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cortisone shots

Posted by john h on 10/30/00 at 10:00 (031631)

i read frequently that 3 cortisone shots should be max for PF. Is this 3 in a year or 3 in a lifetime. Professional athletes must get these shots by the dozen over a carreer. especially football players.

Re: cortisone shots

Dr. Biehler on 10/30/00 at 13:35 (031641)

Alot depends on where the shot is directed, the strenghth and type of the cortizone, and what it is being used to accomplish. Dr. B.

Re: cortisone shots

john h on 10/30/00 at 17:35 (031649)

what if the shot is directed to where the band of fascia from the great toe attaches to the heel (inside edge of foot). goal to reduce pain.

Re: cortisone shots

Dr. Zuckerman on 10/30/00 at 18:52 (031657)

As you probaby know there is an article written by a doctor who is a member of the American College of Foot and Ankle Orthopedics. They talk about a 8-9 % rupture of the plantar fascia with just two steriod injections.

Re: Docs: You all mean risk at second shot per foot, don't you?

Beverly on 10/30/00 at 21:41 (031665)

I hope you mean a rupture risk at the second shot in the same foot.
Because as I am sure you know, I am due to have one shot in each foot.
I have equated that as being the same as having one shot in terms of a rupture risk since I will only being having one shot in each foot.
Thanks,
Beverly

Re: cortisone shots

Scott R on 10/30/00 at 21:46 (031667)

Dr. Z thanks for mentioning this. I mention it in the book, but I don't give a percentage, which I'll add now, along with your observation that the spur is not solid bone. Dr. B has also mentioned some stuff I need to add, but If I don't do things like that right away I forget.

I saw an abstract that indicates 10% of 122 injections. Can you cite this study for me or show me a web page?

Re: heel spur consistency

Scott R on 10/30/00 at 21:51 (031668)

Dr. Z and Dr. B, is the following an accurate statement?

' The spur is not solid bone. It is calcium that is depositing into soft tissue and it bendable like plastic ot cartilage. '

Re: heel spur consistency

Dr. Zuckerman on 10/30/00 at 22:21 (031673)

This is Dr. Z's personal belief and I have seen this as true after looking at the 'spur' that came out of the foot via mis heel spur removal. The bone is soft. You have heard of the people having heel spurs but they never hurt them. Well I have taken thousands of x-rays of patients for other reason which included an x-ray of the heel. There was the typical heel spur but no complaint from the patient. Why?
The body's will lay down bone in reponse to mechanical stress. This is called Wolf's law or Davis law I will have to check the correct name anyway the bone laying down process in either incomplete or soft much like a poor union from a fracture. I believe that failed heel spur treatment and or plantar fasciitis at the insertion is due to the failed laying down of bone or the incomplete laying down of bone. My grandfather Dr. Lewi taught me this as a child. No just kidding this may be a different theory of why you have failed conversative treatment with pf. In addition this is why there is spontaneous remission of pf or heel spur pain. The body puts down enough bone to heal the tear at the insertion. This is why ESWT works . This is a conversation of mechanical energy to the focal site from electrical energy. You then have a type of trauma at the fibrotic site ( poor healing area from the initial tear of pf) This mechanical induced trauma re-starts the initial healing process which is the inflamatory phase of wound healing , tendon healing and even bone healing.

Good nite and God bless . I may given the world the real reason why ESWT works. Or I am just describing the mechanism in different wording.

Re: Docs: You all mean risk at second shot per foot, don't you?

Dr. Zuckerman on 10/30/00 at 22:35 (031675)

Yes

We are taking about two shots in the same foot. Sorry about that

Re: heel spur consistency

Julie F on 10/31/00 at 03:25 (031682)

Dr Z, this is mind-boggling. Are you saying that if the body lays down a 'good' spur in response to the tear, it is the spur that heals the tear? And that if the bone-laying process is incomplete, that may be the reason why a case of PF lingers on despite conservative treatment? If so, what can we do to help the body form good spurs? More calcium? Anything else? Suggestions, please, for those of us who aren't candidates for ESWT (or aren't at that point yet).

Thank you for this fascinating post. Julie

Re: cortisone shots

john h on 10/31/00 at 11:32 (031700)

i still do not have an answer to my question concerning the number of cortisone shots that might safely be administered. let us say it is 3. is that 3 in a lifetime, 3 in a year? i recognize that each of us may have a fascia that is in a different state and each of us may be more or less suspetable to a rupture. i talked to one lady that said she had probably had 50 shots in her lifetime in the foot.

Re: cortisone shots

Dr. Biehler on 10/31/00 at 16:42 (031714)

Cortisone can cause atrophy while at the same time it priovides an antiinflamatory area which promotes healing. The body continuiously heals itself. The number of shots given,the damage done and the type of cotisone used are all variable factors that change with each individuale and situation. The cortisone only lasts for a certain amount of time. Some doctors will give a multiple series of water soluable cortisone shots as long as there are signs of improvement and the area of injection is not starting to break down, all a week or two apart. Others will use one non-soluable shot. There is also variance to the amount of cortisone used and if it is delivered mixed with lidocain or not. It all comes down to discussing it with your doctor and ariving at a place you both feel comfortable with. Dr. B.

Re: cortisone shots

john h on 11/02/00 at 09:59 (031813)

makes sense to me dr biehler. the one thing i read which seems very important is to restrict your activity for about 2 weeks after a shot. i had not read that until recently. i know, when i had a shot the doctor did not advise me to do anything (ice,restrict activity,etc)

Re: cortisone shots

Dr. Biehler on 10/30/00 at 13:35 (031641)

Alot depends on where the shot is directed, the strenghth and type of the cortizone, and what it is being used to accomplish. Dr. B.

Re: cortisone shots

john h on 10/30/00 at 17:35 (031649)

what if the shot is directed to where the band of fascia from the great toe attaches to the heel (inside edge of foot). goal to reduce pain.

Re: cortisone shots

Dr. Zuckerman on 10/30/00 at 18:52 (031657)

As you probaby know there is an article written by a doctor who is a member of the American College of Foot and Ankle Orthopedics. They talk about a 8-9 % rupture of the plantar fascia with just two steriod injections.

Re: Docs: You all mean risk at second shot per foot, don't you?

Beverly on 10/30/00 at 21:41 (031665)

I hope you mean a rupture risk at the second shot in the same foot.
Because as I am sure you know, I am due to have one shot in each foot.
I have equated that as being the same as having one shot in terms of a rupture risk since I will only being having one shot in each foot.
Thanks,
Beverly

Re: cortisone shots

Scott R on 10/30/00 at 21:46 (031667)

Dr. Z thanks for mentioning this. I mention it in the book, but I don't give a percentage, which I'll add now, along with your observation that the spur is not solid bone. Dr. B has also mentioned some stuff I need to add, but If I don't do things like that right away I forget.

I saw an abstract that indicates 10% of 122 injections. Can you cite this study for me or show me a web page?

Re: heel spur consistency

Scott R on 10/30/00 at 21:51 (031668)

Dr. Z and Dr. B, is the following an accurate statement?

' The spur is not solid bone. It is calcium that is depositing into soft tissue and it bendable like plastic ot cartilage. '

Re: heel spur consistency

Dr. Zuckerman on 10/30/00 at 22:21 (031673)

This is Dr. Z's personal belief and I have seen this as true after looking at the 'spur' that came out of the foot via mis heel spur removal. The bone is soft. You have heard of the people having heel spurs but they never hurt them. Well I have taken thousands of x-rays of patients for other reason which included an x-ray of the heel. There was the typical heel spur but no complaint from the patient. Why?
The body's will lay down bone in reponse to mechanical stress. This is called Wolf's law or Davis law I will have to check the correct name anyway the bone laying down process in either incomplete or soft much like a poor union from a fracture. I believe that failed heel spur treatment and or plantar fasciitis at the insertion is due to the failed laying down of bone or the incomplete laying down of bone. My grandfather Dr. Lewi taught me this as a child. No just kidding this may be a different theory of why you have failed conversative treatment with pf. In addition this is why there is spontaneous remission of pf or heel spur pain. The body puts down enough bone to heal the tear at the insertion. This is why ESWT works . This is a conversation of mechanical energy to the focal site from electrical energy. You then have a type of trauma at the fibrotic site ( poor healing area from the initial tear of pf) This mechanical induced trauma re-starts the initial healing process which is the inflamatory phase of wound healing , tendon healing and even bone healing.

Good nite and God bless . I may given the world the real reason why ESWT works. Or I am just describing the mechanism in different wording.

Re: Docs: You all mean risk at second shot per foot, don't you?

Dr. Zuckerman on 10/30/00 at 22:35 (031675)

Yes

We are taking about two shots in the same foot. Sorry about that

Re: heel spur consistency

Julie F on 10/31/00 at 03:25 (031682)

Dr Z, this is mind-boggling. Are you saying that if the body lays down a 'good' spur in response to the tear, it is the spur that heals the tear? And that if the bone-laying process is incomplete, that may be the reason why a case of PF lingers on despite conservative treatment? If so, what can we do to help the body form good spurs? More calcium? Anything else? Suggestions, please, for those of us who aren't candidates for ESWT (or aren't at that point yet).

Thank you for this fascinating post. Julie

Re: cortisone shots

john h on 10/31/00 at 11:32 (031700)

i still do not have an answer to my question concerning the number of cortisone shots that might safely be administered. let us say it is 3. is that 3 in a lifetime, 3 in a year? i recognize that each of us may have a fascia that is in a different state and each of us may be more or less suspetable to a rupture. i talked to one lady that said she had probably had 50 shots in her lifetime in the foot.

Re: cortisone shots

Dr. Biehler on 10/31/00 at 16:42 (031714)

Cortisone can cause atrophy while at the same time it priovides an antiinflamatory area which promotes healing. The body continuiously heals itself. The number of shots given,the damage done and the type of cotisone used are all variable factors that change with each individuale and situation. The cortisone only lasts for a certain amount of time. Some doctors will give a multiple series of water soluable cortisone shots as long as there are signs of improvement and the area of injection is not starting to break down, all a week or two apart. Others will use one non-soluable shot. There is also variance to the amount of cortisone used and if it is delivered mixed with lidocain or not. It all comes down to discussing it with your doctor and ariving at a place you both feel comfortable with. Dr. B.

Re: cortisone shots

john h on 11/02/00 at 09:59 (031813)

makes sense to me dr biehler. the one thing i read which seems very important is to restrict your activity for about 2 weeks after a shot. i had not read that until recently. i know, when i had a shot the doctor did not advise me to do anything (ice,restrict activity,etc)