Plantar heel pain primarily affects sedentary middle aged and older adults. It is estimated to account for 8.0% of all injuries related to running. Planter heel pain is common and can have a negative impact on physical and mental health. The condition is characterized by first step pain when wake up in the morning, pain during weight bearing activities, particularly after periods of rest.
The core approach in the management of plantar heel pain consists of the best evidence-based intervention of plantar fascia stretching and low dye taping complemented by an individualized education approach. All recommended approaches should be used simultaneously for about 4-6 weeks before consideration of alternatives like extracorporeal shockwave therapy (ESWT), foot orthoses and corticosteroid injection.
Corticosteroid injections also known as steroid or cortisone injections have been used to treat plantar heel pain since 1950s. In a survey of orthopaedic surgeons, 73% reported using steroids to treat painful heels.
How Do Cortisone Injections Work?
Cortisol is a steroid hormone that your adrenal glands, the endocrine glands on top of your kidneys produce and release. Hormones are the body’s chemical messengers which telling your body what to do and when to do it.
Cortisol plays important roles in:
· Regulating your body’s stress response
· Suppressing inflammation
· Regulating blood pressure and blood sugar
· Regulating metabolism
· Helping control your sleep wake cycle
Corticosteroids are synthetic versions of cortisol. They can be given in several ways, including into a joint, muscle, spine or blood to treat inflammatory conditions. The injections normally take a few days to start working, although some work in a few hours. The pain relieve appears to be effective in short term, less than 3 months compared to physiotherapy management.
The injections work better in a group with fewer weight bearing hours and low baseline pain. Just remember that corticosteroid injection is a pain management tool – it is not a cure!
The injections are recommended for quick recovery, but repeated doses should be avoided as there are possible complications associated with multiple corticosteroid injections:
· Heel fat pad atrophy – the thinning of the fat pad that support and cushion your heel
· Plantar fascia rupture
Written by Chua Wanli (Physiotherapist)
References:
1. Glen A. Whittaker et al. Corticosteroid Injection for Plantar Heel Pain: A Systematic Review and Meta Analysis. BMC Musculoskeletal Disorders. 2019; 20(378): 1-22.
2. Teck Wee Andrew Ang. The Effectiveness of Corticosteroid Injection in the Treatment of Plantar Fasciitis. Singapore Med J. 2015; 56(8): 423-432.
3. Dylan Morrisey et al. Management of Plantar Heel Pain: A Best Practice Guide Informed by A Systematic Review, Expert Clinical Reasoning and Patient Values. Br J Sports Med. 2021; 55:1106-1118.