SA Orthopaedic Journal
On-line version ISSN 2309-8309
Print version ISSN 1681-150X
ABDIHAKIN, M; WAFULA, K; HASAN, S and MACLEOD, J. A randomised controlled trial of steroid injection in the management of plantar fasciitis. SA orthop. j. [online]. 2012, vol.11, n.4, pp.33-38. ISSN 2309-8309.
ABSTRACT BACKGROUND: The management of plantar fasciitis varies among clinicians because no single treatment has strong scientific evidence to support its use to improve outcome. Steroid injections are more commonly used in our practice with varied and unpredictable response. This study set out to compare the effects of steroid injections with conservative regimen (analgesics, stretch exercises and insoles) versus conservative management alone for the treatment of plantar fasciitis. METHODS: A double blind randomised controlled trial. Eighty-eight patients with plantar fasciitis were randomised to two treatment arms, 47 to the steroid injection arm and 41 to the control arm. Both arms received standard conservative management. Visual analogue scale (VAS) and Foot Function Index (FFI) scores of the patients were recorded at study entry, at one month and at two months. RESULTS: The mean age of the overall study cohort was 42.9 years (SD 9.1). Forty-eight per cent were male. There was a significant reduction in mean pain scores, after one month and after two months in both the steroid and the control arms (p<0.005). The mean FFI at study entry was 50.5 (SD 18.2). At one month and two months follow-up, the mean FFI scores were 43.4 (SD 16.2) and 41.4 (SD 15.3), respectively (P<0.001). There was no statistically significant difference in pain scores between patients who received steroid injections 7.36 (SD 1.6) and those in the control arm 7.22 (SD 1.7) at one month (P = 0.73) (CI-0.64 to 0.9). There was also no statistically significant difference in pain scores between the two groups of patients: steroid injections 6.77 (SD 1.8) and the controls 6.54 (SD 1.7) at two months (P = 0.59) (CI-0.61 to 1.06). FFI scores at one month were 43.25 (SD 17.63) for the steroid group and 43.79 (SD 14.73) for the control group (P = 0.88) (CI-7.78 to 6.6). At two months, the scores were 42.26 (SD 17.19) for the steroid arm and 40.48 (SD 13.30) for the control arm (P = 0.615) (CI-5.21 to 8.75). CONCLUSIONS: Patients with plantar fasciitis improve significantly with conservative management. At one and two months, compared to a control group of conservative management alone, injection of steroids does not make a difference in improving pain and functionality.
Keywords : heel spur; plantar fasciitis; steroids; injection; conservative management.