In 1922, Stiell asserted, “painful heel seems to be a condition that is rarely treated effectively, primarily due to the lack of precise diagnosis of its causation.” Lapidus and Guidotti asserted, “the term painful heel is intentionally employed over any more specific etiological diagnosis, as the cause of this distinct clinical entity remains unidentified.” The differential diagnosis of plantar heel pain must encompass heel pad atrophy, plantar fasciitis (plantar fasciopathy), entrapment of the first branch of the lateral plantar nerve, calcaneal stress fracture, and tarsal tunnel syndrome. [ 1] Plantar fasciitis is one of the most prevalent causes of heel pain in adults. It is presumed to result from inflammation and is generally triggered by biomechanical stress. [ 2] Tong and Furia indicated that about 2 million patients receive therapy for plantar fasciitis annually in the United States, estimating the treatment costs in 2007 to be between $192 million and $376 million. The plantar fascia, more accurately referred to as the plantar aponeurosis, is situated superficially to the muscles on the plantar surface of the foot. The plantar fascia possesses a robust core component that envelops the primary muscle of the first layer, the flexor digitorum brevis, and lies just underneath the superficial fascia of the plantar surface. It is proximally affixed to the calcaneus at the anterior calcaneal tubercle, the locus of muscle attachments, while distally it merges with the skin at the creases of the toe bases, furthermore sending five slips, one to each digit. This anatomical configuration is essential to the etiology of plantar fasciitis. [ 3]

The plantar fascia is the primary tissue that stabilizes the arch. It extends under increasing loads and accumulates elastic energy, functioning as a shock absorber; its dynamic role, especially in aiding the propulsive phase of gait, is essential for appropriate foot function.

Plantar fasciitis is linked to obesity, middle age, and biomechanical irregularities in the foot, including a tight Achilles tendon, pes cavus, and pes planus. It is typically seen as a consequence of a degenerative process at the root of the plantar fascia on the calcaneus. Neurogenic and other etiologies of subcalcaneal pain are often referenced. A confluence of causal variables may exist, or the actual reason may remain elusive. [4] Conservative management is the predominant therapeutic approach for plantar fasciitis. Numerous interventions, including orthoses, night splints, targeted plantar fascia stretching protocols, oral nonsteroidal anti-inflammatory drugs, localized injections, extracorporeal shockwave treatment, and low-level laser therapy, have been documented as effective. Corticosteroid injections are frequently utilized with effectiveness; nevertheless, other injections such as PRP and whole blood have also alleviated symptoms. While there is no consensus about the efficacy of specific conservative treatment regimens, it is acknowledged that nonsurgical therapy is eventually beneficial in around 90% of patients. It is uncommon for a patient with heel pain to necessitate surgical intervention for symptom alleviation.

Numerous studies have been undertaken in recent years to investigate the function of PRP and autologous blood injections in the treatment of plantar fasciitis, evaluating their efficacy and comparing them with other techniques, particularly steroid injections. However, PRP injections and autologous blood injections are not as prevalent therapy modalities as NSAID and steroid injections. After a thorough review of the literature, we identified a limited number of studies that compare the efficacy of the two predominant treatment modalities for plantar fasciitis: NSAIDs and steroid injections, in conjunction with stretching exercises and orthotics. In our institute, these two approaches are the most prevalent treatments for plantar fasciitis.

This study aims to examine the efficacy of steroid injections and NSAIDs, with standard supportive interventions, in the treatment of plantar fasciitis.

A randomized controlled trial was conducted to compare the efficacy of local steroid injections versus oral analgesics combined with physiotherapy in the management of plantar fasciitis. A total of 200 patients diagnosed with plantar fasciitis were enrolled and randomly assigned to one of two treatment groups.

Study Groups

• Group A (n=100): Received a single local injection of 40 mg methylprednisolone acetate.
• Group B (n=100): Received oral nonsteroidal anti-inflammatory drugs (NSAIDs) along with a standardized physiotherapy regimen consisting of stretching and strengthening exercises, administered three times per week for six weeks.

Inclusion Criteria

• Adults aged 18 to 65 years
• Clinical diagnosis of plantar fasciitis
• Symptom duration of at least four weeks

Exclusion Criteria

• History of previous foot surgery
• Presence of systemic inflammatory conditions
• Recent corticosteroid use

Outcome Measures

The primary outcome measures included pain assessment using the Visual Analog Scale (VAS) and functional evaluation using the American Orthopaedic Foot and Ankle Society (AOFAS) score. Patients were assessed at baseline, 1 month, 3 months, and 6 months post-treatment.

Statistical Analysis

Data were analyzed using repeated measures ANOVA to evaluate changes in VAS and AOFAS scores over time within and between groups. A p-value of <0.05 was considered statistically significant.

Master Chart (Patient Demographics & Outcomes Summary)

The study compared patient demographics and outcomes between two groups: Group A (Steroid) and Group B (Oral + Physiotherapy), each consisting of 100 patients. The mean age was 45.3 ± 8.2 years in Group A and 44.9 ± 7.8 years in Group B. The male-to-female ratio was 58:42 in Group A and 60:40 in Group B. At baseline, the mean Visual Analog Scale (VAS) score was 7.8 ± 1.1 in Group A and 7.7 ± 1.2 in Group B. After one month, the VAS score significantly reduced to 3.2 ± 1.0 in Group A, whereas Group B had a higher score of 5.5 ± 1.1. At six months, both groups showed further improvement, with scores of 3.0 ± 0.9 in Group A and 2.8 ± 1.0 in Group B. The American Orthopaedic Foot and Ankle Society (AOFAS) score at baseline was 55.4 ± 5.3 in Group A and 54.9 ± 5.1 in Group B. By six months, the AOFAS score improved to 86.1 ± 4.5 in Group A and 89.4 ± 3.8 in Group B. Notably, no adverse events were reported in either group.

The bar graph illustrates the VAS (Visual Analog Scale) score comparison over time between the Steroid Group and the Oral + Physiotherapy Group. At baseline, both groups had similar pain levels, with VAS scores close to 8. After one month, the Steroid Group showed a significant reduction in pain, with a VAS score of around 3, while the Oral + Physiotherapy Group had a higher score of approximately 5.5. At the three-month mark, the pain levels continued to decline in both groups, but the Steroid Group maintained a slightly lower VAS score. By six months, both groups exhibited comparable pain levels, with the Oral + Physiotherapy Group showing a marginally lower score than the Steroid Group. The trend suggests that while steroid treatment provides more rapid pain relief, the combination of oral medication and physiotherapy yields comparable results in the long term.

The pie chart illustrates the proportion of patients who experienced significant pain relief, defined as a VAS score reduction of more than 50%, at six months. The Oral + Physiotherapy Group demonstrated a slightly higher proportion of patients with significant pain relief, accounting for 51.4% of the total, compared to 48.6% in the Steroid Group. This suggests that while both treatment approaches are effective in reducing pain over the long term, the combination of oral medication and physiotherapy may offer a marginal advantage in achieving substantial pain relief at six months.

our comparative analysis of local steroid injections versus oral NSAIDs with physiotherapy demonstrates distinct temporal efficacy patterns. The steroid group showed superior short-term pain reduction (1-month VAS 3.2 vs 5.5; p<0.001), consistent with prior studies where steroid injections achieved 53.7% excellent outcomes versus 29.6% for NSAIDs[5] and outperformed oral analgesics in meta-analyses. However, by 6 months, both groups exhibited comparable pain relief (VAS 3.0 vs 2.8), suggesting that physiotherapy’s biomechanical corrections in Group B mitigated initial disparities[6]. Functional outcomes favored the combination therapy, with Group B achieving higher AOFAS scores (89.4 vs 86.1), aligning with evidence that structured physiotherapy enhances long-term recovery.

The absence of adverse events in both groups contrasts with earlier reports of plantar fascia rupture (6.6%)[5] potentially attributable to refined injection techniques or shorter follow-up. While steroids offer rapid analgesia, their transient efficacy beyond 3 months underscores the value of integrating physiotherapy to address chronic biomechanical stressors[6]Our findings support a paradigm shift toward multimodal regimens, balancing immediate symptom control with sustained functional improvement.

Study limitations include a 6-month follow-up, which may underestimate late recurrences, and reliance on self-reported scores. Future research should evaluate longer-term outcomes and standardized physiotherapy protocols.

While steroid injections excel in immediate symptom control, combining oral analgesics with physiotherapy provides superior functional restoration, advocating for a stratified approach based on disease chronicity and patient-specific factors

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3. Simon J. Bartold. The plantar fascia as a source of pain- biomechanics, presentation and treatment. J Body Work Mov Thera. 2004; 8:214-26.
4. Gill LH. Plantar fasciitis: Diagnosis and conservative management. J Am Acad Orthop Surg. 2004; 350:2159- 66.
5. Biswas D, Mittal M, Sen P. A comparative study of efficacy of oral nonsteroidal antiinflammatory drugs and local steroid injection in plantar fasciitis. Indian J Orthop. 2012;46(4):426-9.
6. Özden F, Aydoğdu S, Demir S. Thickness of plantar fascia is not predictive of functional outcome in plantar fasciitis treatment. Acta Orthop Traumatol Turc. 2018;52(6):442-6.