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December 15, 2014
Category: F.Y.I.

HEEL INJECTIONS can be of more than one type.  For the purposes of this discussion, we will be talking about STEROID INJECTIONS for heel pain, primarily for Plantar Fasciitis.  Injection  into the bottom of the heel for plantar fasciitis, or what has often been called "heel spur syndrome" is very common, and in many cases, very effective. 

Note that I said IN MANY CASES.  The term Plantar Fasciitis implies that there is inflammation within the ligament we know as the plantar fascia, and that is what causes the pain that heel pain sufferers are very familiar with - pain on arising first thing in the morning, pain that gets worse after walking following a period of rest, pain that is often worse barefoot or when wearing flat or non-supportive shoes.  But the pain we are talking about is due to a MECHANICAL cause, and NOT an inflammatory cause.  There is usually no swelling, redness, or other signs of inflammation in the heel or arch. 

There may be thickening or degeneration of the plantar fascia, which can be seen on Ultrasonic imaging of the foot, and can be very helpful.  But there is NO real inflammation.  Microscopic studies of the "diseased" or thickened plantar fascia that was removed surgically have consistently showed NO signs of inflammation.  So why do non-steroidal medications taken by mouth and steroid injections usually help, at least to a degree?  They have PAIN relieving properties as well as anti-inflammatory properties. 

It has also been showed that the act of "needling" the fascia can help in reducing pain.  It is possible that the act of putting a needle into the fascia can cause it to repair itself, at least to a degree.  Injections can be given into the heel under ULTRASONIC GUIDANCE, making the delivery of the steroid medication more precise.  While steroid injections are not without their risks, the bottom of the heel, with its typically thick pad of fat, is a much safer area to inject than thin skinned areas such as the sides and tips of the toes, or especially the BACK of the heel, where the Achilles Tendon can be damaged or even rupture, especially with repeated injections. 

It is possible to rupture the plantar fascia with steroid injections, but this is fairly uncommon, and since the plantar fascia is not a tendon or muscle, and simply a ligament, there is no loss of function if that should occur.  Surgery for plantar fasciitis, which should only be considered when conservative treatment fails, involves a deliberate cutting of the tight plantar fascia.   Steroid injections should NOT be given haphazardly or repeatedly if no benefit is being obtained with them, but in may cases, corticoteroid injections can give significant relief to the plantar heel pain sufferer, and may eliminate the need for invasive surgery. 


Richard S. Eby, DPM

(423) 622-2663