid Injection Can Cause Negative Side Effects

Side effects of steroid injections include rupture of the plantar fascia, however, this is rare. 

Although your doctor may choose to perform several steroid shots in the heel for maximum relief, the injections should be spaced out over several months to prevent rupture of the fascia. 

Rupture of the plantar fascia can cause increased pain, swelling, and flattening of the arch.

Occasionally, atrophy of the fat pad may be seen with plantar fascia injections as well. This can occur if the steroid is injected directly into the fat pad of the heel and not the plantar fascia. Your doctor will take care to inject the steroid in the correct location.

Your doctor may choose to inject the steroid into your heel using ultrasound guidance. The ultrasonography-guided injection has been shown to both improve the accuracy of the steroid shot into the plantar fascia and at the same time eliminate the risk of injecting the steroid into the fat pad (3)

Other less common side effects include: 

  • Nerve damage
  • Infection
  • Allergic reaction
  • Excessive bruising
  • Bone infection of the heel

How Painful Is a Cortisone Shot?

With any injection, there will be some temporary discomfort associated with the injection. 

Your doctor will numb the heel using a numbing cream first. A syringe with a very thin needle is used to inject the steroid into your heel. 

Your doctor will likely inject the steroid through the side of the heel instead of the plantar heel (bottom of heel) to reduce foot pain while injecting. You may feel some mild tenderness in the heel for 24 to 48 hours after the injection.

Some people may experience a “steroid flare”. This can cause significant tenderness in the heel after the steroid shot. However, this discomfort is usually temporary and resolves on its own. 

Plantar Fasciitis Steroid Injection After Care

You may resume walking after the cortisone shot, but limit high-impact activities for at least 24-48 hours after receiving a cortisone shot for maximum benefit. 

Here are some other instructions you should follow: 

Apply Ice

Applying ice to the injection site can help reduce pain. Use a cold compress or ice pack for 15-20 minutes at a time, three times a day. Do this for one week. 

Avoid Heat

Avoid applying heat to the injection site for the first 24 hours after the injection. This is because heat can increase inflammation and swelling.

Wear Comfortable Shoes

Wear supportive shoes that do not put pressure on the injection site. Do not wear high heels or tight shoes that will make the pain worse.

Take Over-The-Counter Pain Relievers

Over-the-counter pain relievers such as Motrin or Tylenol can help alleviate pain and discomfort. 

Should You Get a Steroid Injection?

You should get a corticosteroid injection if you have pain that has not responded to other conservative therapy. Steroid injections are most effective when used in addition to other conservative treatments such as physical therapy, stretching exercises, and orthotics. 

Studies show that a cortisone injection for plantar fasciitis is more effective in reducing plantar fasciitis pain than a placebo injection (4). The injection can help control your pain so that you can continue your activities. 

What to Do When a Cortisone Shot for Plantar Fasciitis Didn’t Work

If the cortisone shot didn’t work, there are plenty of other conservative treatment options that you can try. These treatments are effective in reducing pain and inflammation. 

Here are some common treatments that would be recommended before a corticosteroid injection:

  1. Stretching exercises: Stretching exercises can help improve flexibility and reduce tension in the plantar fascia. This in turn reduces pain and inflammation.
  2. Physical therapy: Physical therapy can help improve the strength and flexibility of the foot and ankle, reducing the risk of plantar fasciitis and improving symptoms.
  3. Orthotics: Orthotics are shoe inserts that can help redistribute pressure when walking and alleviate heel/arch pain.
  4. Night splints: Wearing a night splint can help keep the plantar fascia stretched while sleeping. This reduces pain and discomfort in the morning.

Conclusion

In conclusion, steroid injections when combined with other conservative therapy options such as stretching exercises, orthotics, and physical therapy can be beneficial to help reduce pain associated with plantar fasciitis. 

Although steroid injections alone cannot cure plantar fasciitis, it can certainly help to improve your symptoms. 

Related article: The Top 5 Reasons Your Heel Hurts From Walking

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References

  1. Cutts S, Obi N, Pasapula C, Chan W. Plantar fasciitis. Ann R Coll Surg Eng. 2012; 94(8):539-42.https://pubmed.ncbi.nlm.nih.gov/23131221/
  2. Shinde, A., Patel, A., Patel, M., & Gupta, N. (2020). A comparative study of passive stretching vs corticosteroid injection vs therapeutic ultrasound in plantar fasciitis. International Journal of Orthopaedics, 6(3), 198-204.http://www.orthopaper.com/archives/2020/vol6issue3/PartD/6-3-24-911.pdf
  3. Tsai, W. C., Hsu, C. C., Chen, C. P., Chen, M. J., Yu, T. Y., & Chen, Y. J. (2006). Plantar fasciitis treated with local steroid injection: comparison between sonographic and palpation guidance. Journal of Clinical Ultrasound, 34(1), 12-16.https://onlinelibrary.wiley.com/doi/abs/10.1002/jcu.20177
  4. Li Z, Yu A, Qi B, Zhao Y, Wang W, Li P, Ding J. Corticosteroid versus placebo injection for plantar fasciitis: A meta-analysis of randomized controlled trials. Exp Ther Med. 2015 Jun;9(6):2263-2268. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4473350/
  5. Khan, M. I., Khail Wali, M. S., & Khan, M. A. (2014). Short Term Results of Local Steroid & Anaesthetic Injection in the Management of Plantar Fasciitis. Ophthalmology, 12(2), 144.https://prime.edu.pk/ophthalmology/2014/apr_jun_2014.pdf#page=61
  6. Abdihakin, M., Wafula, K., Hasan, S., & MacLeod, J. (2012). A randomized controlled trial of steroid injection in the management of plantar fasciitis. SA Orthopaedic Journal, 11(4), 33-38.http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2012000400005
  7. Porter, M. D., & Shadbolt, B. (2005). Intralesional corticosteroid injection versus extracorporeal shock wave therapy for plantar fasciopathy. Clinical Journal of Sports Medicine, 15(3), 119-124. https://journals.lww.com/cjsportsmed/Abstract/2005/05000/Intralesional_Corticosteroid_Injection_Versus.1.aspx

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Vaishnavi Bawa
Dr. Vaishnavi Bawa is a Podiatrist who specializes in treating foot and ankle pathology. LifesLittleSteps mission is to educate the public about foot health in an easy-to-understand manner using evidence-based medicine.
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