Comparative study on functional outcome of steroid injection vs conservative management in plantar Fascitiis

Author(s): Dr. Mathew Panackathottam, Dr. Thomas Devasia, Dr. K Raghuveer Adiga, Dr. Vivian D’almeida and Dr. Ashwin Kamath

Abstract: Plantar fasciitis is the most commonly encountered cause of heel pain often presenting after periods of inactivity. Since its aetiology is obscure, there exist multiple modalities of treatment including both conservative and local injection of steroid. This study aims to evaluate the functional outcome following steroid injection versus conservative management of plantar fasciitis. Sixty two patients with heel pain with clinical diagnosis of plantar fasciitis in whom other causes of heel pain was ruled out were included. One group received plantar fascia stretching exercise, NSAID treatment and footwear modification while the other group received local steroid injection in addition to the exercises and footwear modification and NSAIDS. The VAS scores were re assessed on admission and after 2, 4 and 8 weeks. The conservative group showed a slow decline in VAS scores over 8 weeks whereas the steroid group showed a rapid fall in the first two weeks and a plateau at the end of 8 weeks with no major VAS score difference. There is a statistically significant drop in pain and VAS scores in the steroid group on comparing with the conservative group at 2 and 4 weeks follow up. However there was no significant difference in the VAS scores of steroid injection and stretching exercises by the 8th week. Since, local injection of steroid can sometimes causes unwarranted complications such as heel pad atrophy or Achilles tendon rupture, conservative management is preferred. However with good patient selection and adequate precaution steroid injection can be used for rapid pain relief and early return to activities.

DOI: https://doi.org/10.22271/ortho.2017.v3.i1f.53