Originally Posted by BlueTommy
The problem with PF is that it is a degenerative disease of the fascial insertion and not one of inflammation. So you are giving a steroid injection that causes the same pathologic changes in the tissue that already exist in PF. Degeneration versus inflammation. Multiple studies of an analogous condition of tissue degeneration, tennis elbow (better termed lateral elbow tendinopathy), have shown no benefit from steroid injection.
Let's first get out of the way that we don't know if the OP has PF. He just said he has pain in the middle of the foot and his arches have fallen. It might be PF, it might not. OP, the following discussion is tangential, and may not apply to your condition, so don't overthink the rest of this post.
Speaking in non-specific terms, PF doesn't start out as degenerative fasciosis. When the problem persists for a sufficient amount of time then it can become degenerative, certainly, but it didn't start out that way on day #1. Here is one of the issues with being too conservative during the initial injury, if the problem lingers on it can become a fasciosis. At that point corticosteroids don't make sense but PF often begins with a tissue tear, with an accompanying inflammatory response. There is also histologic evidence that implicates the adjacent flexor digitorum brevis muscle origin rather than the PF ligament, so yes there does exist disagreement on the pathology.
I don't know about tennis elbow but fortunately there is literature showing improvement of PF symptoms with a corticosteroid injection (no, I'm not going to start listing citations on a ski forum -- the thread will become too douchey and I'm not really in the mood for a flame war). In addition to the literature, anecdotally a lot of people improved their PF after having a shot.
Please note that I emphasized in earlier posts using the injection appropriately and on a good candidate. Factors the clinician has to take into account include age and duration of the injury, post-injection activity demands, BMI, foot type, foot biomechanics, lack of improvement with previous treatment, history of previous injections, current fat pad status, and general health and age of the patient. Also selecting the appropriate steroid (short-acting v. long-acting, soluble v. insoluble) and picking the correct dose are important. In the right circumstances a steroid injection can give improvement. It may be temporary, but even if it were to last 3-6 months that gives the patient time to address other issues such as flexibility and BMI.
When someone tells another person on an internet forum that "steroid injections are bad - period" (or any other treatment really) it makes a blanket statement that doesn't factor in the patient and his situation like his physician (or PT, chiropractor, or whomever) can, and may do the patient a disservice by eliminating a potentially helpful treatment and prolonging the problem. You didn't do that BlueTommy, but running forums are notorious for it. Almost any treatment has potential for an adverse outcome but you have to weigh the potential risks and benefits. An analogous example would be Ibuprofen. Ibuprofen can cause significant morbidity and mortality (GI bleeding, stomach ulcers, heart attack, and death -- much worse than fat pad atrophy, IMO) yet most people who can take the medication would not be concerned about taking it once in awhile. Does anyone in this thread use Advil once in awhile?
Fortunately the OP thought his situation over and discussed it with his doc before getting treated. I'm sure they were able to take more factors into consideration than we have been able to here, so I too hope he improves and can keep running and skiing as much as he wants. I'd love it if he would fill us in on his progress.