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Steroid Injections
Steroid injections (more accurately, corticosteroid injections) help by reducing inflammation and modulating pain signalling in irritated tissues.
They are not primarily “painkillers” — they are anti-inflammatory and immunomodulatory agents that reduce the biological drivers of pain. In other words, they are not just masking your pain but are changing the underlying causes of pain.
Steroid injections help by:
- Reducing inflammatory chemistry and calming irritated neural tissue, thereby decreasing pain and improving function.
They are most useful when inflammation is a significant driver — less so when structural degeneration is dominant.
What is actually injected?
- A corticosteroid called Methylprednisolone acetate is the drug we use
- Often a local anaesthetic (LA) accompanies the injection in order to provide immediate analgesia and diagnostic clarity. While the corticosteroid provides the delayed anti-inflammatory effect, mixing it with LA increases injectate volume, which can Improve dispersion within a confined anatomical space and also help bathe inflamed tissue more evenly
The anaesthetic gives short-term relief; the steroid provides the longer anti-inflammatory effect.
How do they work?
- Inhibit phospholipase A2
- Reduce prostaglandin and leukotriene production
- Suppress inflammatory cytokines
- Reduce vascular permeability
Result → less tissue irritation and swelling
2️⃣ Reduced neural sensitisation
Inflamed tissue irritates nearby nociceptors (pain-reporting nerves).
Steroids reduce chemical irritation around the nerve, leading to:
- Reduced peripheral sensitisation
- Decreased nerve firing
- Lower pain intensity
This is particularly relevant in:
- Morton’s neuroma
- Plantar heel pain
- Synovitis
- Capsulitis
3️⃣ Mechanical unloading (secondary effect)
By reducing pain:
- Muscle guarding decreases
- Gait improves
- Pathological loading patterns may normalise
How quickly do they work?
- Local anaesthetic → minutes to hours
- Steroid effect → typically 2–7 days
- Peak benefit → often within 4-6 weeks
Relief may last weeks to months — but varies significantly.
Important nuance (especially for foot conditions)
In many chronic foot problems (e.g. plantar fasciopathy, tendinopathy), the pathology is often degenerative rather than purely inflammatory.
In these cases, steroids:
- Reduce pain
- Do not “repair” tissue
- May not change long-term outcome
This is why recurrence rates can be significant.
Potential risks
- Fat pad atrophy (particularly plantar heel)
- Skin depigmentation
- Tendon weakening or rupture (rare but documented)
- Post-injection flare
- Infection (rare)
- The greatest risk however, is an anaphylactic reaction. These are a medical emergency. They are, fortunately incredible rare events with the British Journal of Anaesthesia stating approx 0.97% of injections causing such a reaction
