Background Plantar heel pain is one of the most common conditions affecting the foot in adults, with prevalence estimates between 4% and 7%.^1,2 Corticosteroid injection is a common intervention used to treat plantar heel pain,³ however there is limited high quality evidence to support this practise. Because corticosteroid injection is frequently used for plantar heel pain, it is important that health professionals understand whether the evidence-base supports the use of this intervention.

Objectives To conduct a systematic review and meta-analysis of the effectiveness of corticosteroid injection for pain and function in people with plantar heel pain.

Methods Databases searched include Medline, CINAHL, SPORTDiscus, Embase and the Cochrane Library. Included studies had to be randomised trials that evaluated the effectiveness of corticosteroid injection on pain or function for plantar heel pain. The primary outcomes were pain (including ‘first step’ pain) and function, categorised as short (0 to 6 weeks), medium (7 to 12 weeks) or longer term (13 to 52 weeks). A secondary outcome was plantar fascia thickness. Mean differences or standardised mean differences and 95% confidence intervals were calculated. The Cochrane Collaboration tool for assessing risk of bias was used to assess trial quality, and the GRADE approach was used to assess the strength of evidence.

Results A total of 37 trials (2200 participants) were included. In the short term, corticosteroid injection was more effective for reducing pain than autologous blood injection (SMD −0.56 [-0.86,–0.26]) and orthotic devices (SMD −1.20 [-2.30,–0.11]). There were no significant findings in the medium term. In the longer term, corticosteroid injection was less effective than platelet-rich plasma injection (SMD 0.87 [0.30, 1.45]). For function, corticosteroid injection was more effective than physical therapy in the short term only (SMD −0.69 [-1.31,–0.07]). Notably, corticosteroid injection was not more effective than placebo injection for reducing pain in the short (SMD −0.98 [-2.06, 0.11]) and medium (SMD −0.86 [-1.90, 0.19]) terms. When trials considered to have high risk of bias were excluded, there were no significant findings.

Conclusions Our review found that corticosteroid injection is more effective for reducing pain than some comparators, and more effective for improving function than physical therapy in the short term. Corticosteroid injection is more effective than platelet-rich plasma injection in the longer term. Corticosteroid injection is not more effective than placebo injection for reducing pain or improving function.

References [1] Hill CL, Gill TK, Menz HB, Taylor AW. Prevalence and correlates of foot pain in a population-based study: the North West Adelaide Health Study. Journal of Foot and Ankle Research2008;1(2):1–7. doi:10.1186/1757–1146–1–2

[2] Dunn JE, Link CL, Felson DT, Crincoli MG, Keysor JJ, McKinlay JB. Prevalence of foot and ankle conditions in a multiethnic community sample of older adults. American Journal of Epidemiology2004;159(5):491–498. doi:10.1093/aje/kwh071

[3] Buchbinder R. Plantar fasciitis. New England Journal of Medicine2004;350(21):2159–2166. doi:10.1056/NEJMcp032745

Disclosure of Interest None declared