Rheumatology 1999; 38: 974-977
© 1999 British Society for Rheumatology
Steroid injection for heel pain: evidence of short-term effectiveness. A randomized controlled trial
Department of Health Sciences and Clinical Evaluation, University of York and
1 Centre for Rheumatology, University College London, London, UK
Correspondence to:
F. Crawford, Department of Health Sciences and Clinical Evaluation, Alcuin College, University of York, Heslington, York YO1 5DD, UK.
Objectives. To compare the effectiveness of a steroid injection (25 mg/ml prednisolone acetate) with a local anaesthetic control in the treatment of heel pain and to determine any advantage for patients' comfort of using a posterior tibial nerve block to anaesthetize the heel prior to infiltration.
Methods. A double-blind randomized controlled trial using a 2x2 design in a hospital-based rheumatology clinic. Subjects comprised 106 patients with heel pain referred by general practitioners and other rheumatologists working in Camden and Islington Health Authority. Main outcome measures: heel pain reduction at 1, 3 and 6 months, and patient comfort at the time of injection. All outcomes were measured using a 10 cm visual analogue scale.
Results. A statistically significant reduction in pain was detected at 1 month (P=0.02) in favour of steroid injection, but thereafter no differences could be detected. Patient comfort was not significantly affected by anaesthesia of the heel (P=0.5).
Conclusions. A steroid injection can provide relief from heel pain in the short term. There appears to be no increase in patient comfort from anaesthetizing the heel prior to infiltration.
KEY WORDS: Steroids, Heel pain, Plantar fasciitis, Enthesopathy, Randomized controlled trial, Clinical practice.
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