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heelpain spur

Posted by bob on 8/09/01 at hrmin (056043)

what are the side effects of cortozone shots. how manyis to many?

Re: heelpain spur

Sebastian r on 8/09/01 at 15:59 (056063)

I had no side effects. I think the legal limit is three.

Re: heelpain spur--cortisone shots

Ed Davis, DPM on 8/09/01 at hrmin (056084)

'Cortisone' actually refers to a number of substances related to the natural substance, cortisol, which is produced by the adrenal glands.
These substances are also called catabolic steroids as opposed to the anabolic steroids used by body builders to enhance their results.

Catabolic steroids have powerful anti-inflammatory effects, can slow the healing process, and decrease scar tissue (fibrosis). Different type of such steroids or 'cortisone' are synthetic substances designed to give different primary effects. In other words, some types of 'cortisone' have strong anti-inflammatory effects (eg. dexamethasone phosphate) and others have little anti-inflammatory effects but strong anti-fibrosis effect (eg. triamcinolone acetonide). Some have such effects in different proportions, strengths and duration of action and thus there are several such products on the market.

We often divide the types of cortisone into 'repository' and 'non-repository' steroids. The non-repository steroids are generally clear in color, thin liquids, have strong anti-inflammatory effects but leave the tissues within a few days after being injected. They tend to enter the bloodstream quickly and thus are effective in helping to treat allergic reactions. They have very few side effects in the to which they are injected. There is no limit to how many injections one can get of a non-repository steroid due to the lack of permanent local tissue effects.
Their rapid absorbtion into the bloodstream can lead to temporary increases in blood pressure and blood sugar.

Repository steroids generally are thicker, white colored opaque liquids (suspensions) that have significant local tissue effects but less systemic absorbtion. Such types of cortisone can cause atrophy of the tissues into which they are injected. They weaken tissues and thus the user must understand the types of strain the tissues which such substances are being injected into undergo. There have been reports of spontaneous rupture of the achilles tendon after only one injection of repository steroids and thus 'cortisone' is rarely injected into the achilles tendon. It is significantly more rare for the plantar fascia to rupture after such an injection. Such a rupture of the plantar fascia would be the equivalent of a surgical plantar fascial release and thus may inadvertently cure the problem.

The type of 'cortisone' injected into the plantar fascia is generally a mixture of repository and non-repository steroids. There are some 'ready made' mixtures, one of the most popular ones being celestone soluspan.
Some docs like the convenience of such products, others prefer to mix them so that they can adjust the degree of anti-imflammatory action.

There is no law or rule that states that the limit to the number of injections is three. It really depends on what is used and how much is used on one shot. The number 'three' has become a popular limit and tends to be reasonable over a 6 month period of time. Repository steroid injections in a particular joint generally are limited to one every 3 months.

I have found that some of the toughest cases of plantar fasciitis are in patients who have had excessive numbers of injections. Occasionally we see the patient who has had 'one shot a month' for a year--they are typically in bad shape because any doctor who has rendered such treatment is not very knowledgeable about plantar fasciitis.
Ed

Re: heelpain spur--cortisone shots

wendyn on 8/09/01 at 22:44 (056117)

Dr Ed - that is the best explanation I have ever heard/read regarding how cortisone works and how it's used.

THANK YOU THANK YOU THANK YOU!

You continue to offer knowledgable but easy to understand information to everyone one here.

Re: heelpain spur--cortisone shots

Julie on 8/10/01 at 01:44 (056129)

Ed
Thanks so much for this. I've printed it out for further study and future reference.

Your explanations are always so clear - thank you for taking the time and trouble to do this. It's educative, and that's what we need.

Julie

Re: heelpain spur

john h on 8/10/01 at 09:13 (056146)

sebastian: i have talked to people who have had 10 or more shots in a year - believe it or not! there are people out there that will just about give them to you on demand.

Re: heelpain spur--cortisone shots

john h on 8/10/01 at 09:46 (056153)

dr davis: one of the foot and ankle orthopedic surgeons i visited had a spontanious rupture of the fascia after having PF for some years. she told me it in fact did cure her. that has been 10 or more years ago and she is fine and totally without pain. she sure understood me and my pf pain from personal experience. julie you would be interested to know she is very big into yoga and conducts yoga classes on a regular basis. she is not adverse to using non traditional medicine. she is an md with a speciality in foot and ankle surgery and a fellowship in same. a most unusual lady. i see her swimming frequently at a local club.

Re: Unusual lady.

Julie on 8/10/01 at 10:03 (056160)

She does sound an exceptional person. Do you still consult her?

Re: heelpain spur

Sebastian r on 8/09/01 at 15:59 (056063)

I had no side effects. I think the legal limit is three.

Re: heelpain spur--cortisone shots

Ed Davis, DPM on 8/09/01 at hrmin (056084)

'Cortisone' actually refers to a number of substances related to the natural substance, cortisol, which is produced by the adrenal glands.
These substances are also called catabolic steroids as opposed to the anabolic steroids used by body builders to enhance their results.

Catabolic steroids have powerful anti-inflammatory effects, can slow the healing process, and decrease scar tissue (fibrosis). Different type of such steroids or 'cortisone' are synthetic substances designed to give different primary effects. In other words, some types of 'cortisone' have strong anti-inflammatory effects (eg. dexamethasone phosphate) and others have little anti-inflammatory effects but strong anti-fibrosis effect (eg. triamcinolone acetonide). Some have such effects in different proportions, strengths and duration of action and thus there are several such products on the market.

We often divide the types of cortisone into 'repository' and 'non-repository' steroids. The non-repository steroids are generally clear in color, thin liquids, have strong anti-inflammatory effects but leave the tissues within a few days after being injected. They tend to enter the bloodstream quickly and thus are effective in helping to treat allergic reactions. They have very few side effects in the to which they are injected. There is no limit to how many injections one can get of a non-repository steroid due to the lack of permanent local tissue effects.
Their rapid absorbtion into the bloodstream can lead to temporary increases in blood pressure and blood sugar.

Repository steroids generally are thicker, white colored opaque liquids (suspensions) that have significant local tissue effects but less systemic absorbtion. Such types of cortisone can cause atrophy of the tissues into which they are injected. They weaken tissues and thus the user must understand the types of strain the tissues which such substances are being injected into undergo. There have been reports of spontaneous rupture of the achilles tendon after only one injection of repository steroids and thus 'cortisone' is rarely injected into the achilles tendon. It is significantly more rare for the plantar fascia to rupture after such an injection. Such a rupture of the plantar fascia would be the equivalent of a surgical plantar fascial release and thus may inadvertently cure the problem.

The type of 'cortisone' injected into the plantar fascia is generally a mixture of repository and non-repository steroids. There are some 'ready made' mixtures, one of the most popular ones being celestone soluspan.
Some docs like the convenience of such products, others prefer to mix them so that they can adjust the degree of anti-imflammatory action.

There is no law or rule that states that the limit to the number of injections is three. It really depends on what is used and how much is used on one shot. The number 'three' has become a popular limit and tends to be reasonable over a 6 month period of time. Repository steroid injections in a particular joint generally are limited to one every 3 months.

I have found that some of the toughest cases of plantar fasciitis are in patients who have had excessive numbers of injections. Occasionally we see the patient who has had 'one shot a month' for a year--they are typically in bad shape because any doctor who has rendered such treatment is not very knowledgeable about plantar fasciitis.
Ed

Re: heelpain spur--cortisone shots

wendyn on 8/09/01 at 22:44 (056117)

Dr Ed - that is the best explanation I have ever heard/read regarding how cortisone works and how it's used.

THANK YOU THANK YOU THANK YOU!

You continue to offer knowledgable but easy to understand information to everyone one here.

Re: heelpain spur--cortisone shots

Julie on 8/10/01 at 01:44 (056129)

Ed
Thanks so much for this. I've printed it out for further study and future reference.

Your explanations are always so clear - thank you for taking the time and trouble to do this. It's educative, and that's what we need.

Julie

Re: heelpain spur

john h on 8/10/01 at 09:13 (056146)

sebastian: i have talked to people who have had 10 or more shots in a year - believe it or not! there are people out there that will just about give them to you on demand.

Re: heelpain spur--cortisone shots

john h on 8/10/01 at 09:46 (056153)

dr davis: one of the foot and ankle orthopedic surgeons i visited had a spontanious rupture of the fascia after having PF for some years. she told me it in fact did cure her. that has been 10 or more years ago and she is fine and totally without pain. she sure understood me and my pf pain from personal experience. julie you would be interested to know she is very big into yoga and conducts yoga classes on a regular basis. she is not adverse to using non traditional medicine. she is an md with a speciality in foot and ankle surgery and a fellowship in same. a most unusual lady. i see her swimming frequently at a local club.

Re: Unusual lady.

Julie on 8/10/01 at 10:03 (056160)

She does sound an exceptional person. Do you still consult her?