Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

Corticosteroid Injections: A Powerful Tool That Demands Precision

Corticosteroid injections — “steroid shots” — are among the most commonly performed procedures in podiatric practice and among the most frequently misunderstood. They are powerful anti-inflammatory tools that can provide significant, lasting relief for certain conditions while causing harm in others. The key to appropriate use is selecting the right patients, the right conditions, the right timing, and the right injection frequency. At Balance Foot & Ankle in Howell and Bloomfield Township, Michigan, we use corticosteroid injections as a precise clinical tool rather than a reflexive first response to foot pain.

Conditions Where Corticosteroids Are Beneficial

Evidence-supported indications for foot corticosteroid injections: plantar fasciitis in the acute-to-subacute phase (first 3-6 months) — injections significantly reduce pain and functional limitation compared to placebo, though effect size decreases if overused; Morton’s neuroma — perineural injection reduces neuroma-associated inflammation and can provide lasting relief, especially with ultrasound guidance for precise delivery; acute gout flares — corticosteroid injection into the affected joint provides rapid anti-inflammatory relief when systemic gout medications are contraindicated; bursitis (retrocalcaneal, adventitial heel bursitis) — targeted injection into the bursa reduces acute inflammatory symptoms; and inflammatory joint arthritis flares in specific joints.

When Corticosteroids Should Be Avoided or Used Cautiously

The risks of corticosteroid injection in foot conditions are real and consequential. Plantar fascia rupture: multiple plantar fasciitis injections weaken the fascial structure — more than 2-3 lifetime injections into the plantar fascia significantly increases rupture risk. Achilles tendon: direct Achilles tendon injection is contraindicated — corticosteroids cause tendon degeneration and significantly increase rupture risk. Diabetic patients: corticosteroids cause transient hyperglycemia (often significant for 24-48 hours) — diabetic patients should monitor glucose after injection and inform their diabetes provider. Patients with active infection: never inject near an infection site. Fat pad atrophy: repeated plantar heel injections can cause permanent loss of heel fat pad cushioning.

Ultrasound Guidance: The Standard of Care

Ultrasound-guided injection ensures corticosteroid is delivered precisely to the intended target — the plantar fascial insertion, the Morton’s neuroma, the bursa — rather than to adjacent structures. Studies comparing ultrasound-guided versus landmark-guided injections consistently show improved accuracy, reduced procedure pain, and better clinical outcomes with ultrasound guidance. Injecting under direct visualization also allows confirmation that the needle is not within a tendon before injection. Contact Balance Foot & Ankle at (810) 206-1402 for precise, ultrasound-guided foot injections with informed discussion of the benefits, limitations, and risks specific to your condition.

Foot or Ankle Pain? We Can Help.

Balance Foot & Ankle — Howell & Bloomfield Township, MI

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When to See a Podiatrist About Cortisone Injections

Cortisone injections can provide significant relief for inflammatory foot conditions, but knowing when they help and when they may cause harm is important. At Balance Foot & Ankle, Dr. Tom Biernacki uses ultrasound-guided injection techniques for precise placement and discusses the benefits and risks specific to your condition.

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Clinical References

1. Grice J, Marsland D, Smith G, et al. Efficacy of foot and ankle corticosteroid injections. Foot Ankle Int. 2017;38(1):8-13.
2. McMillan AM, Landorf KB, Gilheany MF, et al. Ultrasound guided corticosteroid injection for plantar fasciitis: randomised controlled trial. BMJ. 2012;344:e3260.
3. Sellman JR. Plantar fascia rupture associated with corticosteroid injection. Foot Ankle Int. 1994;15(7):376-381.

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Dr. Tom Biernacki, DPM

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Dr. Tom Biernacki, DPM

Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.