Home The Book Dr Articles Products Message Boards Journal Articles Search Our Surveys Surgery ESWT Dr Messages Find Good Drs video

Injection section of the PF book

Posted by Scott R on 8/25/00 at 09:01 (026180)

I'm glad to see Dr.s Zuckerman and Biehler discussing shots. I've been needing more info on why sometimes it's very painful ('worse than childbirth'). I've been giving doctors the benefit of the doubt by assuming sometimes it just hits a nerve. Here's the modification to that section of my 'book' taking into account the recent comments of our Dr.s. Since a much larger number of people read the book than the message board, please take the time to review and correct the section below.
=========================
Corticosteroid injections are often used to reduce pain and inflammation. It is a controversial topic among doctors. Some studies and doctors report a lot of success with shots. Other studies and doctors strongly advise against shots because they slow down the healing process, cause the fascia to detach (one doctor said he see much of a problem with that because that's what surgery does), and causes the fat pad to deteriorate causing long-term damage. The relief is often only temporary. 35% to 50% of our survey respondents have had shots. Shots will mask the pain, so it may not be wise to jump back into activity. There are 'water-soluble' (a.k.a. soluble) and 'fat-soluble' (a.k.a. insoluble) cortisones. The insoluble type stays in the tissue longer, thereby causing more tissue damage (but more pain relief). The soluble type is fast-acting but temporary. Vigorous massage to break up scar tissue before getting an injection has been suggested, but if there is significant pain to the touch, I wouldn't try it. Shots are often very painful. One source says that in order to reduce the pain when injecting, a medial approach using a long and small diameter needle and local anesthesia are necessary. Dr. Zuckerman writes:
'Take a 3cc with a #27 gauge needle. Mix the steriod of your choice with 1% lidocaine plain. No marcaine because it hurts like @#$%% I like depo-medrol, but it costs more. Don't show the needle to your patient. Take the cold spray and spray on the side of the foot. Wait until the area turns white. Put the needle into the foot. Not too far. Inject very slowly to get the area right under the skin numb. The scret is to numb in front of the needle and then move the needle forward. This way you are numbing the path to the painful area. Go real slow.'
Dr. Biehler writes:
'When a shot is called for to the heel it should not be a very painful experience. It the heel is already sore to the touch you can either put the foot asleep first with an ankle shot ( not painful ) or use a topical refrigerent on the heel first. You won't feel the needle go in and if the doctor injects a little lidocain, waits for it to numb the area, moves the needle in a little farther, injects again , waits and repeats. It takes mabe 10 minutes but it can be done. ' ... ' The shots are suposed to deposit the cortisone at the point of maximum tendernes, this is where it is needed. The lidocain not only numbs the area but it helps spread the cortisone. When the numbness wears off in 2 to 6 hours, the heel can feel sore.The cortisone shoud kick in by the next day and start bringing the inflamation and pain down.'

A podiatrist told me orthopaedic surgeons who give injections without local anesthesia increase his business. 50% of 500 visitors to this page who had shots said the pain was 'pretty bad' or 'horrific'. The other 50% said they were 'not too bad'. Some doctors will give shots before resorting to a cast or surgery. It is very rare (if not illegal) for doctors to give more than 3 shots because of the dangers. On separate occasions, I have heard of doctors giving roughly 20 shots for heel pain. I have not been able to figure out 'what's up with that.' Shots are not considered 'conservative' therapy. A new journal article says shots sometimes cause significant harm to the fascia.

Re: Injection section of the PF book

Br. Biehler on 8/25/00 at 11:40 (026189)

When a tendon ruptures do to too much cortisone, that can be a painfull experiance . Remember surgery is done under anesthetic.

Re: Injection section of the PF book

Dr. Zuckerman on 8/25/00 at 15:22 (026201)

Except for my spelling errors it looks good.

Re: Injection section of the PF book

Br. Biehler on 8/25/00 at 11:40 (026189)

When a tendon ruptures do to too much cortisone, that can be a painfull experiance . Remember surgery is done under anesthetic.

Re: Injection section of the PF book

Dr. Zuckerman on 8/25/00 at 15:22 (026201)

Except for my spelling errors it looks good.