Heel Tenderness Index Research Articles

Comparison of the effectiveness of peloid therapy and kinesiotaping in patients with unilateral plantar fasciitis: A prospective, randomized controlled study.

This study aimed to compare the efficacy of peloid therapy and kinesiotaping for unilateral plantar fasciitis (PF). In the randomized controlled study, a total of 114 patients (89 females, 25 males; mean age: 45.1±8.3 years; range, 27 to 65 years) diagnosed with unilateral PF between January 2021 and March 2023 were randomly divided into three equal groups: the peloid group (peloid therapy and home-based exercise + heel pad), the kinesiotaping group (kinesiotaping and home-based exercise + heel pad), and the control group (home-based exercise + heel pad). Peloid therapy was performed over two weeks for a total of 10 sessions. Kinesiotaping was applied four times over two weeks. Plantar fascia, calf, and Achilles stretching exercises and foot strengthening exercises were performed, and prefabricated silicone heel insoles were used daily for six weeks. Patients were evaluated three times with clinical assessment scales for pain, the Heel Tenderness Index, and the Foot and Ankle Outcome Score before treatment, at the end of treatment, and in the first month after treatment. Statistically significant improvements were observed for all parameters at the end of treatment and in the first month after treatment compared to the baseline in every group (p<0.001). No superiority was found between the groups. Peloid therapy or kinesiotaping, given as adjuncts to home-based exercise therapy and shoe insoles in patients with unilateral PF, did not result in additional benefits.

103 Botulinum Toxin Type A (Botox) Injection for Plantar Fasciitis: An Audit of Findings

Abstract Introduction Plantar fasciitis is commonly seen in the musculoskeletal clinic and accounts for around 8-10% of running injuries. NICE recommended corticosteroid injections for patients whose “symptoms are having a significant impact on the person”, however, symptoms lasted for 4 weeks post injection. The use of Botox for the treatment of myofascial pain has increased, with studies showing greater reduction in patients symptoms and improved duration of action. Material and methods 42 patients (27 male, 15 female) were included in this audit. All patients received 100 units of botox. Inclusion/Exclusion criteria All patients who had clinically diagnosed plantar fasciitis and had received the first line treatments of stretching and orthotics. Patients yet to begin a stretching program or had systemic disease or previous surgery were excluded. Outcome measure A patient assessed (VAS) and a physician assessed (Heel Tenderness Index) outcome measure was used. Results 42 patients were assessed. VAS All the patients reported an improvement in symptoms at the 4 week follow up, 38 (90.48%) of whom reported pain free. Of the remaining 4 all advised their symptoms had improved by at least 50% HTI 38 (90.48%) had no pain on palpation of the heel post injection, whilst prior to the injection all patients had pain in differing degrees. 15 patients (35.71%) had severe pain prior to the injection, post injection no patient had severe pain. 40 (95.24%) patients had improved HTI scores. Conclusions Botox is effective in the treatment of plantar fasciitis, however, its effectiveness in the longer term needs to be assessed.

Comparison of the short-term efficacy of peloid and paraffin treatments on pain and quality of life in the treatment of plantar fasciitis: a randomized controlled study.

Although peloid, paraffin, and exercise treatments are effective in patients with plantar fasciitis, there had been no comprehensive and comparative studies of these treatments for plantar fasciitis. The aim of our study was to evaluate the effects of peloid, paraffin, and exercise treatments on pain, functional status, and quality of life in patients with plantar fasciitis. A total of 104 patients, aged 18 years and over, who applied to our clinic with heel pain and were diagnosed with plantar fasciitis according to the American College of Foot and Ankle Surgeons Clinical Consensus Statement: Diagnosis and Treatment of Adult Acquired Infracalcaneal Heel Pain guideline, with pain at the level of 3 and more severe according to the visual analog scale were randomly divided into three groups: the peloid group (peloid therapy and home exercise), the paraffin group (paraffin therapy and home exercise), and the control group (home exercise). Peloid and paraffin applications were applied 5 days a week, a total of 15 sessions in 3 weeks. Participants were evaluated with the visual analog scale, heel tenderness index, and the foot and ankle outcome score before treatment, after treatment, and at the first month after treatment. Compared to pre-treatment evaluation, significant improvements were observed in all parameters after treatment and at the first month controls in all 3 groups (p < 0.05). In the peloidotherapy and paraffin therapy added groups, pain reduction and quality of life increase were higher than the exercise group (p < 0.05). Adding peloidotherapy or paraffin therapy to the home exercise program in the treatment of plantar fasciitis can further reduce pain and improve quality of life.

Comparison of effects of low level laser therapy and local corticosteroid injection in the treatment of plantar fasciitis.

The purpose of the study was to compare low-level laser therapy (LLLT) and local corticosteroid injection in the treatment of plantar fasciitis. This retrospective study was performed with 56 patients (6 males, 50 females; mean age: 44.7±10.1 years; range, 18 to 65 years) between January 2015 and March 2016. The patients were equally divided into two groups: Group 1, comprising patients who underwent a one-time local corticosteroid injection into the heel by the same physician, and Group 2, including patients who had gallium arsenide laser therapy at a wavelength of 904 nm lasting 10 sessions. Evaluations were done at pre-treatment, post-treatment, and two weeks, one month, and three months after the post-treatment evaluation. The post-treatment evaluation was accepted as the 10th day after the injection in Group 1 and as the time after the last session of the laser treatment in Group 2. Each visit was compared with the previous visit for within-group analysis. The Visual Analog Scale (VAS), Heel Tenderness Index (HTI), and Foot Function Index (FFI) were assessed. Pain scores in Group 1 and Group 2 were not associated with statistically significant differences (p>0.05). Within-groups analysis demonstrated statistically significant differences concerning VAS subgroups (p <0.05), except for Group 2's resting VAS values (p=0.159). No statistically significant differences were found between groups in the means of FFI scores (p>0.05). Statistically significant differences were observed regarding within-group analyses for all subscores (p <0.001). No statistically significant differences were observed between the two groups for all visits regarding HTI scores (p>0.05). Statistically significant differences were found between baseline and the first after-treatment visit in all groups (p <0.05). Statistically significant differences were found in the first (p=0.020) and third (p=0.010) months compared to the one-week follow-up in Group 2 regarding HTI scores. Both LLLT and local corticosteroid injection for plantar fasciitis have positive effects for three months after treatment. However, LLLT is more effective than local corticosteroid injection at the end of the third month in local tenderness.

Efficacy of peloidotherapy in unilateral plantar fasciitis: A pilot study.

Objectives The aim of this study was to investigate the efficacy of peloidotherapy on pain, functional status, and quality of life (QoL) in patients with unilateral plantar fasciitis (PF). Patients and methods This prospective, observational pilot study included a total of 80 patients (13 males, 67 females; mean age: 47.7±9.9 years; range, 28 to 68 years) with a diagnosis of unilateral PF between April 2018 and October 2018. The patients were divided into two equal groups. The study group (n=40) received peloidotherapy (five days per week for two weeks, total of 10 sessions) + Achilles tendon and plantar fascia stretching exercises (self-stretching for two weeks twice per day for 30 sec, 10 repeats) + heel cup treatment. The control group (n=40) received Achilles tendon and plantar fascia stretching exercises + heel cup treatment. The patients were evaluated before and after treatment using the Visual Analog Scale-pain (VAS-pain), Foot and Ankle Outcome Scores (FAOS), and Heel Tenderness Index (HTI). Results The study group showed statistically significant improvements for all parameters after treatment compared to baseline (p<0.05). Control group showed statistically significant improvements in the VAS-pain, HTI, and FAOS-QoL subscales after treatment compared to baseline (p<0.05). The study group had a better improvement in the VAS-pain, FAOS-pain, and FAOS-work daily life subscales than the control group (p<0.05). Conclusion These results indicate that peloidotherapy may be effective in reducing pain and improving functional status and QoL for patients with unilateral PF.

A comparative study between intralesional platelet rich plasma injection and extracorporeal shockwave therapy for the treatment of plantar fasciitis

PurposePlantar Fasciitis is a widely prevalent condition and is extremely disabling if it remains unresolved. Despite many available treatment modalities, the management of recalcitrant cases is still a dilemma. We conducted this study to evaluate and compare the role of two novel modalities: Intralesional PRP (Platelet Rich Plasma) injection and Extra Corporeal Shockwave Therapy (ESWT) for the management of this condition. Methods60 patients with a clinical diagnosis of recalcitrant plantar fasciitis were randomized into 2 groups; PRP Group (n = 30) and ESWT Group (n = 30). In PRP group patients received 3 intralesional injections of PRP and in ESWT group 3 sessions of Extra Corporeal Shockwave Therapy were administered. The Primary outcome measures were Visual Analogue Scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score, Roles and Maudsley Index and Heel Tenderness Index (HTI). The secondary outcome measures were complications. The patients were followed up for a period of 6 months and evaluated for various scores. ResultsAt 6 months follow-up, significant results were found only on VAS score for both groups (p-value <0.05). However, both modalities resulted in significant clinical improvement with no complications reported. No statistically significant differences were reported between the two test groups. ConclusionsBoth autologous PRP and ESWT can become extremely useful modalities for management of recalcitrant cases of plantar fasciitis with no known adverse effects.

Effects of adjuvant low-dye Kinesio taping, adjuvant sham taping, or extracorporeal shockwave therapy alone in plantar fasciitis: A randomised double-blind controlled trial.

Extracorporeal shockwave therapy (ESWT) is known as one of the most effective treatment methods in plantar fasciitis (PF). Low-dye taping, which is the most preferred method of banding treatments, provides an analgesic effect by correcting biomechanics. It was aimed to compare the efficacy of adjuvant low-dye kinesio-taping (KT), sham-taping, or ESWT alone in PF. In this double-blind, sham-controlled study, 45 patients with PF were randomised into Group 3 (Group 1: ESWT plus low-dye KT, n=15; Group 2: ESWT plus Sham-taping, n=15; and Group 3: ESWT only, n=15) five-session ESWT were administrated. KT was performed and changed every 1-week for the ESWT sessions in Groups 1 and 2. The main outcome measures were the visual analogue scale (VAS) change, the heel tenderness index (HTI), foot function index (FFI). The patients were evaluated at the beginning and end of the treatment and at the 4-week follow-up. The demographic characteristics and baseline outcomes between groups were similar (P>.05). No significant difference was found between Groups 1 and 2, Groups 1 and 3 and Groups 2 and 3 with respect to VAS, HTI changes during the 4-week follow-up. VAS and HTI changes were observed in all three groups, there were no differences between groups. Repeated-measures ANOVA showed a significant interaction between the time and the groups in FFI-total (F3.919 =2.607; P=.043). For the FFI total, there was only a significant difference in favour of Group 1 when compared with Group 2 (P=.027). Although low-dye KT in addition to ESWT was more effective on foot function improvement than additive sham-taping and ESWT alone, it did not provide a significant benefit on pain and heel tenderness because of PF. The study was registered at the U.S. National Institutes of Health (ClinicalTrials.gov) (NCT03904966).

Extracorporeal shock wave therapy has an excellent therapeutic effect on plantar fasciitis

Objective To explore the long-term effectiveness of using extracorporeal shock waves in the treatment of plantar fasciitis. Methods Extracorporeal shock wave therapy was applied to 23 plantar fasciitis sufferers once a week for three weeks. MRI examinations were performed before and 4 hours after the first treatment. Before the treatment and one month after it was complete, all of the patients rated their pain using a visual analogue scale (VAS), and their infirmity was quantified using a heel tenderness index (HTI) and the ankle-hind foot scale of the American Orthopaedic Foot and Ankle Society (AOFAS). The longest walking time was also recorded. Paired t-tests compared the T2 values of the fascia, muscles and fat pads, the longest walking time and the VAS scores before and after the treatment. Pearson correlation coefficients were evaluated to test the significance of any correlation between the T2 changes and the changes in the VAS scores. Results After the shock wave therapy, the average VAS, HIT and AOFAS scores had significantly decreased, while the longest walking time had increased significantly. The magnetic resonance imaging showed increased edema in the fascia and their surrounding soft tissues. And the extent and degree of the T2 weighted high signal increased four hours after the treatment. The changes in the T2 values correlated positively and significantly with the changes in the VAS scores. Conclusion Extracorporeal shock waves have an excellent therapeutic effect on plantar fasciitis. They can significantly relieve heel pain and improve foot movement. Key words: Plantar fasciitis; Extracorporeal shock wave therapy; Magnetic resonance imaging; Therapeutic effectiveness

The effect of paraffin bath therapy versus extracorporeal shockwave therapy in the management of plantar fasciitis: A randomized clinical trial

Plantar fasciitis (PF) is the most common cause of painful heel. The etiology is multifactorial but usually involves inflammation and degeneration of the plantar fascia origin. Physical therapy interventions such as contrast bath, ultrasonography and iontophoresis help in resolution of symptoms. According to our current knowledge the efficacity paraffin bath therapy (PBT) is ambiguous. This prospective, randomized controlled study aims to compare the efficacy of PBT and extracorporeal shockwave therapy (ESWT) in the treatment of plantar fasciitis. Seventy patients were randomized into either the PBT (12 men, 23 women; mean age 39.12 ± 7.15 years) or ESWT (14 men, 21 women; mean age 38.37 ± 8.87 years) groups. Four patients in PBT group and five patients in ESWT group were lost to follow-up. Groups were similar regarding age, sex, and body mass index (all P > 0.05). PBT group had paraffin bath therapy (5 times per week, for 3-week duration) for affected foot while ESWT was applied twice a week for three weeks. As outcome measures patients’ pain and functional status were evaluated with Visual Analog Scale (VAS), Heel Tenderness Index (HTI), Foot and Ankle Outcome Score (FAOS) and ultrasonographic thickness of the plantar fascia recorded. The study parameters were administered at baseline, immediately after treatment and after 12 weeks. Statistically significant improvement was observed in several studied parameters after the treatment and during the follow-up study in the both groups. The PBT significantly improved the VAS, HTI and FAOS but not in thickness of the plantar fascia, even in the long-term. Both PBT and ESWT treatments improved pain levels and function and quality of life in individuals with plantar fasciitis. But ESWT method was superior according to PBT in treating plantar fasciitis.

Extracorporeal Shockwave Therapy Versus Kinesiology Taping in the Management of Plantar Fasciitis: A Randomized Clinical Trial.

This study aims to compare the efficacy of extracorporeal shockwave therapy (ESWT) and kinesiology taping in the treatment of plantar fasciitis. The study included 80 patients diagnosed with plantar fasciitis. The patients were randomized into two groups as ESWT (9 males, 28 females; mean age 47.8±12.4 years; range 40 to 55 years) and kinesiology taping (KT, 7 males, 26 females; mean age 47.7±9.8 years; range 40 to 55 years) groups. Groups were similar regarding age, sex, and body mass index (all p>0.05). Three patients in ESWT group and seven patients in KT group were lost to follow-up. ESWT was applied once a week for five weeks, while KT was applied every five days for five weeks. Patients' pain and functional status were evaluated with visual analog scale, heel tenderness index, and foot and ankle outcome score before and after treatment. At the study onset, there were no statistically significant differences between the two groups in their visual analog scale, heel tenderness index, and foot and ankle outcome scores. Five weeks later, both groups showed significant improvement in all parameters (p<0.05), but no significant differences were observed between the groups in the visual analog scale, heel tenderness index, and foot and ankle outcome score scores. Both ESWT and KT treatments improved pain levels and function and quality of life in individuals with plantar fasciitis. Neither method was superior in treating plantar fasciitis.

Magnetic Resonance Imaging and Clinical Outcomes of Laser Therapy, Ultrasound Therapy, and Extracorporeal Shock Wave Therapy for Treatment of Plantar Fasciitis: A Randomized Controlled Trial

We determined and compared the effectiveness of low-level laser therapy (LLLT), therapeutic ultrasound (US) therapy, and extracorporeal shock wave therapy (ESWT) using magnetic resonance imaging (MRI). We performed a randomized, prospective, comparative clinical study. A total of 60 patients with a diagnosis of chronic plantar fasciitis were divided randomly into 3 treatment groups: group 1 underwent 15 sessions of LLLT (8 J/cm2; 830 nm); group 2 underwent 15 sessions of continuous US (1 mHz; 2 W/cm2); and group 3 underwent 3 sessions of ESWT (2000 shocks). All patients were assessed using the visual analog scale (VAS), heel tenderness index (HTI), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, Roles–Maudsley score, and MRI before and 1 month after treatment. The primary efficacy success criterion was the percentage of decrease in heel pain of >60% from baseline at 1 month after treatment for ≥2 of the 3 heel pain (VAS) measurements. Significant improvement was measured using the mean VAS, AOFAS scale, and HTI scores for all 3 groups. The thickness of the plantar fascia had decreased significantly on MRI in all 3 groups. The treatment success rate was 70.6% in the LLLT group, 65% in the ESWT group, and 23.5% in the US group. LLLT and ESWT proved significantly superior to US therapy using the primary efficacy criterion (p = .006 and p = .012, respectively), with no significant difference between the LLLT and ESWT groups (p > .05). The treatment of chronic plantar fasciitis with LLLT and ESWT resulted in similar outcomes and both were more successful than US therapy in pain improvement and functional outcomes.

Objective assessment of corticosteroid effect in plantar fasciitis: additional utility of ultrasound.

although plantar fascia thickening is well documented as a sonographic criterion for the diagnosis of plantar fasciitis (PF), however it was less evaluated as an objective measure of response to treatment. It is unknown to what extent if any different responses to different treatments are related to the ultrasound (US) morphology changes. We aimed to evaluate changes in US findings in correlation to pain reported. this prospective observational trial included 21 plantar fasciitis patients (26 feet), resistant to conservative treatment for at least 2 months. Plantar fascia thickness and echogenicity were evaluated, compared to asymptomatic feet and correlated with visual analogue scale (VAS) and Heel Tenderness Index (HTI), before and after dexam-ethasone (DXM) iontophoresis in group I, and DXM injection in group II. increased thickness and reduced echogenicity were constant in symptomatic feet, with high statistical significant difference compared to asymptomatic side. Correlation between plantar fascia thickness with VAS and HTI before and after treatment showed statistically significant positive correlation (p<0.05). ROC curve test showed that reduction of plantar fascia thickness by US in response to DXM had 100% sensitivity, 65.2% specificity and 69% accuracy, with higher specificity and accuracy than VAS. US changes showed concurrent validity correlated with self-reported clinical improvement. Accordingly, ultrasound can be considered an objective useful tool for monitoring response to corticosteroid in patients with plantar fasciitis.

Ultrasound- versus Palpation-Guided Injection of Corticosteroid for Plantar Fasciitis: A Meta-Analysis

BackgroundIt is controversial whether ultrasound-guided injection of corticosteroid is superior to palpation-guided injection for plantar fasciitis. This meta-analysis was performed to compare the effectiveness of ultrasound-guided and palpation-guided injection of corticosteroid for the treatment of plantar fasciitis.MethodsDatabases (MEDLINE, Cochrane library and EMBASE) and reference lists were searched from their establishment to August 30, 2013 for randomized controlled trials (RCTs) comparing ultrasound-guided with palpation-guided injection for plantar fasciitis. The Cochrane risk of bias (ROB) tool was used to assess the methodological quality. Outcome measurements were visual analogue scale (VAS), tenderness threshold (TT), heel tenderness index (HTI), response rate, plantar fascia thickness (PFT), hypoechogenicity and heel pad thickness (HPT). The statistical analysis was performed with software RevMan 5.2 and Stata 12.0. When I2<50%, the fixed-effects model was adopted. Otherwise the randomized-effects model was adopted. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to assess the quality of evidence.ResultsFive RCTs with 149 patients were identified and analyzed. Compared with palpation-guided injection, ultrasound-guided injection was superior with regard to VAS, TT, response rate, PFT and hypoechogenicity. However, there was no statistical significance between the two groups for HPT and HTI.ConclusionUltrasound-guided injection of corticosteroid tends to be more effective than palpation-guided injection. However, it needs to be confirmed by further research.

Full-length silicone insoles versus ultrasound-guided corticosteroid injection in the management of plantar fasciitis

Plantar fasciitis often leads to disability. Optimal treatment for this clinical condition is still unknown. To compare the effectiveness of wearing a full-length silicone insole with ultrasound-guided corticosteroid injection in the management of plantar fasciitis. Randomized clinical trial. Forty-two patients with chronic unilateral plantar fasciitis were allocated randomly to have an ultrasound-guided corticosteroid injection or wear a full-length silicone insole. Data were collected before the procedure and 1 month after. The primary outcome measures included first-step heel pain via Visual Analogue Scale and Heel Tenderness Index. Other outcome measures were the Foot and Ankle Outcome Score and ultrasonographic thickness of the plantar fascia. After 1 month, a significant improvement was shown in Visual Analogue Scale, Heel Tenderness Index, Foot and Ankle Outcome Score, and ultrasonographic thickness of plantar fascia in both groups. Visual Analogue Scale scores, Foot and Ankle Outcome Score pain, Foot and Ankle Outcome Score for activities of daily living, Foot and Ankle Outcome Score for sport and recreation function, and plantar fascia thickness were better in injection group than in insole group (p < 0.05). Although both ultrasound-guided corticosteroid injection and wearing a full-length silicone insole were effective in the conservative treatment of plantar fasciitis, we recommend the use of silicone insoles as a first line of treatment for persons with plantar fasciitis.

Evaluation of therapeutic effects of extracorporeal shock wave therapy in resistant plantar fasciitis patients in a tertiary care setting

Plantar Fasciitis is a widely prevalent condition and is extremely disabling if it remains unresolved. Despite many available treatment modalities, the management of recalcitrant cases is still a dilemma. We conducted this study to evaluate and compare the role of two novel modalities: Intralesional PRP (Platelet Rich Plasma) injection and Extra Corporeal Shockwave Therapy (ESWT) for the management of this condition.60 patients with a clinical diagnosis of recalcitrant plantar fasciitis were randomized into 2 groups; PRP Group (n = 30) and ESWT Group (n = 30). In PRP group patients received 3 intralesional injections of PRP and in ESWT group 3 sessions of Extra Corporeal Shockwave Therapy were administered. The Primary outcome measures were Visual Analogue Scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score, Roles and Maudsley Index and Heel Tenderness Index (HTI). The secondary outcome measures were complications. The patients were followed up for a period of 6 months and evaluated for various scores.At 6 months follow-up, significant results were found only on VAS score for both groups (p-value <0.05). However, both modalities resulted in significant clinical improvement with no complications reported. No statistically significant differences were reported between the two test groups.Both autologous PRP and ESWT can become extremely useful modalities for management of recalcitrant cases of plantar fasciitis with no known adverse effects.

Comparison of High-Dose Extracorporeal Shockwave Therapy and Intralesional Corticosteroid Injection in the Treatment of Plantar Fasciitis

The aim of this study was to evaluate the results of high-dose extracorporeal shockwave therapy applied with an ankle block and corticosteroid injection in patients with plantar fasciitis whose symptoms persisted for more than 6 months. Sixty patients were assessed clinically at presentation and at 3-month follow-up with a patient-assessed 100-mm visual analog scale of pain and a physician-assessed heel tenderness index. A therapeutic response rate was evaluated. A decrease of at least 50% from baseline to 3 months in visual analog scale or heel tenderness index scores was accepted as a successful result. Extracorporeal shockwave therapy and corticosteroid injection provided significant improvements in visual analog scale and heel tenderness index scores, but between the two groups there was no significant difference in the visual analog scale score change 3 months after treatment (P > .05). Twenty-seven of 33 patients (82%) in the extracorporeal shockwave therapy group and 23 of 27 (85%) in the corticosteroid injection group had a successful therapeutic response after 3 months. Corticosteroid injection and extracorporeal shockwave therapy are successful treatment modalities for plantar fasciitis. Corticosteroid injection treatment is cost effective compared with extracorporeal shockwave therapy, and corticosteroid injection may be the first treatment choice according to these results.

Efficacy of tibial nerve block, local steroid injection or both in the treatment of Plantar Heel Pain Syndrome

Background Plantar Heel Pain Syndrome (PHPS) describes centralised plantar heel pain and tenderness. It can account for up to 15% of referrals to clinicians involved in the treatment of foot pain. Objective To compare tibial nerve block, local infiltration with steroid or both combined in the treatment of PHPS. Methods Patients with PHPS were randomly assigned to three treatment groups: Group 1—steroid injection to heel; Group 2—local anaesthetic block to tibial nerve; Group 3—both procedures. Pain visual analogue scale (VAS) was measured at baseline and after 1, 6 and 26 weeks. Heel tenderness index (HTI) was measured at baseline and after 6 weeks. The patient rated their discomfort from the injection(s) using a VAS. Results Forty-five patients (27 female) were recruited, 14 in Group 1, 12 in Group 2 and 19 in Group 3. Median age was 55, disease duration was 10 months and baseline pain VAS was 7.0 cm. All groups experienced a sustained improvement in pain VAS between baseline and weeks 1, 6 and 26 (all p < 0.0001). Group 1 reported significantly lower pain VAS that those in Group 2 ( p < 0.01) or Group 3 ( p < 0.05) at week 6. Group 2 found the procedure less uncomfortable than Group 1 ( p < 0.01). The HTI was significantly higher in Group 2 at 6 weeks compared to Group 1 ( p < 0.005) and Group 3 ( p < 0.05). Conclusions This study suggests that the natural history of PHPS following an injection is encouraging, that a tibial nerve block reduces the discomfort of the procedure, that a steroid injection to the heel may accelerate improvement and that clinicians should consider a combination of both strategies.