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How many cortisone shots?

Posted by Paula S on 1/29/02 at 14:54 (071820)

I have seen several doctors over the past 4 years for my pf, and some have recommended a series of up to 10 cortisone shots (which I refused). Is this normal, especially considering the first shot I received only helped for 2 weeks? I have seen other doctors who recommended absolutely no more than 3 shots in the same area per lifetime.

Re: How many cortisone shots?

DR Zuckerman on 1/29/02 at 18:12 (071842)

The fact that they aren't removing the pain in a very good indicator to stop with the shots. Too many steriod injections can cause rupture, loss of fat padding . There are studies showing an average of two can cause a rupture of the plantar fascia in 10% of the patients receiveing just two
local steriod injections

Re: How many cortisone shots?

Dr. Marlene Reid on 1/29/02 at 22:22 (071878)

The general rule is 3 shots to an area in a year, not a lifetime. And I say general, if a patient had success with 2 treatments 6 months ago and the heel pain was back, I would give an additional 2, but no more. I have given 4 shots within a few months as well, depending on the person's response. Sometimes, the shot actually misses the spot. If the first shot does nothing but the second gives 40-50% improvment and an additional 30% with the third, I would try a 4th if physical therapy, shoe/orthotic therapy did not get the last 20-30%.

Re: How many cortisone shots?

Dr. Zuckerman on 1/30/02 at 11:11 (071930)

Over the past two years I have seen too many plantar fascia ruptures 2nd to local steriod injections. We must be very careful when we give these injections. They can rupture the fascia and leave the foot in pain for a very long time, sometimes there damage can be forever

Re: How many cortisone shots?

Paula S on 1/30/02 at 13:55 (071951)

Dr. Zuckerman, about 3 weeks after my first (and only) cortisone shot, my feet were hurting badly again, and my doctor gave me a night splint. The first morning after I wore the splint, I was in so much pain that I could not walk at all. Not just regular pf morning pain but excruciating pain that did not go away with walking. I was given crutches and a walking cast for 6 weeks. The doctor said it was possible that I had a rupture because the fascia was weak from the shot and then wearing the splint was too much. The same doc has said at subsequent appts that it was the splint I should have more shots. I've refused to have any more shots because of that incident. Even though the cast and crutches relieved the pain for awhile, the pain is back and is worse than ever since.

Re: How many cortisone shots?

DR Zuckerman on 1/30/02 at 14:53 (071959)

Sounds like a rupture to me. Cast, rest, and physical therapy are important. In the cases that don't resolve with above ESWT can help alot

Re: How many cortisone shots?

Janice L on 2/06/02 at 10:49 (072783)

How it a rupture diagnosed; i.e., x-ray, physical examination, ???

Re: How many cortisone shots?

Dr. Zuckerman on 2/06/02 at 11:42 (072786)

Physical examination with comparison of the other foot is very important

Re: How many cortisone shots?

DR Zuckerman on 1/29/02 at 18:12 (071842)

The fact that they aren't removing the pain in a very good indicator to stop with the shots. Too many steriod injections can cause rupture, loss of fat padding . There are studies showing an average of two can cause a rupture of the plantar fascia in 10% of the patients receiveing just two
local steriod injections

Re: How many cortisone shots?

Dr. Marlene Reid on 1/29/02 at 22:22 (071878)

The general rule is 3 shots to an area in a year, not a lifetime. And I say general, if a patient had success with 2 treatments 6 months ago and the heel pain was back, I would give an additional 2, but no more. I have given 4 shots within a few months as well, depending on the person's response. Sometimes, the shot actually misses the spot. If the first shot does nothing but the second gives 40-50% improvment and an additional 30% with the third, I would try a 4th if physical therapy, shoe/orthotic therapy did not get the last 20-30%.

Re: How many cortisone shots?

Dr. Zuckerman on 1/30/02 at 11:11 (071930)

Over the past two years I have seen too many plantar fascia ruptures 2nd to local steriod injections. We must be very careful when we give these injections. They can rupture the fascia and leave the foot in pain for a very long time, sometimes there damage can be forever

Re: How many cortisone shots?

Paula S on 1/30/02 at 13:55 (071951)

Dr. Zuckerman, about 3 weeks after my first (and only) cortisone shot, my feet were hurting badly again, and my doctor gave me a night splint. The first morning after I wore the splint, I was in so much pain that I could not walk at all. Not just regular pf morning pain but excruciating pain that did not go away with walking. I was given crutches and a walking cast for 6 weeks. The doctor said it was possible that I had a rupture because the fascia was weak from the shot and then wearing the splint was too much. The same doc has said at subsequent appts that it was the splint I should have more shots. I've refused to have any more shots because of that incident. Even though the cast and crutches relieved the pain for awhile, the pain is back and is worse than ever since.

Re: How many cortisone shots?

DR Zuckerman on 1/30/02 at 14:53 (071959)

Sounds like a rupture to me. Cast, rest, and physical therapy are important. In the cases that don't resolve with above ESWT can help alot

Re: How many cortisone shots?

Janice L on 2/06/02 at 10:49 (072783)

How it a rupture diagnosed; i.e., x-ray, physical examination, ???

Re: How many cortisone shots?

Dr. Zuckerman on 2/06/02 at 11:42 (072786)

Physical examination with comparison of the other foot is very important