Corticosteroid injection is the best treatment in plantar fasciitis if combined with controlled training

Key points

1. 01A single randomized controlled trial compared injection, training, and the two combined in 90 patients with plantar fasciitis confirmed on ultrasound (fascia thickness over 4 mm).
2. 02All three groups improved over the 2-year follow-up.
3. 03The combination of injection plus controlled training was superior to either treatment alone at every time point.
4. 04Patients were also advised to reduce load on the foot for 3 months.
5. 05The authors conclude the combined approach is the best first-line treatment, rated as Level of evidence 1.

How it was conducted

Design

Randomized controlled trial conducted 2013 to 2014 with 2-year follow-up

Participants

90 patients with plantar fasciitis and ultrasound fascia thickness over 4 mm

Groups

Training alone (n=30), corticosteroid injection until thickness under 4 mm, max 3 injections (n=31), or combination (n=29)

Co-intervention

Load reduction recommended for 3 months

Primary outcome

VAS function pain and Foot Function Index (FFI) at 6 months

What they found

• Combination was superior to training alone at all time points (FFI mean difference 40, p<0.001; VAS 20 mm).
• Combination was superior to injection alone (FFI difference 29; VAS 17 mm), described as clinically relevant.
• All groups improved over the follow-up period.

Limitations

• Single trial with a relatively small sample of 90 patients split across three groups.
• Load reduction was recommended rather than strictly controlled, which could vary between patients.
• The abstract reports primary outcomes at 6 months and overall superiority but does not provide the full numeric results at every individual time point.
• Patients were limited to those with ultrasound fascia thickness over 4 mm, so findings may not apply to all plantar fasciitis cases.

Why it matters

For patients

If you have plantar fasciitis, pairing a corticosteroid injection with a guided strength and stretching program may relieve pain and improve foot function better than either approach on its own.

For clinicians

Consider offering corticosteroid injection combined with controlled training, plus a period of load reduction, as a first-line plantar fasciitis protocol rather than injection or exercise in isolation.

For readers

This Level 1 randomized trial suggests combining injection with exercise outperforms single treatments for plantar fasciitis.