563 Little evidence of benefit for injected corticosteroids in plantar heel pain

December 01, 2017

written by Brian R McAvoy.

Clinical question
How effective are injected corticosteroids for treating plantar heel pain in adults?

Bottom line
There was low-quality evidence that local steroid injections (compared with placebo or no treatment) might slightly reduce heel pain for up to 1 month after treatment, but not in the longer term, including up to 6 months. The available evidence for other outcomes of this comparison (longer-term function or treatment failure) was very low quality. Follow-up was from 1 month to over 2 years. Where available, the evidence from comparisons of steroid injections with other interventions used to treat heel pain, and of different methods of guiding the injection, was also of very low quality. Although serious adverse events relating to steroid injection were rare, these were underreported, and a higher risk could not be ruled out.

Caveat
The evidence for all reported outcomes, including heel pain, for the other comparisons was very low quality.

Context
Plantar heel pain, commonly resulting from plantar fasciitis, often results in significant morbidity. Treatment options include nonsteroidal anti-inflammatory drugs, orthoses, physiotherapy, tibial nerve block, physical agents (eg, extracorporeal shockwave therapy, laser) and invasive procedures, including steroid injections.

Cochrane Systematic Review
David JA et al. Injected corticosteroids for treating plantar heel pain in adults. Cochrane Reviews, 2017, Issue 6. Art. No.: CD009348.DOI: 10.1002/14651858. CD009348. pub2. This review contains 39 studies involving 2492 participants.

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.