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Steroid injection

Posted by Rachel W. on 6/16/02 at 07:16 (087723)

I had a steroid injection in my right heel on Friday. It felt like a pea was underneath the skin at first. The next day, which was yesterday, it felt a bit better than it was before the injection, but today it seems to have got worse again.
So, the steroid injection seems to have helped me for one day.
Has this ever happened to anyone else or am I just a stubborn case in absolutely everything I try?

Re: Steroid injection

nancy s. on 6/16/02 at 07:35 (087725)

rachel, i'm not a doctor, but the pf relief from the one cortisone shot i had lasted about as long as the anesthetic. then i was back in the same boat i'd been in.

i have no clue about the statistics, but my impression from two and a half years on the board is that the majority of difficult pf cases tend not to respond much to The Shot. (doctors, please correct me if i'm wrong.) i'd move on to longer-term possible solutions if i were you and not worry about this.

good luck from nancy

Re: Steroid injection

Rachel W. on 6/16/02 at 07:49 (087726)

Thankyou Nancy. I'll just have to keep trying other things until I find something that works.

Night splints next I think.

Rachel.

Re: Steroid injection

Dr. David S. Wander on 6/17/02 at 20:11 (087854)

Patients often have significant relief with steroid injections. Naturally, the injection simply treats the symptoms and not the problem, therefore additional treatment is also necessary such as taping, orthoses, night splints, ice, stretching, etc. There is one very important point that must be addressed. Although I perform ESWT, EPF and offer a wide spectrum of treatments for heel pain, it should be emphasized that most patients obtain relief without ESWT or surgery. Most of the patients on this web site have failed conservative care, therefore it almost seems as if all patients have chronic plantar fasciitis. Fortunately, this site exists for those who are in pain and need help due to failed conservative care. Fortunately, most of the patients on this site are in the minority. When reading posts on this site, it is easy to forget that these cases are the 'tough' ones, because the patients that obtain relief in a few visits to the doctor don't visit this site!

Re: Steroid injection

nancy s. on 6/18/02 at 03:20 (087869)

thank you, dr. wander, for this additional info and perspective.

i have a question for you. the podiatrist i saw initially in 1999 gave me a cortisone shot at my first appointment, prescribed a night splint, and then, when those things didn't help, ordered hard plastic 3/4 orthotics, which made my pf worse. he then scheduled me for epf surgery.

throughout my first eight months of pf, he never examined my gait, never examined the shoes i was wearing (though i asked him). he failed to prescribe rest, to tell me about icing, to give me stretches or any other kind of non-weight-bearing exercise that might have helped.

when i inquired about physical therapy, he said, 'might make it worse.' i learned of the multitude of conservative measures only after finding heelspurs.com, at which point i canceled my surgery. after changing my footwear to birkenstocks and a three-month self-imposed rest based on info at this site, and then two years of conservative measures under the care of another doctor, plus six months of physical therapy, i finally started to get better.

my question is this: was my failure to respond to the cortisone shot any sort of indicator that conservative measures were going to take a long time to help me? oh, and another two: do you think it's common (and wise) to give a shot on the very first pf appointment? and what do you think of a podiatrist who schedules surgery after eight months of trying almost no conservative measures? this person is long gone from my life; i'm just curious.

thanks very much for your time.

nancy

Re: Steroid injection

Dr. David S. Wander on 6/18/02 at 07:42 (087877)

Nancy,

I'll attempt to answer one question at a time. In my practice, failure to obtain relief with a cortisone injection is not necessarily an indicator of who will fail conservative care. There are many variables, including the placement of the injection, etc. Although I rarely give an injection on the first visit, if a patient is in significant discomfort and I don't think that mechanical control alone (such as taping/strapping) will relieve the acute discomfort, I will sometimes inject during the first visit. (Especially if a patient has had tapings, PT, etc., prior to the initial visit in my office) Each physician must practice according to what works best for him/her. My general rule in practice is that I won't consider ESWT or surgery until at least 6 months of failed conservative care. That means 6 months of continuous care. If a patient has had pain for 8 months, but no continuous care, than I personally would not consider surgery on this patient. On a side note, considering the high success rate of ESWT, without many reported complications, surgery for heel pain in my practice has certainly greatly decreased. ESWT is an excellent treatment option for those with continued heel pain following failed conservative care.

Re: Steroid injection

nancy s. on 6/18/02 at 09:36 (087895)

thanks, dr. wander. i wish i'd seen you in 1999!
nancy

Re: Steroid injection

nancy s. on 6/16/02 at 07:35 (087725)

rachel, i'm not a doctor, but the pf relief from the one cortisone shot i had lasted about as long as the anesthetic. then i was back in the same boat i'd been in.

i have no clue about the statistics, but my impression from two and a half years on the board is that the majority of difficult pf cases tend not to respond much to The Shot. (doctors, please correct me if i'm wrong.) i'd move on to longer-term possible solutions if i were you and not worry about this.

good luck from nancy

Re: Steroid injection

Rachel W. on 6/16/02 at 07:49 (087726)

Thankyou Nancy. I'll just have to keep trying other things until I find something that works.

Night splints next I think.

Rachel.

Re: Steroid injection

Dr. David S. Wander on 6/17/02 at 20:11 (087854)

Patients often have significant relief with steroid injections. Naturally, the injection simply treats the symptoms and not the problem, therefore additional treatment is also necessary such as taping, orthoses, night splints, ice, stretching, etc. There is one very important point that must be addressed. Although I perform ESWT, EPF and offer a wide spectrum of treatments for heel pain, it should be emphasized that most patients obtain relief without ESWT or surgery. Most of the patients on this web site have failed conservative care, therefore it almost seems as if all patients have chronic plantar fasciitis. Fortunately, this site exists for those who are in pain and need help due to failed conservative care. Fortunately, most of the patients on this site are in the minority. When reading posts on this site, it is easy to forget that these cases are the 'tough' ones, because the patients that obtain relief in a few visits to the doctor don't visit this site!

Re: Steroid injection

nancy s. on 6/18/02 at 03:20 (087869)

thank you, dr. wander, for this additional info and perspective.

i have a question for you. the podiatrist i saw initially in 1999 gave me a cortisone shot at my first appointment, prescribed a night splint, and then, when those things didn't help, ordered hard plastic 3/4 orthotics, which made my pf worse. he then scheduled me for epf surgery.

throughout my first eight months of pf, he never examined my gait, never examined the shoes i was wearing (though i asked him). he failed to prescribe rest, to tell me about icing, to give me stretches or any other kind of non-weight-bearing exercise that might have helped.

when i inquired about physical therapy, he said, 'might make it worse.' i learned of the multitude of conservative measures only after finding heelspurs.com, at which point i canceled my surgery. after changing my footwear to birkenstocks and a three-month self-imposed rest based on info at this site, and then two years of conservative measures under the care of another doctor, plus six months of physical therapy, i finally started to get better.

my question is this: was my failure to respond to the cortisone shot any sort of indicator that conservative measures were going to take a long time to help me? oh, and another two: do you think it's common (and wise) to give a shot on the very first pf appointment? and what do you think of a podiatrist who schedules surgery after eight months of trying almost no conservative measures? this person is long gone from my life; i'm just curious.

thanks very much for your time.

nancy

Re: Steroid injection

Dr. David S. Wander on 6/18/02 at 07:42 (087877)

Nancy,

I'll attempt to answer one question at a time. In my practice, failure to obtain relief with a cortisone injection is not necessarily an indicator of who will fail conservative care. There are many variables, including the placement of the injection, etc. Although I rarely give an injection on the first visit, if a patient is in significant discomfort and I don't think that mechanical control alone (such as taping/strapping) will relieve the acute discomfort, I will sometimes inject during the first visit. (Especially if a patient has had tapings, PT, etc., prior to the initial visit in my office) Each physician must practice according to what works best for him/her. My general rule in practice is that I won't consider ESWT or surgery until at least 6 months of failed conservative care. That means 6 months of continuous care. If a patient has had pain for 8 months, but no continuous care, than I personally would not consider surgery on this patient. On a side note, considering the high success rate of ESWT, without many reported complications, surgery for heel pain in my practice has certainly greatly decreased. ESWT is an excellent treatment option for those with continued heel pain following failed conservative care.

Re: Steroid injection

nancy s. on 6/18/02 at 09:36 (087895)

thanks, dr. wander. i wish i'd seen you in 1999!
nancy