Steroid injections for painful soles of heels in adults


Original post, click here

Review question

We wanted to assess the effects of injected steroids for treating adults with painful soles of heels (plantar heel pain).

Background

Plantar heel pain is typically noticed when a person takes their first steps after being inactive or after weight bearing. The pain may get better by itself without treatment. However, it can persist for months and be incapacitating. Treatments include painkillers, heel and arch supports, exercises, shock wave therapy and local steroid injections.

We reviewed the evidence from studies assessing the effects of injected steroids for treating adults with painful soles of heel soles (plantar heel pain).

We assessed the effects of injected steroids to treat adults with painful soles of heels (plantar heel pain) compared with fake treatment (placebo – injections of salt water) or no treatment.

Search date

We searched the medical literature for studies (randomised or quasi-randomised controlled trials) up to 27 March 2017.

Study characteristics

We included 39 studies that involved a total of 2492 adults. The average ages of the participants in the studies ranged from 34 years to 59 years. When reported, most participants had heel pain for several months. Studies were usually conducted in outpatient specialty clinics of hospitals in 17 countries. Steroid injections were usually given with a local anaesthetic agent. Study follow-up was from one month to over two years.

The studies compared steroid injection with placebo or no treatment (8 studies); tibial nerve block with anaesthetic (2 studies); heel pads (4 studies); oral anti-inflammatory drugs (NSAIDs) (2 studies); an intensive exercise programme (1 study); shock wave therapy (5 studies); laser (2 studies); radiation therapy (1 study); local NSAID injection (1 study); platelet-rich plasma injections (5 studies); injection of the person’s own (autologous) blood (2 studies); botulinum toxin (Botox) injections (2 studies); frozen (cryopreserved) human amniotic membrane injection (1 study); localised peppering involving multiple pricking of the tissues using an inserted needle (1 study); dry needling (1 study); and mini scalpel-needle release (1 study). We also compared different techniques of local steroid injection (5 studies).

Key results

The eight studies comparing steroid injection with placebo or no steroid injection control provided evidence on heel pain, function, serious adverse events and treatment failure. No studies reported on time to return to work or other activities or short-term adverse events, such as injection-site pain. Steroid injection may slightly reduce heel pain for up to one month after treatment, but not in the longer term including up to six months. We are very unsure whether steroid injection affects longer-term function or reduces treatment failure. There were no serious adverse events, such as infection, reported by these studies. However, these are known to be rare events and we looked at the evidence from all of the studies in the review. Of the 21 studies that reported on adverse events, two studies reported three infections and two ruptures of heel tissues in relation to steroid injection.

The evidence for all reported outcomes, including heel pain, for the other comparisons was always very low quality. This means we are very unsure of the results of these trials.

Conclusions

There is low quality evidence that local steroid injections may slightly reduce heel pain up to one month but not subsequently. Although serious complications relating to steroid injection were rare, these were under-reported in the included studies and more cannot be ruled out.