34Risk Factors Affecting Chronic Rupture of the Plantar Fascia
Foot & Ankle International (2014) · Ho Seong Lee, Young Rak Choi, Sang Woo Kim, Jin Yong Lee, Jeong Ho Seo, Jae Jung Jeong
This retrospective comparative study analyzed 286 patients with plantar fasciitis to identify risk factors associated with chronic rupture of the plantar fascia. Among the 35 patients who experienced a rupture, 33 had received corticosteroid injections, indicating a strong association between steroid use and rupture risk. The study concluded that corticosteroid injections should be administered cautiously due to the significantly higher risk of plantar fascia rupture.
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31Efficacy of Foot Orthoses for the Treatment of Plantar Heel Pain
British Journal of Sports Medicine (2018) · Nadine Rasenberg, Henrik Riel, Michael S Rathleff, Sita M A Bierma-Zeinstra, Marienke van Middelkoop
This systematic review and meta-analysis evaluated randomized controlled trials comparing foot orthoses with control interventions, including no treatment, sham orthoses, and other conservative therapies. The analysis found no significant difference in short-term pain relief between custom, prefabricated, and sham orthoses. Functional outcomes were similarly unaffected. The study concludes that foot orthoses are not superior to sham or conservative treatments in managing plantar heel pain.
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42Weak Evidence for the Safety and Effectiveness of Endoscopic Plantar Fascia Release
Foot and Ankle Surgery (2020) · Michael-Alexander Malahias, Erwin Brian Cantiller, Vikram V. Kadu, Sebastian Muller
This review evaluated 15 studies on endoscopic plantar fascia release (EPFR), totaling 535 patients and 576 feet. Most studies were low-quality case series, with only two randomized controlled trials. Though subjective scores improved postoperatively, the review concluded there is weak evidence supporting EPFR as safe or effective. The overall complication rate was 11.0%, with persistent heel pain (5.6%), paresthesias or numbness (4.3%), soft tissue healing issues (1.7%), and superficial infection (0.4%) being the most common.
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83Corticosteroid Injections Carry Real Risks Including Tendon Rupture
BMC Musculoskeletal Disorders (2010) · Brinks A, Koes BW, Volkers AC, Verhaar JA, Bierma-Zeinstra SM
This systematic review examined 87 studies to estimate the occurrence and types of adverse effects after extra-articular (soft tissue) corticosteroid injections. The researchers categorized adverse events as major or minor. Major adverse events, which required intervention or did not resolve, included serious infections such as osteomyelitis and cellulitis, one fatal case of necrotizing fasciitis, tendon ruptures, skin atrophy, hypopigmentation, and local skin defects. The incidence of major adverse events ranged from 0 to 5.8% across studies. Minor adverse events, which were transient and did not require intervention, ranged from skin rash to flushing and disturbed menstrual patterns, with incidence as high as 81% in some studies. Increased pain or steroid flare after injection was reported in 19 studies. The review confirms that corticosteroid injections, while commonly used for pain relief, carry meaningful risks including tendon rupture, tissue atrophy, and serious infection. These findings support the recommendation that patients should be educated about these risks and encouraged to seek a second opinion before proceeding with corticosteroid injections, particularly when the injection is targeting tendon or ligament tissue that could be weakened by the steroid.
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