Corticosteroid Versus Ozone Injections in Chronic Plantar Fasciitis: A Comparative Clinical Study

Abstract

Objective: Plantar fasciitis is a common degenerative condition causing chronic heel pain and functional limitation. Corticosteroid injections are widely used but carry potential adverse effects, whereas ozone therapy has emerged as an alternative with anti-inflammatory and regenerative properties.The aim of this study is to compare the efficacy of ultrasound-guided corticosteroid and ozone injections on pain, function, and quality of life in chronic plantar fasciitis.
Methods: This retrospective cohort study included 59 patients unresponsive to conservative treatment. Patients received either a single corticosteroid injection (Group S, n=30) or three weekly ozone injections (Group O, n=29). Outcomes were assessed using the Numerical Rating Scale (NRS), Foot Function Index (FFI), and Short Form-12 (SF-12) at baseline, 1 month, and 3 months. Treatment response was defined as ≥50% reduction in NRS.
Results: Both groups showed significant improvement over time (p<0.001). Pain reduction was similar at 1 month. At 3 months, corticosteroids resulted in lower NRS scores (p=0.024) and higher responder rates (70.0% vs. 31.0%, p=0.003). Corticosteroids provided greater short-term functional improvement, whereas ozone showed superior FFI scores at 3 months (p<0.001). SF-12 physical scores improved similarly; mental scores favored corticosteroids (p=0.025). No serious adverse events occurred.
Conclusions: Both injections effectively improve pain, function, and quality of life in plantar fasciitis. Corticosteroids provide superior pain relief, while ozone may offer better long-term functional improvement. Treatment selection should be individualized based on clinical priorities.

Keywords

• Plantar fasciitis
• Corticosteroid injection
• Ozone injection
• Pain management
• Heel pain

Project Number

E-43012747-050.04-481636-361

Ethical Statement

Prior to the start of the study, ethical approval was obtained from the university ethics committee under the protocol number E-43012747-050.04-481636-361.

References

1. Lemont H, Ammirati KM, Usen N. Plantar fasciitis: a degenerative process (fasciosis) without inflammation. J Am Podiatr Med Assoc. 2003 May-Jun;93(3):234-7. doi:10.7547/87507315-93-3-234.
2. Liebmann K, Kimbrough DW, Best TM, Kouroupis D, Rodriguez Materon S. Plantar fasciitis pathophysiology and the potential role of mesenchymal stem cell-derived extracellular vesicles as therapy. Biomedicines. 2025 Jun 23;13(7):1528. doi:10.3390/biomedicines13071528.
3. Nahin RL. Prevalence and pharmaceutical treatment of plantar fasciitis in united states adults. J Pain. 2018 Aug;19(8):885-96. doi:10.1016/j.jpain.2018.03.003.
4. Hansen L, Krogh TP, Ellingsen T, Bolvig L, Fredberg U. Long-term prognosis of plantar fasciitis: a 5- to 15-year follow-up study of 174 patients with ultrasound examination. Orthop J Sports Med. 2018 Mar 6;6(3):2325967118757983. doi:10.1177/2325967118757983.
5. Tseng WC, Chen YC, Lee TM, Chen WS. Plantar fasciitis: an updated review. J Med Ultrasound. 2023 Oct 6;31(4):268-74. doi:10.4103/jmu.jmu_2_23.
6. Goff JD, Crawford R. Diagnosis and treatment of plantar fasciitis. Am Fam Physician. 2011 Sep 15;84(6):676-82.
7. Thomas JL, Christensen JC, Kravitz SR, Mendicino RW, Schuberth JM, Vanore JV, et al. The diagnosis and treatment of heel pain: a clinical practice guideline-revision 2010. J Foot Ankle Surg. 2010 May-Jun;49(3 Suppl):S1-19. doi:10.1053/j.jfas.2010.01.001.
8. Guimarães JS, Arcanjo FL, Leporace G, Metsavaht LF, Conceição CS, Moreno MVMG, et al. Effects of therapeutic interventions on pain due to plantar fasciitis: a systematic review and meta-analysis. Clin Rehabil. 2023 Jun;37(6):727-46. doi:10.1177/02692155221143865.

9. Karaarslan F, Yılmaz H. Unilateral plantar topuk ağrısı olan hastalarda termal peloid tedavisi etkinliğinin retrospektif değerlendirilmesi. Sakarya Med J. 2021;11(4):889-96. doi:10.31832/smj.984680.
10. Kim C, Cashdollar MR, Mendicino RW, Catanzariti AR, Fuge L. Incidence of plantar fascia ruptures following corticosteroid injection. Foot Ankle Spec. 2010 Dec;3(6):335-7. doi:10.1177/1938640010378530.
11. Jeyaraman M, Jeyaraman N, Ramasubramanian S, Balaji S, Nallakumarasamy A, Patro BP, et al. Ozone therapy in musculoskeletal medicine: a comprehensive review. Eur J Med Res. 2024 Jul 31;29(1):398. doi:10.1186/s40001-024-01976-4.
12. Arias-Vázquez PI, Guzzardo MN, Guzzardo DR, Castillo-Avila RG, Tovilla-Zárate CA, Ake Montiel MAN. Efficacy of ozone injections for reducing musculoskeletal pain in comparison with corticosteroid injections: A systematic review and meta-analysis. J Back Musculoskelet Rehabil. 2024;37(4):821-38. doi:10.3233/BMR-230173.
13. Kurtoğlu A, Oto M, Kıter AE. Intra-articular ozone treatment of infection in a knee prosthesis model. Sakarya Med J. 2019;9(3):528-35. doi:10.31832/smj.558630.
14. Price DD, McGrath PA, Rafii A, Buckingham B. The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain. 1983 Sep;17(1):45-56. doi:10.1016/0304-3959(83)90126-4.
15. Yalıman A, Şen Eİ, Eskiyurt N, Budiman Mak E. Turkish translation and adaptation of foot function index in patients with plantar fasciitis. Turk J Phys Med Rehab. 2014;60(3):212-22. doi:10.5152/tftrd.2014.28086.
16. Soysal Gündüz Ö, Mutlu S, Aslan Basli A, Gül C, Akgül Ö, Yilmaz E, et al. Validation of the Turkish form of short form-12 health survey version 2 (SF-12v2). Arch Rheumatol. 2021 Jan 14;36(2):280-6. doi:10.46497/archrheumatol.2021.8458.
17. Babaei-Ghazani A, Karimi N, Forogh B, Madani SP, Ebadi S, Fadavi HR, et al. Comparison of ultrasound-guided local ozone (O2-O3) injection vs corticosteroid injection in the treatment of chronic plantar fasciitis: a randomized clinical trial. Pain Medicine. 2019;20:314-22. doi:10.1093/pm/pny066.
18. McMillan AM, Landorf KB, Gilheany MF, Bird AR, Morrow AD, Menz HB. Ultrasound guided corticosteroid injection for plantar fasciitis: randomised controlled trial. BMJ. 2012;344:e3260. doi:10.1136/bmj.e3260.
19. Bahrami MH, Raeissadat SA, Barchinejad M, Elyaspour D, Rahimi-Dehgolan S. Local ozone (O2-O3) versus corticosteroid injection efficacy in plantar fasciitis treatment: a double-blinded RCT. J Pain Res. 2019;12:2251–9. doi:10.2147/JPR.S202045.
20. Romero-Collado À, Hernández-Martínez-Esparza E, Zabaleta-del-Olmo E, Urpí-Fernández A-M, Santesmases-Masana R. Patient-reported outcome measures of quality of life in people affected by diabetic foot: a psychometric systematic review. Value in Health 2022;25:1602–18. doi:10.1016/j.jval.2022.04.1737.