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Where on the foot do you put the injection

Posted by Jana on 5/15/01 at hrmin (047873)

Where do you put cortisone injections?

My current doctor says he puts the injection in the arch (the side of the foot).
This seems like an odd play since the pain is at the bottom.

Re: Where on the foot do you put the injection

Dr. David S. Wander on 5/15/01 at 21:39 (047876)

This is really dependent on the doctor. Many doctors inject at the side of the heel and aim at the area of the origin of the plantar fascia. Other doctors inject directly into the bottom of the foot. This is really up to the individual doctor, since there are pro's and con's to both methods. I've had success with both locations, and it's really a matter of personal preference.

Re: Where on the foot do you put the injection

Dr. Zuckerman on 5/16/01 at 09:18 (047938)

I like the side. It is very easy to get to the area from the side. With proper palpation and experience. My own personal opinon is the bottom approach is very painful and sometime can be cruel

Re: Where on the foot do you put the injection

Dr. David S. Wander on 5/16/01 at 14:17 (047970)

Dr. Zuckerman, although I know you're joking, I don't think it is cruel to give an injection at the bottom of the heel. I often give injections plantarly, when I feel it is indicated. I have not had patients relate any increased pain with plantar injections when compared to medial injections. It's all a matter of technique, experience and the comfort level of the doctor. I don't treat my patients cruelly, and think it is very unwise to tell patients that plantar injections are cruel, even if you're joking.

Re: Where on the foot do you put the injection

Dr. Zuckerman on 5/16/01 at 18:01 (047986)

OK,

I am not joking it is cruel and not needed. This is my personal opinion it is someething that I have observed . PLANTAR INJECTIONS HURT!!!

Now if you really want to do them I recommend a combination of a posterior nerve block and then the plantar injection.

Let's see I saw my father put patients on the ceiling with the plantar injection.

I saw my some of my ex-associates cause tears in the eyes of patients.

Noticed I just told you ex

Re: Where on the foot do you put the injection

Tammie on 5/16/01 at 18:27 (047995)

Jana,
I recieved two cortisone shots, one was under on the heel and one was to the side. I was terrified of them truly I was I was in tears before he even did the first which was to the side of the heel, he promised me he would go slow and he would stop if it hurt , I must say he was true to his words, he put in something first it sounded like a click noise like a staple gun? Then he did the shot and went slow talking about anything to relax me It was not bad not something I want to do every day mind u but bearable! The second and last cortisone shot was done the same way only underneath he did the exact same way, knowing my fear, he was gentle and yes the second was a bit worse I thought maybe he got to the tender area more as I did tear up and not from the fear, I squezed my hubbys hand for that one. I found there was more pain later after the shot,maybe a few hours later. I vowed after that last one it would take allot for me to let anyone do that again!!!!!! I do not know if where it was done was the reason or if it was the spot he hit as my foot was a pretty hot spot anyways when he did the last one. I believe the dr.s can give good shots and can also give bad ones,but if u let them know you are terrified they try harder to make it better for you. I thought my last one the dr. was mad cause I wanted it as a last trial before I consented to the surgery and my hubby and him at that point wanted me to just scheduale the surgery without the last trial of cortisone. Which did not work for me I might add. I was wrong and they were right. Anyways Jana let him know in advance if u are scared and hopefully he will be patient and gentle!!!!Good Luck and let us know how it works out for you!

Re: Where on the foot do you put the injection

Dr. David S. Wander on 5/16/01 at 20:07 (048007)

Dr. Zuckerman, give me a call and I'll give you the name of hundreds of patients that I've injected via plantar injections and medial injections and I'll let you ask them if it was cruel. To say that plantar injections are 'not needed' is ridiculous. To state that your patients have experienced severe pain from plantar injections may be accurate, but I can assure you that I have not experienced this in my practice. I have never given an ankle block prior to giving a plantar injection for heel pain, because I haven't found it necessary. When I give injections from a plantar approach, I use a topical anesthetic and inject very slowly, therefore the discomfort level is extremely low and I slowly move the needle to the exact area I am aiming for. It is possible to hit the nerve directly and cause significant discomfort when injecting medially and cause post injection pain. I am not questioning your technique or rationale for injecting medially (and I do inject medially when I feel it is indicated), and I don't expect you to criticize my technique or philosophy unless you've seen me inject or spoken with my patients.
In my previous posting I simply stated that the area of injection is a personal preference of the doctor, and to make a blanket statement that all plantar injections are cruel is simply irresponsible.

Re: Where on the foot do you put the injection

Dr. David S. Wander on 5/16/01 at 20:11 (048009)

Tammie,
I think that your posting was very well stated. It is truly dependent on the technique and attitude of the doctor and not the site of the injection.

Re: Where on the foot do you put the injection

MarthaB. on 5/16/01 at 20:31 (048010)

I was crazy or dumb enough to get 4 shots in 1 foot and 3 in the other and all of them were excruciating!! The pod did all of them in the heel. I hadnt found heelspurs.com prior to getting them or I wouldnt have done it. Guess I was so desperate for pain relief I didnt research cortisone. Ossatron worked for me thank the Lord!

Re: Where on the foot do you put the injection

Dr. Zuckerman on 5/16/01 at 22:08 (048018)

I have more to say about this. It is my opinion and I stand by it.

Re: How many months post-ossatron are you

Dr. Zuckerman on 5/16/01 at 22:10 (048020)

Martha

how many months are you post-ossatron now.

Re: Where on the foot do you put the injection

wendyn on 5/16/01 at 22:46 (048026)

My two cents on injections...I know nothing about foot injections...

My dentist is SO SKILLED at giving the freezing for fillings...he froze my 7 year old...and afterwards my son did not even realize he'd had a needle - I THANK the dentist every time he freezes me...he is that good.

We drive 45 minutes across the city to go to him, rather than see anyone else.

For dentists anyway - technique is everything.

Re: Where on the foot do you put the injection

Dr. David S. Wander on 5/17/01 at 08:24 (048059)

Wendy, that is exactly my point. Technique when administering injections can make a huge difference in patient comfort levels. If Dr. Zuckerman would like to discuss this or debate this further, I don't think this is the forum. I'd be happy to speak with him on the phone or in person if he'd like to discuss this matter.

Re: Where on the foot do you put the injection

JudyS on 5/17/01 at 10:22 (048083)

Jana - I'm so sorry to see that you're still suffering with PF! Are you seeing the same Pod? I've had the shots both in the bottom of my foot as well as in the side. The side was less painful but it was also after I'd had about 60 to 70% recovery from PF. None of the shots helped me butt I understand that they have helped many others.

Re: Where on the foot do you put the injection

Dr. Biehler on 5/17/01 at 14:16 (048104)

I have given shots from the side and the bottom. I am tending to go more for the bottom shot as it is easier to get the shot to the exact point intended, and for plantar fasccitis, it is easier to deposit the cortizone both above and below the fascia at the exact point needed. Heels can be in different degrees of pain and inflamation. If need, it is easy to numb the heel prior to the injection with a posterior tibial nerve block. These blocks are relativly painless. Dr. B.

Re: Where on the foot do you put the injection

Dr. David S. Wander on 5/17/01 at 21:02 (048152)

I agree with Dr. Biehler that it is often easier to reach the painful area more accurately with a plantar (bottom) injection. In my own experience, injections plantarly have not caused the patients any addtional discomfort, and I have had more long term relief of symptoms with the injections given plantarly. Fortunately, I have not found it necessary to perform an ankle block prior to giving a plantar injection.

Re: How many months post-ossatron are you

MarthaB. on 5/20/01 at 20:23 (048419)

Been out of town so didnt see your note til tonite. I had ossatron Sept.of 1999.

Re: How many months post-ossatron are you

Dr. Zuckerman on 5/21/01 at 21:25 (048519)

Thanks. I have some seventeen month old orbasones still pain free. When it works it is so amazing

Re: Where on the foot do you put the injection

Dr. David S. Wander on 5/15/01 at 21:39 (047876)

This is really dependent on the doctor. Many doctors inject at the side of the heel and aim at the area of the origin of the plantar fascia. Other doctors inject directly into the bottom of the foot. This is really up to the individual doctor, since there are pro's and con's to both methods. I've had success with both locations, and it's really a matter of personal preference.

Re: Where on the foot do you put the injection

Dr. Zuckerman on 5/16/01 at 09:18 (047938)

I like the side. It is very easy to get to the area from the side. With proper palpation and experience. My own personal opinon is the bottom approach is very painful and sometime can be cruel

Re: Where on the foot do you put the injection

Dr. David S. Wander on 5/16/01 at 14:17 (047970)

Dr. Zuckerman, although I know you're joking, I don't think it is cruel to give an injection at the bottom of the heel. I often give injections plantarly, when I feel it is indicated. I have not had patients relate any increased pain with plantar injections when compared to medial injections. It's all a matter of technique, experience and the comfort level of the doctor. I don't treat my patients cruelly, and think it is very unwise to tell patients that plantar injections are cruel, even if you're joking.

Re: Where on the foot do you put the injection

Dr. Zuckerman on 5/16/01 at 18:01 (047986)

OK,

I am not joking it is cruel and not needed. This is my personal opinion it is someething that I have observed . PLANTAR INJECTIONS HURT!!!

Now if you really want to do them I recommend a combination of a posterior nerve block and then the plantar injection.

Let's see I saw my father put patients on the ceiling with the plantar injection.

I saw my some of my ex-associates cause tears in the eyes of patients.

Noticed I just told you ex

Re: Where on the foot do you put the injection

Tammie on 5/16/01 at 18:27 (047995)

Jana,
I recieved two cortisone shots, one was under on the heel and one was to the side. I was terrified of them truly I was I was in tears before he even did the first which was to the side of the heel, he promised me he would go slow and he would stop if it hurt , I must say he was true to his words, he put in something first it sounded like a click noise like a staple gun? Then he did the shot and went slow talking about anything to relax me It was not bad not something I want to do every day mind u but bearable! The second and last cortisone shot was done the same way only underneath he did the exact same way, knowing my fear, he was gentle and yes the second was a bit worse I thought maybe he got to the tender area more as I did tear up and not from the fear, I squezed my hubbys hand for that one. I found there was more pain later after the shot,maybe a few hours later. I vowed after that last one it would take allot for me to let anyone do that again!!!!!! I do not know if where it was done was the reason or if it was the spot he hit as my foot was a pretty hot spot anyways when he did the last one. I believe the dr.s can give good shots and can also give bad ones,but if u let them know you are terrified they try harder to make it better for you. I thought my last one the dr. was mad cause I wanted it as a last trial before I consented to the surgery and my hubby and him at that point wanted me to just scheduale the surgery without the last trial of cortisone. Which did not work for me I might add. I was wrong and they were right. Anyways Jana let him know in advance if u are scared and hopefully he will be patient and gentle!!!!Good Luck and let us know how it works out for you!

Re: Where on the foot do you put the injection

Dr. David S. Wander on 5/16/01 at 20:07 (048007)

Dr. Zuckerman, give me a call and I'll give you the name of hundreds of patients that I've injected via plantar injections and medial injections and I'll let you ask them if it was cruel. To say that plantar injections are 'not needed' is ridiculous. To state that your patients have experienced severe pain from plantar injections may be accurate, but I can assure you that I have not experienced this in my practice. I have never given an ankle block prior to giving a plantar injection for heel pain, because I haven't found it necessary. When I give injections from a plantar approach, I use a topical anesthetic and inject very slowly, therefore the discomfort level is extremely low and I slowly move the needle to the exact area I am aiming for. It is possible to hit the nerve directly and cause significant discomfort when injecting medially and cause post injection pain. I am not questioning your technique or rationale for injecting medially (and I do inject medially when I feel it is indicated), and I don't expect you to criticize my technique or philosophy unless you've seen me inject or spoken with my patients.
In my previous posting I simply stated that the area of injection is a personal preference of the doctor, and to make a blanket statement that all plantar injections are cruel is simply irresponsible.

Re: Where on the foot do you put the injection

Dr. David S. Wander on 5/16/01 at 20:11 (048009)

Tammie,
I think that your posting was very well stated. It is truly dependent on the technique and attitude of the doctor and not the site of the injection.

Re: Where on the foot do you put the injection

MarthaB. on 5/16/01 at 20:31 (048010)

I was crazy or dumb enough to get 4 shots in 1 foot and 3 in the other and all of them were excruciating!! The pod did all of them in the heel. I hadnt found heelspurs.com prior to getting them or I wouldnt have done it. Guess I was so desperate for pain relief I didnt research cortisone. Ossatron worked for me thank the Lord!

Re: Where on the foot do you put the injection

Dr. Zuckerman on 5/16/01 at 22:08 (048018)

I have more to say about this. It is my opinion and I stand by it.

Re: How many months post-ossatron are you

Dr. Zuckerman on 5/16/01 at 22:10 (048020)

Martha

how many months are you post-ossatron now.

Re: Where on the foot do you put the injection

wendyn on 5/16/01 at 22:46 (048026)

My two cents on injections...I know nothing about foot injections...

My dentist is SO SKILLED at giving the freezing for fillings...he froze my 7 year old...and afterwards my son did not even realize he'd had a needle - I THANK the dentist every time he freezes me...he is that good.

We drive 45 minutes across the city to go to him, rather than see anyone else.

For dentists anyway - technique is everything.

Re: Where on the foot do you put the injection

Dr. David S. Wander on 5/17/01 at 08:24 (048059)

Wendy, that is exactly my point. Technique when administering injections can make a huge difference in patient comfort levels. If Dr. Zuckerman would like to discuss this or debate this further, I don't think this is the forum. I'd be happy to speak with him on the phone or in person if he'd like to discuss this matter.

Re: Where on the foot do you put the injection

JudyS on 5/17/01 at 10:22 (048083)

Jana - I'm so sorry to see that you're still suffering with PF! Are you seeing the same Pod? I've had the shots both in the bottom of my foot as well as in the side. The side was less painful but it was also after I'd had about 60 to 70% recovery from PF. None of the shots helped me butt I understand that they have helped many others.

Re: Where on the foot do you put the injection

Dr. Biehler on 5/17/01 at 14:16 (048104)

I have given shots from the side and the bottom. I am tending to go more for the bottom shot as it is easier to get the shot to the exact point intended, and for plantar fasccitis, it is easier to deposit the cortizone both above and below the fascia at the exact point needed. Heels can be in different degrees of pain and inflamation. If need, it is easy to numb the heel prior to the injection with a posterior tibial nerve block. These blocks are relativly painless. Dr. B.

Re: Where on the foot do you put the injection

Dr. David S. Wander on 5/17/01 at 21:02 (048152)

I agree with Dr. Biehler that it is often easier to reach the painful area more accurately with a plantar (bottom) injection. In my own experience, injections plantarly have not caused the patients any addtional discomfort, and I have had more long term relief of symptoms with the injections given plantarly. Fortunately, I have not found it necessary to perform an ankle block prior to giving a plantar injection.

Re: How many months post-ossatron are you

MarthaB. on 5/20/01 at 20:23 (048419)

Been out of town so didnt see your note til tonite. I had ossatron Sept.of 1999.

Re: How many months post-ossatron are you

Dr. Zuckerman on 5/21/01 at 21:25 (048519)

Thanks. I have some seventeen month old orbasones still pain free. When it works it is so amazing