A Cortisone Shot for Plantar Fasciitis? Here's How to Think about Its Pros and Cons
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If you are struggling with severe Plantar Fasciitis pain that limits your daily activities, your doctor may recommend a cortisone shot. An injection directly into the painful area, a cortisone shot can bring temporary relief. However, doctors limit how frequently you can get this pain-relieving treatment, because it has drawbacks, as well as several important side effects.
Let’s look at the pros and cons of cortisone shots for Plantar Fasciitis, and how to decide whether it’s a good choice for you.
Cortisone, or corticosteroid, is a synthetic version of cortisol, which is an anti-inflammatory steroid hormone that suppresses the immune system and reduces inflammation.
A cortisone shot in the plantar fascia (the connective tissue at the bottom of your foot that gets aggravated by Plantar Fasciitis) can provide temporary relief by reducing the inflammation in the affected area and calming down the sensitive nerves. For some people, this can offer relatively fast-acting relief and allow them to return to their regular activities.
However, unlike physical therapy, a cortisone shot is not a permanent solution for Plantar Fasciitis, because it doesn’t treat the underlying tissue problem that’s causing your pain or inflammation. It’s a symptom relief.
How effective are cortisone shots for Plantar Fasciitis? The reports in the medical literature are mixed. For example, a 2015 review of 10 randomized controlled trials concluded that while cortisone shots were effective at reducing pain, the effect lasted only for 4-12 weeks.
Similarly, a 2019 meta analysis found that while cortisone shots are more effective at pain relief than some other forms of treatment (like using Plantar Fasciitis insoles), they were no more effective than placebo. This meta analysis also found overall medium to low quality evidence that cortisone shots can be more effective than alternative treatment for a short term.
The bad news: a cortisone shot can be quite painful. The good news: your doctor can help you deal with the pain of the injection. Some doctors even offer local anesthetic to numb the area before the shot. So, if you’re concerned, do speak up!
The cost of cortisone shots for Plantar Fasciitis depends on several factors, like the facility you get the shot at, your insurance coverage, and so on, but typically, a single cortisone shot can cost somewhere between $100 and $300. For a treatment that doesn't last, the cost adds up!
Some studies found that there is a small group of lucky patients who get long-term pain relief from one cortisone injection. However, these instances are the exception rather than the rule.
Unfortunately, for a majority of people, the relief from a cortisone shot is only temporary. The pain can return after a few months, and sometimes the pain is worse when it returns.
The big problem is that we don’t have a way to tell who belongs to this small group of lucky patients. So, when you get a cortisone shot, it’s like a lottery - you might get pain relief that lasts, or you may need more shots or other treatment later.
A single cortisone shot is usually quite safe. However, one of the more concerning risks of repeated cortisone injections is necrosis, or tissue death. Because of the way it reduces inflammation, cortisone can have a negative impact on surrounding tissues, if used too frequently.
In particular, too many cortisone shots in too short a period can weaken various tissues and cause the breakdown of cartridges, ligaments, tendons, and bones - including your plantar fascia itself. It can also cause nerve damage.
The root cause of Plantar Fasciitis is the weakness and instability in your kinetic chain, and the resulting extra stress on the plantar fascia. So, further weakening of your tissue is clearly not ideal.
While cortisone shots are safe when used properly, this risk is why doctors limit the number of cortisone shots to one every 3-6 months for most people. So, if your pain comes back after a few months from your first shot, another shot may not be a safe option for you.
Possibly the biggest con of cortisone shots as a treatment for Plantar Fasciitis is that it’s a symptom masker that can’t treat the underlying problem in the tissue.
The stiffness and pain of Plantar Fasciitis come from microscopic tears and scar tissue that form on the plantar fascia. For long-term results without flare-ups, you need to replace this weaker, damaged tissue with healthier, stronger tissue that can withstand the stress of your activities. Cortisone shots can’t do that.
This brings us to how you should think about a cortisone shot. Physical therapy is the gold standard of non-invasive treatment that brings lasting results.
If your pain is severe enough that you can’t do physical therapy, a cortisone shot can be a good treatment to get your pain under control first. With reduced pain, you can start working on your long-term recovery through physical therapy. Whether you get treatment from an in-person clinic or use a Plantar Fasciitis home treatment protocol like our System 2, make sure your plan includes:
Load management, where you reduce the stress on the sensitive tissue and protect it while it heals, either with daily taping or a Plantar Fasciitis brace
Soft tissue mobilization (massage), where you work directly with the damaged tissue to reduce tension, relieve pain, and encourage the growth of healthy tissue
Progressive strengthening (a.k.a., PT exercises for Plantar Fasciitis), where you gradually rebuild strength and stability throughout your kinetic chain, so your plantar fascia is well-supported and you are protected from recurrences
Seeing the possible side effects and limitations of cortisone shots, you might be looking for alternative ways to get quick Plantar Fasciitis pain relief so that you can go about your day without wincing. There are some effective options without the risks of cortisone shots!
To learn more about how to relieve your heel or arch pain, using physical therapy principles, check out this guide.
Cortisone shots have mixed, temporary results: for Plantar Fasciitis, cortisone shots can relieve pain for some people, but for most people, the effect doesn't last more than a few months.
Cortisone shots can't treat the underlying problem: while they can be effective at quick pain relief, cortisone shots can't induce therapeutic change in the damaged plantar fascia, so the pain is likely to return.
Use it to relieve pain enough so that you can work on the root cause: the best way to use a cortisone shot for Plantar Fasciitis is to use it as a way to reduce severe pain enough so you can rebuild strength and prevent pain and flare-ups with physical therapy treatment.
Alleviate was founded by a patient-clinician duo to bring the effective chronic pain treatment from physical therapy offices to everyone's home. With the all-in-one Plantar Fasciitis System 2, you can easily follow the Alleviate Method to treat your arch and heel pain now, and make it stick, without the hassle and cost of traditional physical therapy or the risks involved in getting multiple cortisone shots.
Get all the tools and guidance you need to reduce your ankle pain, and reclaim what moves you - in just 10-15 minutes a day.
Luke Ferdinands, Physical Therapist & Co-Founder
A New Zealand-trained physical therapist with over 20 years of experience, Luke developed the Alleviate Method to bring the gold standard of physical therapy care to everyone's home. Luke leads the development of physical tools and digital physical therapy content, focusing on driving clinical outcomes for people with chronic musculoskeletal pain conditions like Tennis Elbow, Plantar Fasciitis, Runner's Knee, and more.
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