A randomized-controlled trial of steroid injection in the management of plantar fasciitis at the Aga Khan University Hospital
Date of Award
Master of Medicine (MMed)
General Surgery (East Africa)
Background: Plantar fasciitis is a common painful condition often associated with significant morbidity. Its management varies among clinicians because no single treatment has strong scientific evidence to support its use to improve outcome. Patients present to clinicians with pain and disability but most patients with plantar fasciitis eventually improve over time irrespective of the modality of treatment provided. Steroid injections are one of the more commonly used modalities and the response to the treatment is varied and unpredictable.
Objectives: The objective of this study was to compare the effects of two treatment options for plantar fasciitis: steroid injections with conservative treatment (analgesics, stretch exercises, and insoles) and conservative management alone.
Design: A double blind randomized controlled trial to compare these two treatment options.
Setting: The study was conducted between December 2010 and May 2011 at The Aga Khan University hospital and affiliated outreach centers.
Methodology: Eighty eight patients with plantar fasciitis were randomized to two treatment arms, 47 to the steroid injection arm and 41 to the control arm. Both arms received standard conservative management. Visual analogue scales (VAS) and Foot Function Index (FFI) scores of the patients were recorded at study entry, at one month and at two months.
Analysis: The change from baseline VAS scores and FFI scores were analyzed using Student’s t-test and chi square analysis.
Results: The mean age of the overall study cohort was 42.9 years (SD 9.1). Forty two were male and 46 female. The majority (87%) were active individuals in occupations that required prolonged walking or standing. The mean Body Mass Index (BMI) was 31.7 and eleven (12.5%) of the study cohort had flatfoot. There was a significant reduction in mean pain scores, after one month and after two months in both the steroid and the control arms. The mean VAS scores at study entry were 8.6 (SD 1.4); 7.2 (SD 1.7) at one month and 6.6 (SD 1.7) at two months (P<0.001). The mean morning pain was 7.5 (SD 2.2) at enrollment; 6.2 (SD 1.9) at one month and 5.6 (SD 1.8) at two months (P<0.001). 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 (SD1.6) 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 patients who received steroid injections 6.77 (SD 1.8) and the controls 6.54 (SD 1.7) at two months (P=0.59) (CI-0.61to1.06). The difference in Foot Function Index scores at one month between the steroid group 43.25 (SD 17.63) and the control group 43.79 (SD 14.73) also did not reach statistical significance (P=0.88) (CI-7.78 to 6.6) and again at two months with no statistically significant difference between the steroid arm 42.26 (SD 17.19) and the control arm 40.48 (SD 13.30) (P=0.615) (CI-5.21to8.75).
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.
Mohamed, A. H. (2011). A randomized-controlled trial of steroid injection in the management of plantar fasciitis at the Aga Khan University Hospital (Unpublished master's dissertation). .