PAIN+ CPN

Doctor, I have plantar heel pain. Is it better for me to consider foot orthoses or corticosteroid injection to treat my pain?


A corticosteroid injection may be more effective in the short term (4 weeks), but foot orthoses may be more effective in the longer term (12 weeks). You may not notice a meaningful difference between these treatments for your pain relief.

What is the evidence?


Researchers looked at patients who had plantar heel pain and compared those who used foot orthoses to those who received a corticosteroid injection. They measured pain, improvement, and quality of life at 4, 8, and 12 weeks after starting treatment. They found that:

  • At 4 weeks, patients receiving a corticosteroid injection had less pain than those with foot orthoses
  • At 8 weeks, there was no difference between the groups. At 12 weeks, patients with foot orthoses had less pain than those receiving a corticosteroid injection
  • The differences between groups observed at 4 and 12 weeks were less than the minimally important difference for the pain scale used (Foot Health Status Questionnaire foot pain subscale)
  • There was no difference between groups for health-related quality of life at any time point
  • There was no difference between groups for self-rated improvement at 8 or 12 weeks


What kind of study was this?


This was a randomized controlled trial (RCT). In an RCT, patients are randomly assigned to receive the treatment under study or a comparator treatment.

Who participated in the study? This study included 103 people who had plantar heel pain for at least 4 weeks.

How was the study done? The study compared foot orthoses with corticosteroid injection.


Foot orthoses

vs

Corticosteroid injection


The foot orthoses used in this study were Formthotics, full length, dual-density devices made with a soft polyethylene foam top layer and a firm polyethylene base layer. Orthoses were placed in the patient’s footwear, heated, and conformed to the patient’s foot. Patients reported the number of days and hour per day they wore the orthoses during the study period.

Patients also received a plantar fascia- and calf-stretching program.




Patients in this arm received a single ultrasound-guided injection to the heel. The solution contained 1 mL of a betamethasone acetate and betamethasone sodium phosphate solution, and 1 mL of bupivacaine.

Patients also received a plantar fascia- and calf-stretching program.


Why was this research done?


Plantar heel pain is common and can cause significant disability. While it usually resolves on its own after a year or two, many patients can experience pain for several years. Patients who have not responded to first-line treatment (stretches, activity modification, and changing footwear) may wish to try a corticosteroid injection or foot orthoses to manage this condition.

Both corticosteroid injection and foot orthoses have been shown in previous trials to be more effective than receiving no treatment, or sham or placebo treatment. Previous reviews have suggested that corticosteroid injection is better than no treatment in the short term but not the long term, and that foot orthoses are not effective in the short term but have benefit over control in the long term.

The authors wanted to evaluate the effectiveness of foot orthoses and corticosteroid injection for plantar foot pain over the course of 12 weeks.


This Evidence Summary is based on the following article:

Whittaker GA, Munteanu SE, Menz HB, et al. Effectiveness of Foot Orthoses Versus Corticosteroid Injection for Plantar Heel Pain: The SOOTHE Randomized Clinical Trial. J Orthop Sports Phys Ther. 2019 Jul;49(7):491-500. doi: 10.2519/jospt.2019.8807. Epub 2019 May 26. PubMed

Published: Wednesday, August 14, 2019