Cortisone Shot for Plantar Fasciitis Didn't Work? What Next

Quick Answer

In clinical trials, a cortisone injection for plantar fasciitis eases pain for about a month at most, so a shot that wore off or did not help is a common result. Repeat injections carry documented risks, including plantar fascia rupture, so it makes sense to recheck the diagnosis and look at other options before having another.

You had a cortisone shot for plantar fasciitis. Maybe it did nothing. Maybe it gave you a few good weeks and then the heel pain came back. Either way, you are in good company, and the result does not mean your foot is beyond help. It does mean it is time to think carefully before repeating the same injection.

How long relief usually lasts

Shorter than most people expect. The best summary comes from a 2017 Cochrane review that pooled 39 studies with 2,492 adults. It found low-quality evidence that a steroid injection may slightly reduce heel pain for up to one month, but not after that.

One well-run trial shows the pattern clearly. In a 2012 study, 82 people received either an ultrasound-guided steroid injection or a salt water injection, and neither they nor the examiners knew which. The steroid group had less pain at 4 weeks. By 8 and 12 weeks, the difference was no longer significant.

A 2019 review of 47 trials with 2,989 participants went a step further and concluded that cortisone was not more effective than a placebo injection for pain or function.

So a shot that wore off after a month behaved the way the research says it often does. A shot that never helped at all is also a common result.

Why the shot may not have helped

The problem is not mainly inflammation. Cortisone is an anti-inflammatory drug. Long-lasting plantar fasciitis is now understood as wear and degeneration of the tissue more than inflammation, so there may be little for the drug to calm down.
The cause is still there. A tight calf, long hours of standing and unsupportive shoes keep loading the fascia after the medicine fades.
Placement matters. A 2014 pooled analysis found that injections guided by ultrasound did better than injections placed by feel.
The diagnosis may be off. A nerve problem, a stress fracture or a thinned heel pad will not respond to a shot aimed at the fascia.

If your heel pain has been going on for many months, our page on plantar fasciitis that will not go away explains when to have the diagnosis rechecked.

Should you get another one?

This is a real decision, not a formality. We did not find an agreed maximum number of cortisone injections for the heel in the guidance we reviewed, and doctors differ. What the sources do agree on is caution. The American Academy of Orthopaedic Surgeons says your doctor may limit this treatment or avoid it altogether, because steroid injections can weaken the plantar fascia and lead to a tear.

Reasonable questions to ask before a repeat injection:

How much relief did the first one give, and for how long?
Will it be placed with ultrasound guidance?
How many injections has this heel already had, from any doctor?
What will be different about my stretching, footwear or activity this time?

If the first shot gave you nothing, a second one of the same kind is hard to justify. If it gave you a short window of relief, the better use of a repeat window is to get rehab done, not to keep returning for more.

Questions about your treatment options? Dr. Fox can help.

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This article is part of our Heel Pain Guide.

The documented risks

Plantar fascia rupture

A tear of the fascia is the complication with the most evidence behind it.

In a review of 765 patients with plantar fasciitis seen by one specialist over three years, 51 were diagnosed with a rupture, and 44 of those ruptures were associated with a cortisone injection.
In a 2014 study of 286 patients, 35 had a rupture. Steroid injection was the only risk factor linked to it, and 33 of the 35 had received injections.
In a 2010 chart review of 120 patients who had injections, the authors reported rupture in 2.4%, after an average of about 2.7 injections.
In the Cochrane review, 2 ruptures were recorded among 699 trial participants given steroid.

These numbers come from very different settings, which is why they vary so much. Referral clinics see the complications, while short trials often do not follow people long enough to catch them. The Cochrane authors wrote that serious problems were rare but under-reported, and that a higher risk cannot be ruled out.

A rupture is not a harmless way for the pain to end. In the 765-patient review, the original heel pain often eased after the tear, but new problems followed, including arch strain, pain along the outer and top of the midfoot, and stress fractures. Many feet were still symptomatic a year later.

Fat pad atrophy

The heel has a thick cushion of fat that absorbs impact. Reviews in family medicine and orthopedic journals list thinning of this fat pad as a possible complication of steroid injection, and a thin fat pad can cause its own heel pain. The evidence here is weaker than for rupture. In a long-term study of 174 patients, heel fat pad thickness was nearly the same in people who had received an ultrasound-guided injection (9.0 mm) and those who had not (9.4 mm).

Infection and flare

The Cochrane review recorded 3 injection-site infections among the same 699 participants. Short-lived soreness after the shot was also reported and was treated with ice or pain relievers.

Signs you should be seen right away

Call a doctor promptly, or go to urgent care, if after an injection or at any time you notice:

A sudden pop or tearing feeling in the heel or arch, especially with bruising, swelling or a newly flattened arch.
Pain so severe you cannot put weight on the foot.
Redness, warmth or swelling that spreads, drainage from the injection site, or fever.
New numbness or tingling in the foot.
Deep pain at night or at rest that does not ease.

What to try next

Your options depend on how long the pain has lasted and what you have already done. In rough order from least to most involved:

A structured loading and stretching program. If you have not done two to three months of consistent, guided work, this is still the base that everything else is built on.
Platelet-rich plasma (PRP). The 2019 review found cortisone less effective than PRP between 13 and 52 weeks, although that finding did not hold up when lower-quality trials were removed. The AAOS says PRP does not carry the same rupture risk as cortisone and that more research is needed.
Shockwave therapy. Noninvasive, with mixed trial results. If you have already tried it, see when shockwave therapy did not work.
Embolization, needle-based procedures or surgery. These are for heel pain that has lasted many months despite real effort. Our heel pain guide lays out each one.

Where embolization fits after cortisone

Plantar fasciitis embolization (PFE) works on a different target. Instead of placing medicine into the fascia, a doctor guides a thin catheter through an artery and reduces flow through the small abnormal vessels around the painful tissue. Nothing is injected into the fascia itself. Details are on our plantar fasciitis embolization page.

The research is early, and you should weigh it that way. In a 2026 prospective series, 17 of 24 patients (70.8%) responded at 6 months, and in a 2026 retrospective study 8 of 11 (72.7%) did. Both were small studies with no comparison group. No randomized trial exists, and PFE has not been compared directly with cortisone. A 2026 review described the complications reported so far as minor and temporary, while noting the studies were small and of low quality. Any artery procedure carries its own risks, which Dr. Fox reviews with you.

For a side-by-side look at the two treatments, see PFE vs. cortisone injections. If you are new to the idea of embolization for pain, our embolization guide is a good place to start.

Frequently Asked Questions

How long should a cortisone shot for plantar fasciitis last?

A 2017 Cochrane review of 39 studies found that steroid injections may slightly reduce heel pain for up to one month, but not beyond that. Some people get longer relief and some get none.

How many cortisone shots can you have in your heel?

We did not find an agreed maximum number in the guidance we reviewed. The American Academy of Orthopaedic Surgeons says doctors may limit or avoid the injection because it can weaken the plantar fascia and lead to a tear.

Can a cortisone shot make plantar fasciitis worse?

It can cause a short flare of soreness, and it has been linked to plantar fascia rupture. In one 2014 study of 286 patients, 33 of the 35 people with a rupture had received steroid injections.

What does a plantar fascia rupture feel like?

Many people describe a sudden pop or tearing in the heel or arch, often followed by bruising and swelling. In one review, about two thirds of ruptures began suddenly and one third came on gradually. Get examined promptly if this happens.

Is embolization better than a cortisone shot?

No one knows yet. Embolization has only been studied in small series without comparison groups, and it has not been tested directly against cortisone.

Keep Reading

Sources

Medically reviewed by David Fox, MD, FACS, RPVI. This article is general information, not a substitute for a medical evaluation.

Living with joint or tendon pain that hasn’t improved? Schedule a consultation with Dr. David Fox at Fox Vein & Vascular in Manhattan to find out whether embolization is right for you. Call (212) 362-3470 or request an appointment online.

Your Cortisone Shot for Plantar Fasciitis Did Not Work. What Now?