Ross Hauser, MD; Danielle Matias, PA-C; Demi Foster, APRN
Cortisone shots and anti-inflammatory drugs have been shown to produce short-term pain relief benefits, but both result in long-term loss of function and even more chronic pain by actually inhibiting the healing process of soft tissues and accelerating cartilage degeneration. For example, cortisone will eventually weaken the fascia. If they are not strengthened, a painful heel spur will result. In our office we will suggest Prolotherapy injections to patients. The injection typically contains a simple dextrose. More information on Prolotherapy is included later in this article.
- Corticosteroid Injections, Extracorporeal Shock Wave Therapy, and Radiofrequency nerve ablation.
- Dry Needling is better than cortisone.
- Plantar Fasciopathy Research – Why is Cortisone still an option?
- Is Cortisone no better than a placebo for restoring function?
- Hyaluronic Acid and Cortisone results and outcomes are just about the same.
- Endoscopic fasciotomy and cortisone.
- A confusing diagnosis and a condition made worse by cortisone.
- Non-surgical Nerve Release & Regeneration Injection Therapy and Joint Stabilizing Treatments.
Plantar Fasciopathy Research – Why is Cortisone still an option?
Researchers are constantly trying to prove the effectiveness of one treatment over another to answer the simple question: What treatments work best for Plantar fasciitis and chronic plantar fasciopathy (disease of the plantar fascia)?
A February 2026 study in The Journal of foot and ankle surgery (9) evaluated and compared the short-term clinical outcomes of four injection types for plantar fasciitis. The researchers looked at 83 patients and divided them in four groups of treatments. Peppering (dry needling) alone, peppering in combination with corticosteroid, corticosteroid injection alone, and autologous blood injection (re-injecting a patient’s own blood). The researchers used the Visual Analog Scale (VAS) self-reporting pain scale to measure the patient’s pain reduction, Pain intensity was evaluated using the VAS at baseline, at the third week, and at the third month.
The groups receiving peppering with corticosteroid and corticosteroid alone experienced greater reductions in pain compared to those receiving peppering alone or autologous blood injection. In the peppering group, notable improvement in pain was observed only at the third month. The autologous blood group did not demonstrate significant short-term improvement. The combination of peppering and corticosteroid provided a more sustained decrease in pain levels compared to corticosteroid alone.
In May 2024, (1) researchers writing in the journal Clinical Rehabilitation compared extracorporeal shock waves and corticosteroid injections on pain, thickness of plantar fascia, and foot function in patients with plantar fasciitis. Reviewing data from sixteen studies involving 1121 patients, the researchers suggested at three months, extracorporeal shock wave outcomes were better than corticosteroid injections in reducing pain and thickness of the plantar fascia and increasing foot function. Further, at six months, extracorporeal shock waves were found to be more effective in reducing pain and increasing foot function.
Researchers at the University of Northern Iowa wrote in the Journal of Sports Rehabilitation:
“For active individuals, plantar fasciitis is one of the most clinically diagnosed causes of heel pain. When conservative treatment fails, one of the next most commonly used treatments includes corticosteroid injections. Although plantar fasciitis has been identified as a degenerative condition, rather than inflammatory, corticosteroid injection is still commonly prescribed. . . ” (2) They also concluded that PRP injections would be more effective as a choice of treatment.
Doctors writing in the medical journal Rheumatology compared the effectiveness of several treatments. This included Platelet Rich Plasma Therapy, shock-wave therapy, and corticosteroid injection.
The researchers discovered a trend that favored the PRP treatment. They noted that Platelet Rich Plasma Therapy, followed by shock-wave therapy, was best in providing relief from pain at 3 months over cortisone. Shock-wave therapy and PRP had similar probabilities of providing pain relief at 6 months. (3)
Doctors in the United Kingdom published comparative research for platelet-rich plasma versus corticosteroid injections in treating plantar fasciopathy. Writing in the journal International Orthopaedics, (4) the UK researchers noted: PRP injections are associated with improved pain and function scores at a three-month follow-up when compared with corticosteroid injections.
Corticosteroids or stretching exercise?
An August 2025 paper in the Journal of orthopedic case reports (7) published results of 100 patients diagnosed with plantar fasciitis randomly divided into two treatment groups. The first group underwent a conservative regimen that included plantar fascia-specific stretching exercises, anti-inflammatory medications, contrast baths, and the use of shoe insoles. The second group received a single corticosteroid injection, specifically Triamcinolone acetonide (1 mL, 40 mg), anti-inflammatory medications, contrast baths, and shoe insoles as adjunctive therapy. Treatment outcomes were assessed using the Visual Analog Scale (VAS) for pain and the Foot and Ankle Ability Measure (FAAM) for function. These measures were recorded at baseline, and then at 2, 6, 12, and 16 weeks post-treatment.
In the early phases of treatment, the steroid injection group exhibited more rapid pain relief and functional improvement at 2 and 6 weeks. However, by weeks 12 and 16, the stretching exercise group demonstrated significantly better outcomes. Long-term analysis favored the stretching group, with statistically significant differences in both pain and function.
Is Cortisone no better than a placebo for restoring function?
This is an August 2019 study from medical university researchers in Australia published in the journal BioMed Central Musculoskeletal Disorders. (5) Here are the learning points of this study:
- Corticosteroid injection is frequently used for plantar heel pain (plantar fasciitis), although there is limited high-quality evidence to support this treatment.
- For reducing pain in the short term, corticosteroid injection was more effective than autologous blood injection and foot orthoses.
- There were no significant findings in the medium term.
- In the longer term, corticosteroid injection was less effective than dry needling and Platelet-Rich Plasma injection.
- Notably, corticosteroid injection was found to have similar effectiveness to placebo injection for reducing pain in the short and medium terms.
- For improving function, corticosteroid injection was more effective than physical therapy in the short term.
- Corticosteroid injections are not more effective than a placebo injection for reducing pain or improving function.
Hyaluronic Acid and Cortisone results and outcomes are just about the same
A January 2020 study in the Journal of Pain Research (6) suggests both cortisone and Hyaluronic Acid were effective modalities for plantar fasciitis and can improve pain and function with no superiority in 24th-week follow-ups, although cortisone seems to have a faster trend of improvement in the short term.
A confusing diagnosis and a condition made worse by cortisone
Many people have excellent success with cortisone. Sometimes it is an initial success and sometimes it is a long-term success. It is also very likely that if you have made it this far into this article cortisone injections did not provide the degree of treatment and symptom relief that you and your healthcare professionals desired for you. When cortisone fails, many times it fails because it was not the right treatment for the right diagnosis.
Here is a sample story emailed to us:
I have been experiencing foot pain for the past two years. Initially, my doctors thought I had plantar fasciitis, but, since none of the conservative care treatments and remedies were working for me, and in fact, because my pain was getting worse, I sought further opinions. I saw an orthopedic specialist and a physical therapist. I have flat feet so I was fitted for custom orthotics but this made the pain worse. One night the pain in my foot was so bad I made an “emergency” visit with another foot specialist to see if I could get any answers. This doctor diagnosed me with Tarsal Tunnel Syndrome and suggested I needed better orthotics, more cortisone injections, and I needed to start wearing a foot splint.
The doctor then proceeded to give me a cortisone injection. My foot swelled up even more and I think the cortisone is now a source of my pain. My pain is now very severe and I cannot walk or stand without enormous discomfort. I walk very little now and only with the aid of a walker.
What are we to make of a case like this?
The story above unfortunately is not a unique tale. It may in fact be a story that describes your current situation. Like the story above, we will often see patients who have been diagnosed with plantar fasciitis only to be later diagnosed with Tarsal Tunnel Syndrome because the proven treatment for plantar fasciitis has failed. Then we may see a patient whose upgrade diagnosis to Tarsal Tunnel Syndrome is now again thought to be a problem of plantar fasciitis when proven nerve entrapment remedies for Tarsal Tunnel Syndrome failed.
Prolotherapy vs corticosteroid injections
A study conducted in December 2024 (8) evaluated the efficacy of ultrasound-guided corticosteroid injections compared to ultrasound-guided dextrose prolotherapy for treating patients diagnosed with plantar fasciitis. The study included 38 patients with confirmed plantar fasciitis, consisting of 24 females and 14 males, with an average age of 48 years. In the corticosteroid injection group, participants received methylprednisolone, while those in the prolotherapy group were treated with dextrose. Ultrasound guidance was utilized throughout the procedure to ensure accuracy and safety. Patients were monitored and evaluated at two follow-up intervals: one month (short term) and three months (middle term) post-treatment. The primary outcomes assessed were pain severity and foot function. Both treatment groups demonstrated significant improvements in pain severity and foot function index by the middle term. The enhancement was somewhat more notable in the dextrose prolotherapy group. Conversely, in the corticosteroid injection group, the treatment’s effectiveness appeared to decline over time.
More reading
Alternatives to cortisone shots: Updated reviews. Ross Hauser MD – If you read this article, you are likely looking for answers for your long time pain problems that may offer some hope that you can get pain relief today, avoid a hip, knee, or shoulder replacement surgery, or get some pain relief until you can get a joint replacement. Corticosteroids, such as cortisone and prednisone, have an adverse effect on bone and soft tissue healing. Corticosteroids inactivate vitamin D, limiting calcium absorption by the gastrointestinal tract and increasing urinary excretion of calcium. Bone also shows a decrease in calcium uptake, ultimately leading to weakness at the fibro-osseous junction. Corticosteroids also inhibit the release of Growth Hormone which further decreases soft tissue and bone repair. Ultimately, corticosteroids lead to a decrease in bone, ligament, and tendon strength.
References
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