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Peppering Injection for Plantar Heel Pain: A Double-Blind Randomized Feasibility Study (a Short Report).

Michael A Jones^1,2, Garrett S Bullock^1,2, Kerry A Danelson^1,2

¹Atrium Health Wake Forest Baptist Department of Orthopaedic Surgery, Winston-Salem, NC, USA.

Foot & Ankle Orthopaedics

|May 12, 2026

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This pilot study found that a peppering injection technique for plantar heel pain was feasible. Early results suggest mechanical effects, not the corticosteroid itself, may provide pain relief.

Area of Science:

Orthopedics
Sports Medicine
Pain Management

Background:

Plantar heel pain impacts many, limiting daily activities.
Corticosteroid injections offer temporary relief, but mechanical stimulation might be the key factor.
This study explored the feasibility of a trial comparing corticosteroid vs. saline injections using a peppering technique.

Purpose of the Study:

To assess the feasibility of a double-blind randomized trial for plantar heel pain.
To compare corticosteroid versus saline injections via a standardized peppering technique.
To explore short-term changes in Foot Function Index (FFI) and visual analog scale (VAS) pain scores.

Main Methods:

A pilot study involving 41 adults with plantar heel pain.
Randomized comparison of corticosteroid versus saline injections using a peppering (fenestration) technique.

Keywords:

corticosteroids feasibility studies heel pain injections plantar fasciitis randomized controlled trial saline solution

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Feasibility assessed by recruitment, adherence, and data completeness; outcomes measured by FFI and VAS pain scores.

Main Results:

The study demonstrated feasibility with adequate recruitment and high protocol adherence.
Exploratory analysis favored saline injections, showing slightly better FFI and VAS pain score changes.
Observed differences between groups were below minimal important difference thresholds, suggesting a need for further investigation.

Conclusions:

A randomized peppering-injection trial for plantar heel pain is feasible.
Initial findings suggest a mechanically mediated effect, potentially independent of corticosteroid pharmacology.
Larger trials with longer follow-up and non-injection controls are necessary to confirm clinical effectiveness.