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Steroid injection for inferior heel pain: a randomised controlled trial
  1. Elisabeth M A Ball1,
  2. Helen M A McKeeman2,
  3. Christopher Patterson3,
  4. James Burns1,
  5. Wing Hoi Yau4,
  6. Owen A Moore1,
  7. Claire Benson1,
  8. Joanne Foo5,
  9. Gary D Wright1,
  10. Allister J Taggart1
  1. 1Department of Rheumatology, Musgrave Park Hospital, Belfast, UK
  2. 2Department of Podiatry, Belfast City Hospital, Belfast, UK
  3. 3Centre for Public Health, Queens’ University Belfast, Belfast, UK
  4. 4Department of Rheumatology, Altnagelvin Area Hospital, Londonderry, UK
  5. 5Department of Rheumatology, Chapel Allerton Hospital, Leeds, UK
  1. Correspondence to Dr Elisabeth MA Ball, Department of Rheumatology, Musgrave Park Hospital, Belfast BT9 7JB, UK; elisabethball21{at}gmail.com

Abstract

Background Plantar fasciitis is a common cause of heel pain. The aim of this study was twofold: to compare steroid injection with placebo injection and to compare ultrasound guided with unguided steroid injection in the management of this condition.

Methods 65 patients with inferior heel pain were recruited between November 2008 and June 2011. Heel pain was measured using a visual analogue scale (VAS) at baseline and follow-up 6 and 12 weeks after injection.

Results 22 patients were randomised to ultrasound guided steroid injection, 21 patients to palpation guided steroid injection and 22 to ultrasound guided placebo injection. There was a significant difference in VAS scores between the groups at 6 and 12 weeks (p=0.018 and p=0.004, respectively). There was a 19.7 (95% CI 2.5 to 37.0) difference in mean VAS scores at 6 weeks between the ultrasound guided steroid group and the placebo group and a 24.0 (95% CI 6.6 to 41.3) difference between the unguided steroid group and the placebo group at 6 weeks. At 12 weeks, the mean difference was 25.1 (95% CI 6.5 to 43.6) and 28.4 (95% CI 11.1 to 45.7) respectively between both steroid injection groups and the placebo group. There was no difference in VAS scores following steroid injection between the ultrasound guided and the unguided groups at either time point. Plantar fascia thickness was significantly reduced after injection in both active treatment groups (p=0.00).

Conclusions In this study, steroid injection showed a clear benefit over placebo at 6 weeks and this difference was maintained at 12 weeks.

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