Cochrane for Clinicians
Putting Evidence into Practice
Injected Corticosteroids for Plantar Heel Pain
Am Fam Physician. 2018 Feb 1;97(3):169-170.
Author disclosure: No relevant financial affiliations.
Do corticosteroid injections improve plantar heel pain?
There is low-quality evidence that corticosteroid injections slightly reduce heel pain at one month, but they make no significant difference beyond that time. Patients treated with corticosteroid injections were less likely to experience treatment failure—a designation that was defined differently between studies (number needed to treat [NNT] = 3). Injections do not appear to provide any functional benefits.1 (Strength of Recommendation: B, based on inconsistent or limited-quality patient-oriented evidence.)
Plantar heel pain is common, accounting for four in 1,000 outpatient physician visits and an estimated 1 million visits per year in the United States.2 Most plantar heel pain is caused by plantar fasciopathy, commonly called plantar fasciitis. Plantar fasciopathy is more likely in patients who are obese (odds ratio [OR] = 3.7; 95% confidence interval [CI], 2.9 to 5.6) and in those who have occupations in which the majority of time is spent standing (OR = 3.6; 95% CI, 1.3 to 10.1).3 Plantar fasciopathy is common in runners, with an incidence of 31% over five years in one study.4 The authors of this review sought to evaluate the effect of corticosteroid injections on plantar heel pain in adults.1
This Cochrane review included 39 randomized trials with 2,492 adults who had plantar heel pain.1 Studies ranged from one month to two years in duration. The studies were of low to very low quality and were judged to have high risk of bias. Eight studies compared local corticosteroid injections with placebo or no treatment. At one month, corticosteroid injections provided slight clinical benefit (mean difference [MD] on a visual analog scale [0 to 100 mm; higher scores indicate worse pain] = −6.38 mm; 95% CI, −11.13 to −1.64). Between one and six months, corticosteroid injections had no significant pain benefit (MD = −3.47 mm; 95% CI, −8.43 to 1.48).
Referencesshow all references
1. David JA, Sankarapandian V, Christopher PR, Chatterjee A, Macaden AS. Injected corticosteroids for treating plantar heel pain in adults. Cochrane Database Syst Rev. 2017;(6):CD009348....
2. Riddle DL, Schappert SM. Volume of ambulatory care visits and patterns of care for patients diagnosed with plantar fasciitis: a national study of medical doctors. Foot Ankle Int. 2004;25(5):303–310.
3. van Leeuwen KD, Rogers J, Winzenberg T, van Middelkoop M. Higher body mass index is associated with plantar fasciopathy/‘plantar fasciitis’: systematic review and meta-analysis of various clinical and imaging risk factors. Br J Sports Med. 2016;50(16):972–981.
4. Di Caprio F, Buda R, Mosca M, Calabro' A, Giannini S. Foot and lower limb diseases in runners: assessment of risk factors. J Sports Sci Med. 2010;9(4):587–596.
5. Tsikopoulos K, Vasiliadis HS, Mavridis D. Injection therapies for plantar fasciopathy (‘plantar fasciitis’): a systematic review and network meta-analysis of 22 randomised controlled trials. Br J Sports Med. 2016;50(22):1367–1375.
6. Thomas JL, Christensen JC, Kravitz SR, et al.; American College of Foot and Ankle Surgeons heel pain committee. The diagnosis and treatment of heel pain: a clinical practice guideline–revision 2010. J Foot Ankle Surg. 2010;49(3 suppl):S1–S19.
These are summaries of reviews from the Cochrane Library.
This series is coordinated by Corey D. Fogleman, MD, Assistant Medical Editor.
A collection of Cochrane for Clinicians published in AFP is available at http://www.aafp.org/afp/cochrane.
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