Plantar fasciitis is a common source of heel pain, affecting millions annually. It occurs when the plantar fascia, a strong band of tissue connecting the heel bone to the toes, becomes irritated or inflamed. This condition can significantly impact daily activities, making walking and standing uncomfortable. Various treatment approaches are available to manage this condition.
Cortisone Injections for Plantar Fasciitis
Cortisone injections are a treatment option used to alleviate the pain and inflammation associated with plantar fasciitis, particularly in cases of chronic discomfort. These injections deliver a synthetic version of cortisone, a powerful anti-inflammatory substance, directly to the affected area. The goal is to reduce localized inflammation, which can lead to pain relief. Medical professionals typically consider cortisone shots after more conservative treatments, such as rest, stretching, and physical therapy, have been tried for at least six to nine months without sufficient improvement.
How the Injection is Administered
The procedure for a cortisone injection for plantar fasciitis is straightforward and performed in an outpatient setting. A local anesthetic is often used to numb the area around the injection site, minimizing discomfort during the procedure. The injection is typically administered to the inner part of the foot, near the heel, to target the most painful area of the plantar fascia.
Many practitioners utilize ultrasound guidance during the injection process. This imaging technique allows the healthcare provider to visualize the plantar fascia and surrounding structures in real-time. Ultrasound guidance ensures accurate placement of the medication, aiming to inject it around the inflamed fascia rather than directly into the tissue, which can minimize potential risks.
Expected Outcomes and Potential Side Effects
Cortisone injections can provide effective short-term pain relief for many individuals with plantar fasciitis. The duration of this relief varies, commonly lasting anywhere from three weeks to six months. Some patients may experience a temporary increase in pain, known as a “steroid flare,” within a few hours to a few days after the injection, which typically subsides.
Cortisone injections carry several risks and potential side effects. One concern is fat pad atrophy, where the protective fatty tissue under the heel thins out, potentially leading to increased discomfort. Skin discoloration at the injection site is another possible side effect. While rare, there is a small risk of infection.
A more serious, though uncommon, complication is the potential for plantar fascia rupture. Incidence of rupture after cortisone injections to range from 1.5% to 10%. This risk is generally higher with multiple injections or if the injection is made directly into the fascia. Due to these potential complications, cortisone injections are generally not considered a first-line treatment and their use is often limited to a few injections over a patient’s treatment course.
Alternative and Complementary Treatments
A range of alternative and complementary treatments are often explored before or alongside cortisone injections. Regular stretching exercises for the calf muscles and plantar fascia are frequently recommended. Night splints, which gently stretch the fascia overnight, can also be beneficial in reducing morning pain.
Supportive footwear and custom or over-the-counter orthotics can help provide cushioning and proper arch support, reducing strain on the plantar fascia. Physical therapy offering structured exercise programs to improve flexibility and strengthen foot and ankle muscles. Other non-invasive options include ice application to reduce inflammation and the use of non-steroidal anti-inflammatory drugs (NSAIDs). More advanced treatments, considered when conservative methods fail, include extracorporeal shockwave therapy (ESWT) and platelet-rich plasma (PRP) injections, which aim to stimulate healing.