Background Plantar fasciitis commonly seen in the musculoskeletal clinic and accounts for around 8% of running injuries. BMJ best practice advises that primary treatment should be rest and reducing the precipitating factors with corticosteroid injections used as an adjunct if primary treatment failes to improve symptoms. The National Institute of Health and Care Excellence (NICE) guidance of 2019 recommended corticosteroid injections for patients whose ‘symptoms are having a significant impact on the person’ however, they also feel that this treatment will only provide short term relief. Methylprednisolone is a medium duration corticosteroid which may improve patient satisfaction however there is limited research on its effectiveness.
Material and Methods 93 patients (58 female, 35 male) were included in this audit. All patients received 1ml of 40mg depomedrone (methylprednisolone)
All patients who had clinically diagnosed plantar fasciitis foot 8 weeks and had received the first line treatments of stretching and orthotics. All patients were over the age of 18.
Patients yet to begin a stretching program or had alternative treatments (e.g., shockwave), had systemic disease or previous surgery were excluded.
A patient assessed (Visual analogue scale - VAS) and a physician assessed (Heel tenderness index -HTI) outcome measure was used
Results 93 patients with ages ranging from 42.5 to 58.4 years were assessed.
80 (86.02%) reported an improvement in symptoms at the 4 week follow up, 62 (66.67%) of whom reported to be pain free. Of the remaining 18 patients all advised their symptoms had improved by at least 50%. 13 patients (13.98%) reported no improvement.
83 (89.25%) patients had no pain on palpation of the heel post injection, whilst prior to the injection all patients had pain in differing degrees. 18 patients (19.35%) had severe pain prior to the injection, post injection no patient had severe pain. 90 (96.77%) of patients has improved HTI scores.
Conclusion Plantar fasciitis is a debilitating disorder but is generally a self-limiting disease with the majority of patients reporting a spontaneous recovery, however for approximately 10% of patients, symptoms do not abate, and they seek help from medical professionals. With respect to reducing patients’ symptoms of pain in the short term, corticosteroid injections are an effective second line treatment. However, other modalities of treatment such as shockwave therapy, Botox injections and PRP may be effective in the longer term management of plantar fasciitis but further research is required.
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