Effectiveness of Foot Orthoses Versus Corticosteroid Injection for Plantar Heel Pain

NewsBot · May 27, 2019

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Effectiveness of Foot Orthoses Versus Corticosteroid Injection for Plantar Heel Pain: The SOOTHE Randomized Clinical Trial
Glen A. Whittaker et al
Journal of Orthopaedic & Sports Physical Therapy, 2019 Volume:0 Issue:0 Pages:1–34 DOI:

Study Design
Randomized clinical trial.

Background
Plantar heel pain is a common foot complaint that causes significant disability and poorer health-related quality of life. Foot orthoses and corticosteroid injection are effective treatments for plantar heel pain, however it is unclear if one is more effective than the other. Therefore, the aim of this trial was to compare the effectiveness of foot orthoses and corticosteroid injection for plantar heel pain.

Methods
A parallel-group, assessor-blinded randomized trial. Participants received prefabricated, arch-contouring foot orthoses or a single ultrasound-guided corticosteroid injection. The primary outcome measure was the foot pain subscale of the Foot Health Status Questionnaire at 4 and 12 weeks.

Results
103 participants aged 21 to 72 years (63 female) with plantar heel pain were recruited from the community and received an intervention. For the primary outcome of foot pain, corticosteroid injection was more effective at week 4 (adjusted mean difference 8.2 points; 95% CI 0.6, 15.8). However, foot orthoses were more effective at week 12 (adjusted mean difference 8.5 points; 95% CI 0.2, 16.8). Although these findings were statistically significant, they did not meet the previously calculated minimal important difference value of 12.5 points.

Conclusion
Corticosteroid injection is more effective than foot orthoses at week 4, but this effect does not last, and appropriately contoured foot orthoses are more effective than corticosteroid injection at week 12. However, patients may not notice a clinically worthwhile difference between the interventions.
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Rob Kidd · May 28, 2019

When I was at Pod school, approaching 50 years ago, we were taught that a decent therapeutic package contained something for the symptom, and something for the cause; is that not what the above is advocating, without actually saying so?

mike weber · May 28, 2019

You could see it that way Rob

NewsBot · Oct 30, 2019

Plantar fasciitis management: A comparative study between plantar fascia stretching exercises versus local corticosteroid injection
May 10, 2019/0 Comments/in Vol 7 | Issue 2 | May - Aug 2019 /by jkoaadmin
Volume 7 | Issue 2 | May – August 2019 | Page: 17-21 | Prabhu Ethiraj, Sagar Venkataraman, Arun H.S, Abhijeet Salunkhe

Background: Plantar fasciitis is one of the common causes of heel pain. Various modalities of treatment have been described in literature are plantar fascia stretching exercises, local corticosteroid injection, extracorporeal shock wave therapy, Platelet rich plasma injection at site of insertion and operative management. Our study was conducted to compare treatment between stretching exercises and local corticosteroid injection in rural population of patients with plantar fasciitis.
Materials and Methods: Our study included 60 patients diagnosed with plantar fasciitis. We divided randomly into two groups. Group 1 included 30 patients treated with stretching exercises, non-steroidal anti-inflammatory medications, microcellular (MCR) footwear and other group 2 includes 30 patients with analgesics, microcellular (MCR) footwear and local corticosteroid injection. Patients were assessed after 2 weeks, 4 weeks, 8 weeks and 12 weeks from start of treatment with regard to pain and function. Pain was assessed using visual analogue scale.
Results: We analyzed our data using Visual Analogue Scale (VAS) where score 0 is no pain and score 10 severe pain. The VAS scores were calculated at 2nd 4th 8th and 12th week. In our study obtained results showed pain severity in group 2 was significantly reduced after 2nd week and 4th week from start of the treatment when compared to group 1. However on subsequent follow up 8thweek and 12thweek pain severity was reduced in both the group and was almost similar. All the data from the study was evaluated by Student t test and ANOVA test with P value calculated in 2nd week, 4th week, 8th week and 12th week and out of which it was found to be statistically significant difference at end of 2nd, 4th and 8th week in both group, whereas at the end of 12th week there was not much statistically significant difference in both groups pain score.
Conclusion: In patients with plantar fasciitis, corticosteroid injection at site of maximal tenderness will relieves pain significantly but results are good for short duration pain relief that is up to 4 weeks after the injection. Where as in patients who continues to do stretching exercises are symptomatically better at end of 8th and 12th week of therapy. At end of 12th week both local steroid injection and Plantar fascia stretching exercise showed similar results in terms of pain relief
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Dr Rich Blake · Nov 2, 2019

NewsBot said: ↑

Effectiveness of Foot Orthoses Versus Corticosteroid Injection for Plantar Heel Pain: The SOOTHE Randomized Clinical Trial
Glen A. Whittaker et al
Journal of Orthopaedic & Sports Physical Therapy, 2019 Volume:0 Issue:0 Pages:1–34 DOI:
Click to expand...

Some of these studies are so far from clinical practice. In practice you need to rest the fascia with arch supports and taping, stretching of the Achilles and fascia, and icing and other anti-inflammatory measures like shots. The world of sports medicine is trying hard to steer away from cortisone shots anyway. Rich Blake

NewsBot · Jan 26, 2022

Comparison of the Effects of Physiotherapy vs. Corticosteroid Injection in
Patients with Chronic Plantar Fasciitis
Yeon-Ki Choo, PT, Ph.D, Hyeon-Su Kim, PT, Ph.D
Journal of The Korean Society of Integrative Medicine, 2021, 9(4), 237~249

Purpose : This study was to compare the effect changes after physical therapy (extracorporeal shock wave therapy + high-load
strengthening exercise) or corticosteroid injection in patients diagnosed with chronic plantar fasciitis.
Methods : A total of 40 patients were randomly assigned to each group of 20. According to the intervention method, “Group
1. Physiotherapy” was performed for 12 weeks, and “Group 2. Corticosteroid injection” was performed only once.
As a pre-intervention test, plantar fascia thickness, pain intensity Ⅰ, Ⅱ (What is the most painful moment of the day?, How
painful is the first step in the morning?), and functional performance were measured. To compare the effects of each group, the
tests 3, 6, and 12 weeks after were also performed using the same measurement method. Also, after 12 weeks, patient satisfaction
was also compared.
Results : There was no significant difference between the groups in the change in the thickness of the plantar fascia during all
periods. However, pain intensity Ⅰ, Ⅱ was significantly lower in Group 1 than in Group 2 at only 12 weeks and functional
performance was also significantly increased in Group 1 compared to Group 2 at only 12 weeks. Also, there was no significant
difference between groups in patient satisfaction.
Conclusion : The physiotherapy protocol, which consisted of extracorporeal shock wave therapy and high-load strengthening
exercise, showed excellent results, especially after 12 weeks, compared to corticosteroid injection. It is recommended as a more
effective treatment method as it is possible to safely return to daily life by reducing pain and improving functional performance
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NewsBot · Apr 14, 2022

A prospective study to assess the effectiveness of
corticosteroid injection in the treatment of chronic
plantar fasciitis
K Parasuraman, A Senthilnathan, K Vijaya Shankar and P Krishna
Balaji
International Journal of Orthopaedics Sciences 2022; 8(1): 211-215

Introduction: Corticosteroids have been used in the treatment of plantar fasciitis since 1950’s19. Steroids
are known to inhibit the proliferation of fibroblasts and synthesis of ground substances. The beneficial
effect of steroid injection is due to the above action in addition to its anti-inflammatory role.
Materials and Methods: 25 patients with unilateral chronic plantar fasciitis who were not responding to
conservative management for 6 weeks were included in this study. The study was done at Orthopaedics
department at RMMCH, Annamalai University from October 2020 to October 2021. Functional outcome
was evaluated using visual analog score [VAS] and Foot and ankle ability measure [FAAM] scores at
0,4,8,12 and 24 weeks. Plantar fascia thickness was measured pre-injection and 6 months post injection
using ultrasound.
Results: Patients had pre- treatment VAS score of 8.30 and FAAM score of 29.96 after 6 months follow
up the score improved to3.85 and 70.18 respectively. Pre-treatment Plantar fascia thickness was 5.76
mm, 6 months follow up study showed thickness of 4.56 mm.
Conclusion: Corticosteroid injections are effective in the treatment of chronic plantar fasciitis that gives
rapid relief in pain symptoms and increases the functional outcome.
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NewsBot · Oct 3, 2023

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
Henrik Riel et al
British Journal of Sports Medicine 2023;57:1180-1186.

Objective To compare the effectiveness of patient advice plus heel cup alone (PA) versus PA and lower limb exercise (PAX) versus PAX plus corticosteroid injection (PAXI) to improve self-reported pain in patients with plantar fasciopathy.

Methods We recruited 180 adults with plantar fasciopathy confirmed by ultrasonography for this prospectively registered three-armed, randomised, single-blinded superiority trial. Patients were randomly allocated to PA (n=62), PA plus self-dosed lower limb heavy–slow resistance training consisting of heel raises (PAX) (n=59), or PAX plus an ultrasound-guided injection of 1 mL triamcinolone 20 mg/mL (PAXI) (n=59). The primary outcome was changed in the pain domain of the Foot Health Status Questionnaire (ranging from 0 ‘worst’ to 100 ‘best’) from baseline to the 12-week follow-up. The minimal important difference in the pain domain is 14.1 points. The outcome was collected at baseline and at 4, 12, 26, and 52 weeks.

Results The primary analysis found a statistically significant difference between PA and PAXI after 12 weeks favouring PAXI (adjusted mean difference: −9.1 (95% CI −16.8 to −1.3; p=0.023)) and over 52 weeks (adjusted mean difference: −5.2 (95% CI −10.4 to −0.1; p=0.045)). At no follow-up did the mean difference between groups exceed the pre-specified minimal important difference. No statistically significant difference was found between PAX and PAXI or between PA and PAX at any time.

Conclusion No clinically relevant between-group differences were found after 12 weeks. The results indicate that combining a corticosteroid injection with exercise is not superior to exercise or no exercise.
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