Effectiveness of Foot Orthoses Versus Corticosteroid Injection for Plantar Heel Pain: The SOOTHE Randomized Clinical Trial

Abstract

Background Plantar heel pain is a common foot complaint that causes significant disability and poorer health-related quality of life. Foot orthoses and corticosteroid injection are effective treatments for plantar heel pain; however, it is unclear whether one is more effective than the other. Objective The aim of this trial was to compare the effectiveness of foot orthoses and corticosteroid injection for plantar heel pain. Methods In this parallel-group, assessor-blinded, randomized clinical trial, participants received prefabricated, arch-contouring foot orthoses or a single ultrasound-guided corticosteroid injection. The primary outcome measure was the foot pain subscale of the Foot Health Status Questionnaire at 4 and 12 weeks. Results One hundred three participants aged 21 to 72 years (63 female) with plantar heel pain were recruited from the community and received an intervention. For the primary outcome of foot pain, corticosteroid injection was more effective at week 4 (adjusted mean difference, 8.2 points; 95% confidence interval: 0.6, 15.8 points). However, foot orthoses were more effective at week 12 (adjusted mean difference, 8.5 points; 95% confidence interval: 0.2, 16.8 points). Although these findings were statistically significant, the differences between the interventions did not meet the previously calculated minimal important difference value of 12.5 points. Conclusion Corticosteroid injection is more effective than foot orthoses at week 4, but this effect does not last; and appropriately contoured foot orthoses are more effective than corticosteroid injection at week 12. However, patients may not notice a clinically worthwhile difference between the interventions. Level of Evidence Therapy, level 1b. J Orthop Sports Phys Ther 2019;49(7):491–500. Epub 26 May 2019. doi:10.2519/jospt.2019.8807

Corticosteroid injection for plantar heel pain: a systematic review and meta-analysis

“…4) [22, 38, 42, 62] and foot orthoses (SMD -0.91; 95% CI, − 1.69 to − 0.13) (Fig. 5) [40, 61, 64]. There was very-low quality evidence that corticosteroid injection is similar to physical therapy (SMD -1.07; 95% CI, − 2.75 to 0.60) (Fig.…”

“…In the medium term (7 to 12 weeks), there was low quality evidence that corticosteroid injection is similar to physical therapy (SMD -0.74; 95% CI, − 1.51 to 0.03) [25, 37, 52], and very-low quality evidence corticosteroid injection is similar to autologous blood injection (SMD -0.31; 95% CI, − 0.83 to 0.21) [22, 38, 42, 62], foot orthoses (SMD -0.17; 95% CI; − 1.30 to 0.97) [40, 61], platelet-rich plasma injection (SMD 0.32; 95% CI, − 0.19 to 0.83) [21, 35, 36, 44, 57, 58, 60], extracorporeal shockwave therapy (SMD -0.05; 95% CI, − 0.60 to 0.49) [29, 30, 33, 34, 41, 45, 50, 54, 58, 63], and local anaesthetic injection (SMD 0.04; 95% CI, − 0.34 to 0.42) [26].…”

“…There was very-low quality evidence that corticosteroid injection is similar to foot orthoses (SMD -0.78; 95% CI, − 1.81 to 0.25) (Fig. 15) [61, 64], extracorporeal shockwave therapy (SMD 0.11; 95% CI, − 0.18 to 0.41) (Fig. 16) [41, 58], and botulinum toxin-A injection (SMD 0.76; 95% CI, − 0.24 to 1.76) (Fig.…”

Predictors of response to foot orthoses and corticosteroid injection for plantar heel pain

“…A recent randomised trial (the SOOTHE heel pain trial) aimed to clarify the effectiveness of two common interventions used to treat plantar heel pain, which were foot orthoses and corticosteroid injection [6]. The trial found that corticosteroid injection was more effective than foot orthoses in the short term (at week 4) and that foot orthoses were more effective than corticosteroid injection in the longer term (at week 12).…”

“…The trial found that corticosteroid injection was more effective than foot orthoses in the short term (at week 4) and that foot orthoses were more effective than corticosteroid injection in the longer term (at week 12). The published article that presented the findings for this trial focused on the comparative effectiveness of these interventions, but it did not provide information about the variables that predict response to each intervention [6]. Understanding variables that predict response may help health professionals choose interventions that are most appropriate for their patients and assist researchers to design clinically relevant randomised trials.…”