What role do corticosteroid injections play in the management of plantar fasciitis?

Corticosteroid injections in plantar fasciitis management may provide short-term pain relief but lack strong evidence for sustained long-term benefit. The UK best practice guidelines and Cochrane reviews indicate low-quality evidence that corticosteroid injections can slightly reduce heel pain for up to one month compared with placebo or no treatment, but do not demonstrate sustained improvements in pain or function beyond this period NICE CKS.

Ultrasound-guided corticosteroid injections appear more effective than palpation-guided injections in reducing pain and plantar fascia thickness, suggesting technique influences short-term outcomes NICE CKS.

Comparative studies show corticosteroid injections may be more effective than autologous blood injections and foot orthoses for short-term pain relief, and more effective than physical therapy for short-term functional improvement; however, when high risk of bias studies are excluded, these benefits are not statistically significant NICE CKS.

Potential harms of corticosteroid injections include injection site pain, infection, fat pad atrophy, skin pigmentation changes, plantar fascia rupture, peripheral nerve injury, and muscle damage, although serious adverse events are rare but possibly underreported NICE CKS.

Recent meta-analyses from the literature support these findings, showing corticosteroid injections provide clinical improvement in pain and function in the short term but with variable effect sizes and no clear long-term superiority over other treatments such as extracorporeal shockwave therapy Li et al. 2018Cortés-Pérez et al. 2024.

Given the limited and conflicting evidence, corticosteroid injections are generally reserved for patients with persistent plantar fasciitis symptoms lasting more than six months who have not responded to conservative treatments like stretching, taping, and orthoses NICE CKS.

In summary, corticosteroid injections may be considered as a minimally invasive option for short-term symptom relief in refractory plantar fasciitis, but clinicians should weigh the modest benefits against potential risks and the lack of long-term efficacy.