If you've had or know someone who has had plantar fasciitis, you've undoubtedly heard of a multitude of treatment options. Physical therapy and other stretches, icing, orthotics for your shoes, and last but not least, a cortisone or steroid injection are among the most common choices for treatment. Most people want to get back to their pain-free normal lives as soon as possible, so a cortisone injection into the foot is a popular choice for patients.
Quickly effective, the steroid will go to work on the inflammation affecting the plantar fascia and the pain will start to subside. The patient can now walk normally, return to exercise, and wear those shoes they love but have been avoiding because they hurt their feet. For the next month, life is good. For a vast majority of patients, that familiar ache in the heel will gradually return. It may progress to cover the entire bottom of the foot again and change to a sharp stabbing pain that feels like the foot is on fire again. For some patients, the pain is even WORSE than before the injection. What do they do now? Most patients go back for another injection and the cycle continues. What they don't know is that the cortisone is slowly weakening the connective tissues of the foot and plantar fascia and accelerating the degeneration.
Steroids are fantastic drugs to fight inflammation when there is TOO much inflammation to go around, but little amounts of inflammation in a damaged tissue is a good thing! The components of inflammation are all the things needed to heal injuries, fight infections, and repair damage in the body. Too much inflammation certainly can be bothersome and affect the rehabilitation process if treatment is being provided, so a steroid may HELP reduce some of the inflammation so treatment can continue. But taking away the inflammation over and over again means you are taking away the healing as well as the pain. That damaged tissue will never heal properly and the body will start to replace it with scar/fibrous tissue that is less stretchy than normal. Being less stretchy, it cannot handle the normal wear-and-tear of daily life, and it begins to inflame again, this time faster and most intense than previously. Thus the pain cycle continues!
In a 2017 article evaluating the effectiveness of steroid injections, David et al. showed that compared to a placebo injection, a steroid injection slightly improved plantar fasciitis pain and symptoms for the first four weeks, but not for any time after that. This supports the theory that plantar fasciitis is a chronic degenerative condition, not an inflammatory reaction. The inflammatory reaction is a RESULT of the degenerated tissue t