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Steroid injections-How many can you have?

Posted by Kim Klein on 7/04/01 at hrmin (052198)

I would like to know how many steroid injections can you have in one foot, my new Podiatrist says up to 12. I had another podiatrist say up to three. Is there a risk of tearing the plantar fascia with too many injections and how can this happen? Is tearing of the plantar fascia a very dangerous consequence? I would appreciate some feedback on this.

Re: Steroid injections-How many can you have?

Julie on 7/04/01 at 10:58 (052201)

Kim, I think your second podiatrist is right (some think two is maximum). Repeated steroid injections can weaken the tissues - and seldom do more than give temporary relief. Perhaps one of the doctors will come in with more detail.

Re: Steroid injections-How many can you have?

john h on 7/04/01 at 11:10 (052205)

julie: is your understanding two in a year or two in a lifetime?

Re: Steroid injections-How many can you have?

Julie on 7/04/01 at 11:22 (052208)

I would imagine it depends on the individual and the rate at which that person's tissues recover. What do you think? I don't know whether steroids do permanent, undo-able damage. I remember my doctor telling me that he was happy doing two injections for my tennis elbow, and I had them. Three or four years later it recurred, he said it would be all right to do two more, and I had them and have been ok since (about 15 years). So I doubt there was permanent damage. My stab at responding to the question was in the context of a podiatrist saying 12 (presumably during the duration of a continuous 'attack' of pf) was all right. But - the usual disclaimer - I am not a doctor.

Re: Steroid injections-How many can you have?

john h on 7/04/01 at 12:58 (052218)

using the same disclaimer i suspect it would be 2 in a year. lots of people get injections in the shoulder, back, elbow throughout their lives (within limits).athletes get them routinely. as you say everyone is different and age, condition of the fascia, etc would all play arole.

Re: Steroid injections-How many can you have?

wendyn on 7/04/01 at 13:50 (052221)

There is a risk of rupturing the PF - the more doses you have, I would think would increase the risk.

You also run the risk of decreasing the fat pad on the heel (which can't be replaced).

For most people a shot or two is usually okay - but 12 sounds like an awful lot.

Better to get the source of the problem (i.e. shoes or pronation etc) and try to deal with it that way.

Re: Steroid injections-How many can you have?

Julie on 7/04/01 at 16:52 (052230)

Yes - but I wouldn't hold athletes up as an example to follow. They do all sorts of damaging things to themselves in pursuit of their short careers, and many of them pay dearly for it later in life.

Re: Steroid injections-How many can you have?

Kay S on 7/04/01 at 20:12 (052244)

Hi Kim. Most of us have been advised to have no more than three in one year. I work at a hospital with a pain clinic, and that's what our docs tell their patients about steroid injections. Also, you can rupture the fascia if you get too many, and that is BAD. I would definitely get another opinion before having that doctor inject you. At least think about it.
Kay

Re: Steroid injections-How many can you have?

Kim K. on 7/05/01 at 11:13 (052283)

Thanks for the replies, I am going to get another opinion from a podiatrist before getting any more injections. So far he has given me two injections that only last a day or two. I had two injections last year from my former podiatrist. I have orthotics for nine months now, I use night splints, I've tried ibuprofen, aleve, vioxx, and now I am on Indocin. I am still in alot of pain from my PF in both heels, the left is worse. I am getting very discouraged. I need to lose weight , but I cant do any weight bearing exercise like walking, which I love. I am trying to swim everyday and eating a low fat , high fiber diet. I need to lose at least 50 lbs which is not going to happen overnight. I am looking into ESWT or surgery in the near future.

Re: Kim, what else are you doing?

Julie on 7/05/01 at 12:07 (052287)

Kim, we've concentrated on responding to your question about steroid injections, but I'd like to ask you now what else has your podiatrist come up with to help you?

There is so much you can do to help yourself! Read the heel pain book for information about conservative treatments for dealing with PF, and then come back and ask more questions.

Re: Steroid injections-How many can you have?

Julie on 7/05/01 at 12:09 (052288)

Kim, I've just seen your post on the Doctors' board. I think your instincts are right. If your pod talks down to you and has nothing to offer you but injections - find another.

Re: Re:Thanks Julie for your support

Kim K. on 7/05/01 at 18:45 (052303)

Thank you for your reply, I cancelled my appointment with the Podiatrist who talks down to me and going back to my original podiatrist. I am going to tell him about the Dr. who loves to give steroid shots and how he put me on indocin. My original Dr. started me with orthotics, stretching, night splints, ibuprofin, aleve,and vioxx. I started feeling a little better and began walking for exercise again, then I had a set back and am in alot of pain now. The steroid injections only last a few days at best.

Re: Re:Thanks Julie for your support

Julie on 7/06/01 at 05:04 (052322)

Hi Kim

I guess it might have been the walking for exercise that set you back. It does seem that REST is essential for healing in plantar fasciitis. Do try to keep off your feet as much as possible - i.e. only essential walking. Never go barefoot, not even when you get up in the night, and be patient. It will get better, but it does need rest.

Sometimes the most important 'treatments' are not what we do, but what we refrain from doing.

Take care with stretching.The generally recommended 'wall stretches' can do more harm than good. Non-weight-bearing stretching and strengthening exercises are more appropriate. For general exercise, as a substitute for walking, have you thought about swimming? Wonderful non-weight-bearing aerobic exercise. And lots of people here have found the stationary bike helpful.

Taping (see the heel pain book for instructions) rests the fascia and thus helps with healing as well as relieving the pain.

Icing relieves inflammation.

I'm glad you are dumping the needle-happy talk-down guy! Good luck.

Re: Re:Thanks Julie for your support

Eleanor L on 7/08/01 at 09:35 (052458)

I have had 3 injections of steriod since late February and have had only temporary relief. After checking this website I startd ice,rest,some stretching and have substitued the stationary bike for walking. After one week I noticed a great deal of relief. Can one ever go back to walking as an exercise?

Re: Re:Thanks Julie for your support

Nancy N on 7/07/01 at 21:58 (052484)

Eleanor--

It's possible to go back to walking for exercise--but it's best to wait until you feel 'cured' for several weeks before starting a walking program, and I would take it slowly, gradually increasing your walking time, and being sure you pay attention to any signs of trouble. Ultimately, your feet will tell you when they're up to it.

Re: Steroid injections-How many can you have?

Jeff on 7/20/01 at hrmin (053847)

Kim,
Injectable steroids don't really come with directions for treating one pain vs another. As a result, there's some controversy about overuse. If something doesn't work with one or two tries, why use more?
Jeff

Re: Steroid injections-How many can you have?

Julie on 7/04/01 at 10:58 (052201)

Kim, I think your second podiatrist is right (some think two is maximum). Repeated steroid injections can weaken the tissues - and seldom do more than give temporary relief. Perhaps one of the doctors will come in with more detail.

Re: Steroid injections-How many can you have?

john h on 7/04/01 at 11:10 (052205)

julie: is your understanding two in a year or two in a lifetime?

Re: Steroid injections-How many can you have?

Julie on 7/04/01 at 11:22 (052208)

I would imagine it depends on the individual and the rate at which that person's tissues recover. What do you think? I don't know whether steroids do permanent, undo-able damage. I remember my doctor telling me that he was happy doing two injections for my tennis elbow, and I had them. Three or four years later it recurred, he said it would be all right to do two more, and I had them and have been ok since (about 15 years). So I doubt there was permanent damage. My stab at responding to the question was in the context of a podiatrist saying 12 (presumably during the duration of a continuous 'attack' of pf) was all right. But - the usual disclaimer - I am not a doctor.

Re: Steroid injections-How many can you have?

john h on 7/04/01 at 12:58 (052218)

using the same disclaimer i suspect it would be 2 in a year. lots of people get injections in the shoulder, back, elbow throughout their lives (within limits).athletes get them routinely. as you say everyone is different and age, condition of the fascia, etc would all play arole.

Re: Steroid injections-How many can you have?

wendyn on 7/04/01 at 13:50 (052221)

There is a risk of rupturing the PF - the more doses you have, I would think would increase the risk.

You also run the risk of decreasing the fat pad on the heel (which can't be replaced).

For most people a shot or two is usually okay - but 12 sounds like an awful lot.

Better to get the source of the problem (i.e. shoes or pronation etc) and try to deal with it that way.

Re: Steroid injections-How many can you have?

Julie on 7/04/01 at 16:52 (052230)

Yes - but I wouldn't hold athletes up as an example to follow. They do all sorts of damaging things to themselves in pursuit of their short careers, and many of them pay dearly for it later in life.

Re: Steroid injections-How many can you have?

Kay S on 7/04/01 at 20:12 (052244)

Hi Kim. Most of us have been advised to have no more than three in one year. I work at a hospital with a pain clinic, and that's what our docs tell their patients about steroid injections. Also, you can rupture the fascia if you get too many, and that is BAD. I would definitely get another opinion before having that doctor inject you. At least think about it.
Kay

Re: Steroid injections-How many can you have?

Kim K. on 7/05/01 at 11:13 (052283)

Thanks for the replies, I am going to get another opinion from a podiatrist before getting any more injections. So far he has given me two injections that only last a day or two. I had two injections last year from my former podiatrist. I have orthotics for nine months now, I use night splints, I've tried ibuprofen, aleve, vioxx, and now I am on Indocin. I am still in alot of pain from my PF in both heels, the left is worse. I am getting very discouraged. I need to lose weight , but I cant do any weight bearing exercise like walking, which I love. I am trying to swim everyday and eating a low fat , high fiber diet. I need to lose at least 50 lbs which is not going to happen overnight. I am looking into ESWT or surgery in the near future.

Re: Kim, what else are you doing?

Julie on 7/05/01 at 12:07 (052287)

Kim, we've concentrated on responding to your question about steroid injections, but I'd like to ask you now what else has your podiatrist come up with to help you?

There is so much you can do to help yourself! Read the heel pain book for information about conservative treatments for dealing with PF, and then come back and ask more questions.

Re: Steroid injections-How many can you have?

Julie on 7/05/01 at 12:09 (052288)

Kim, I've just seen your post on the Doctors' board. I think your instincts are right. If your pod talks down to you and has nothing to offer you but injections - find another.

Re: Re:Thanks Julie for your support

Kim K. on 7/05/01 at 18:45 (052303)

Thank you for your reply, I cancelled my appointment with the Podiatrist who talks down to me and going back to my original podiatrist. I am going to tell him about the Dr. who loves to give steroid shots and how he put me on indocin. My original Dr. started me with orthotics, stretching, night splints, ibuprofin, aleve,and vioxx. I started feeling a little better and began walking for exercise again, then I had a set back and am in alot of pain now. The steroid injections only last a few days at best.

Re: Re:Thanks Julie for your support

Julie on 7/06/01 at 05:04 (052322)

Hi Kim

I guess it might have been the walking for exercise that set you back. It does seem that REST is essential for healing in plantar fasciitis. Do try to keep off your feet as much as possible - i.e. only essential walking. Never go barefoot, not even when you get up in the night, and be patient. It will get better, but it does need rest.

Sometimes the most important 'treatments' are not what we do, but what we refrain from doing.

Take care with stretching.The generally recommended 'wall stretches' can do more harm than good. Non-weight-bearing stretching and strengthening exercises are more appropriate. For general exercise, as a substitute for walking, have you thought about swimming? Wonderful non-weight-bearing aerobic exercise. And lots of people here have found the stationary bike helpful.

Taping (see the heel pain book for instructions) rests the fascia and thus helps with healing as well as relieving the pain.

Icing relieves inflammation.

I'm glad you are dumping the needle-happy talk-down guy! Good luck.

Re: Re:Thanks Julie for your support

Eleanor L on 7/08/01 at 09:35 (052458)

I have had 3 injections of steriod since late February and have had only temporary relief. After checking this website I startd ice,rest,some stretching and have substitued the stationary bike for walking. After one week I noticed a great deal of relief. Can one ever go back to walking as an exercise?

Re: Re:Thanks Julie for your support

Nancy N on 7/07/01 at 21:58 (052484)

Eleanor--

It's possible to go back to walking for exercise--but it's best to wait until you feel 'cured' for several weeks before starting a walking program, and I would take it slowly, gradually increasing your walking time, and being sure you pay attention to any signs of trouble. Ultimately, your feet will tell you when they're up to it.

Re: Steroid injections-How many can you have?

Jeff on 7/20/01 at hrmin (053847)

Kim,
Injectable steroids don't really come with directions for treating one pain vs another. As a result, there's some controversy about overuse. If something doesn't work with one or two tries, why use more?
Jeff