Why Did My Cortisone Shot for Plantar Fasciitis Stop Working?

A cortisone shot quiets pain and inflammatory signaling, but chronic plantar fasciitis is mostly a degeneration problem, so the injection dulls the symptom without repairing the tissue. Corticosteroids also suppress the cells that build collagen, so relief fades once the drug wears off while the overload that caused the problem continues.

Getting a few good weeks and then watching the pain return is discouraging, and it does not mean the injection was given wrong or that you did something to undo it.

The Mechanism

Corticosteroids work by binding glucocorticoid receptors inside cells and turning down the genes that drive inflammation. That is effective in tissues that are truly inflamed. In a degenerated plantar fascia, there is little inflammation to turn down, so much of the relief comes from dampening pain signaling around the heel, and it lasts only as long as the drug does.

The same receptors sit on fibroblasts, the cells that manufacture collagen. Glucocorticoids reduce fibroblast activity and collagen production, which is a problem in a tissue whose core issue is incomplete repair. The injection quiets the alarm while slowing the crew that fixes the damage.

Relief also changes behavior. When the heel stops hurting, you walk, stand, and train harder, and the fascia meets full load at a moment when its repair capacity is lower. The calf tightness and weak hip mechanics that overloaded it in the first place are still there. Plantar fascia rupture after injection is documented, and repeated injections are associated with heel fat pad atrophy, thinning of the natural cushion under the heel bone, which reduces shock absorption and can add a second source of pain. None of this means an injection was a mistake. It means the injection treated the symptom while the cycle continued.

When It's Something More Serious

Sudden sharp pain with a pop or tearing sensation, new swelling or bruising, or a flattening of the arch after an injection needs prompt evaluation, since it can signal a rupture. Redness, warmth, drainage, or fever at the injection site also needs prompt attention. Any question about whether to have another injection should be discussed with your physician.

How This Gets Addressed

After an injection, the work is to rebuild what the drug could not.

Dry needling provides a direct stimulus to the degenerated tissue to reactivate collagen repair, and chiropractic care restores ankle and foot mechanics so the fascia is not absorbing forces it was never meant to.

Physical therapy provides graded loading, timed to your tissue's actual recovery, along with hip and calf work to reduce overload, and naturopathic medicine evaluates the nutrient, hormonal, and inflammatory factors that determine whether repair is completed.

Each targets a piece of what the injection left untouched. You can learn more about our full approach to plantar fasciitis here.

Most patients find that once real repair is stimulated and the overload is corrected, improvement lasts longer than the injection did, although recovery is measured in weeks to months, and a heel that has had several injections may take longer to rebuild.

Written By:

Dr. Jason Winkelmann

Naturopathic doctor, Chiropractor, Chronic Pain Specialist, and Educator

Frequently Asked Questions

How long does a cortisone shot for plantar fasciitis last?

Studies generally show the benefit is short-term, concentrated in the first weeks to a month or so, with little difference from other treatments over a few months. How long it lasts for you depends on how much load your heel meets afterward and whether the overloading forces are corrected.

Can a cortisone shot make plantar fasciitis worse?

It can. Steroids slow collagen repair, and rupture of the plantar fascia and heel fat pad atrophy have been reported, with risk rising as injections are repeated. Talk with your physician about the number and timing of any injections.

What should I do if a cortisone shot did not work?

Start by having the cause of the overload assessed, including the calf, ankle, hip strength, and foot mechanics, and consider whether a different problem such as nerve entrapment or a stress fracture is involved, since those do not respond to the same approach. Then combine direct tissue treatment with graded loading and a look at the internal factors that limit repair. Decisions about further injections belong with your physician.