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Cortisone for tts?

Posted by sherry l. on 7/15/02 at 06:32 (089649)

Just read a post that said that a cortisone injection may be risky in the case of tts,is that true? My doc is going to give me one tomorrow and now i am afraid. Can this cause some other problem and has this helped some people? Sherry

Re: Cortisone for tts?

wendyn on 7/15/02 at 07:04 (089651)

Sherry, in case the doctors don't answer in time....

My doctor explained that there is a potential risk of rupturing the post tib tendon from the shot. I don't think it's a high risk but it's there. If you have the shot in your plantar fascia - you can have a rupture there.

Please discuss the potential risks with your doctor. Some people have had some relief with the shots - but you'll probably want to be quite careful for a few weeks afterwards (i.e. don't go jogging).

Re: Cortisone for tts?

Pauline on 7/15/02 at 07:44 (089654)

Wendyn,
I know we've all heard about the rupture risk, but do you know if we have actually seen any statistics on the degree of risk that actually exist?

I have never seen anything posted, and wonder what the studies show. Have you seen any actual figures?

Since we hear so much about this risk, maybe one of the doctors has the actual stats. and could post them.

I'm wondering if the risk is on the first injection or the ones that follow and how much it might increase per injection.

I know many doctors use them---so I'm beginning to wonder just how much must be used in order to see a rupture, and if that quantity is so small why do so many doctors still do it? Why would they want to risk a rupture on a patient. What purpose would it serve to do so?

Here we repeat the story about a potiential risk factor, but doctors out there don't seem to be telling their patients about it.

If the risk is as high as we think then maybe the various medical societies should set guide lines for their members. This way all the doctors would be on the same page when it comes to using injections for P.F.

Would appreciate your thoughts.

Re: Cortisone for tts?

Pauline on 7/15/02 at 07:46 (089655)

Meant to say TTS not P.F., although P.F. I think should also be included.

Re: Cortisone for tts?

sherry l. on 7/15/02 at 07:47 (089656)

Thanks Wendy I will discuss this with the doc. I have had 2 treatments of active release technique for pf and tts and are in more pain than before the treatments, I've read posts that said that the art showed good results fast and now i am scheduled for it today but i am cancelling for fear i will have severe pain afterwards. Have you had the coritsone for tts, i'm ever in fear of that. i don't need any added pain! Thanks, Sherry

Re: Had cortisone in arch last week!

sherry l. on 7/15/02 at 07:53 (089659)

Hwy Pauline, I had a cortisone shot in my arch last week for pf and the doc did not mention any risk. Of coarse the shot did not help but I quess it was worth a try.He wanted to do it for the tts but I asked to try art first, but now that I am hardly walking i am considering the cortisone for the tts. Do you know if there is some sort of brace for tts or is a custom made orthotic better? Can anyone answer that one? Sherry

Re: Cortisone for tts?

wendyn on 7/15/02 at 08:26 (089663)

I had one pod who wanted to do it. He did not discuss any risks with me whatsover - and it was actually his 'no big deal' attitude that made me decide not to do it (I didn't trust him). A sports med doctor suggested that I might try it - he explained the risks though.

Once they found out for sure what I had - weak post tib tendon, TTS, RSD - my orthopedic surgeon said 'absolutely not' to the shot.

In my case - I was probably really lucky that I didn't do it. But, I do know that it can be used to help diagnose TTS (real relief means you've identified the source of the problem). And some people here have found it helps a bit.

If anyone tried ART on my inner ankle - I would go through the roof, even now.

Re: Cortisone for tts?

wendyn on 7/15/02 at 08:29 (089664)

Pauline, I don't know about the statistical risks for TTS in particular. I only know what I've been told by my doctors, and what I've heard from other people here.

I do know that most of the doctors here talk about the risks from the PF injection - even after the very first shot. When my first pod briefly discussed cortisone for my PF - he said the only risk was a thinning fat pad on the bottom of the foot.

It amazes me that there isn't more consistency in what doctors tell patients.

Re: statistics

elliott on 7/15/02 at 08:45 (089665)

Check out the links below. Based on one set of docs' results, seems like the risk of PF rupture due to cortisone is around 10% (12/122), probably more reliable a figure (and interestingly higher) than 44/765 = 6%. Of course, throw in doc variability, patient base (all runners?!), etc., and you know next to nothing.

Interestingly, another link claims that around 50% eventually did very well post-PF rupture (of course, 50% didn't), and yet another that over 50% with PF rupture who had surgery did very well, even returning to previous sports level (of course, if that's walking to the fridge, it may be less impressive :-)).

I thought I recall once seeing a PF cortisone rupture figure much higher, but maybe I'm mistaken.

My quick search couldn't quite pin down a stat on posterior tibial tendon rupture; one link addresses it without giving a figure. You could track down that article, but it looks like the sample size of those who had injections and rupture is too small to be meaningful anyway. The PTT case associated with TTS is a little more tricky anyway, e.g. one may or may not have associated PTT dysfunction (sometimes a contributing factor or even the cause) accompanying the TTS.

What I'd really like to know is, what's the success rate of cortisone shots curing TTS?

Re: links

elliott on 7/15/02 at 08:46 (089666)

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9498581&dopt=Abstract

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8122010&dopt=Abstract

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1349292&dopt=Abstract

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11070802&dopt=Abstract

Re: statistics

Sharon W on 7/15/02 at 09:02 (089670)

Elliott,

I don't know any numbers for that -- and I kind of doubt if anyone DOES, although one of the doctors might be able to offer some info based on his own clinical practice. My pod said that steroid shots for TTS (which I've had) don't usually cure the condition but they often provide relief for a period of time.

TTS itself really isn't that common and it's HARD to find good information about it (-- so thanks for the links, Elliott!)

In my case, I had two shots (the first one was also used as a diagnostic block) and between them, they relieved my pain CONSIDERABLY for a total of about 7 weeks. There were no ruptures or any other complications. The injectionsw were painful, but my pod used lidocaine and marcaine to help numb the area, and it wasn't bad AT ALL complared with the amount of relief it provided me!

Most doctors seem to have a limit on the number of steeroid injections they will do in a year -- my pod won't do more than 3.

-- Sharon

Re: statistics

elliott on 7/15/02 at 09:17 (089673)

I had a total of I believe 3 in my right foot. Didn't do much, if anything. Done by someone competent, I don't think someone should panic about a shot, especially since for TTS all options likely to help are limited, and definitive diagnosis upon which subsequent treatment depends (e.g. surgery) may be aided by it. I'd still like to know what the odds are of at least partial but permanent relief. I think even two shots in short succession are OK, but probably not at the same location. In retrospect, I wouldn't have tried to run for a few months after the shots (not that I ruptured anything, just that I perceive a greater risk than the docs talk about).

Re: Cortisone for tts?

Sharon W on 7/15/02 at 09:20 (089674)

Sherry & Wendyn,

I had the steroid injections for TTS (2 of them). Between the two injections I experienced a REMARKABLE level of relief -- I felt really good for about 7 weeks -- and NO problems with ruptures or nerve punctures or anything like that. Personally, I am much more worried about other types of complications. (I would have had another shot if I could -- but I have a lifelong problem with high blood pressure, and with the second shot my blood pressure went up so much I had to take another medication for it for a while.)

On the other hand, although I do have plantar facaetis, I WOULDN'T allow my pod to inject my plantar facia. To me that sounds like a much riskier thing than the TTS injection... And I've read personal stories on these boards from people who had their PF rupture because of steroid injections; it sounds really awful! I've never seen a post talking about damage to the posterior tibial tendon from a steroid shot, though... had ANYONE here actually had that happen??

-- Sharon

Re: statistics

Sharon W on 7/15/02 at 09:35 (089676)

Elliott,

Actually, in my case the two shots were NOT in exactly the same place. She was using the first one, at least partially, as a diagnostic block to identify the location of my entrapment(s). The first was lower down on my ankle, and it helped to relieve the pain from my lateral plantar nerve, which was causing a lot of burning and shooting pains toward the outer bottom of my foot near my last two toes. The second was higher up, because in my case the calcaneal branch of the posterior tibial nerve splits off higher up on my leg, and she suspected (correctly, I think) an entrapment of that sensory nerve branch, or perhaps even a very small neuroma. It was causing pulsing, throbbing pain in my heel -- which was almost completely relieved by the steroid shot, and that nerve has NEVER gone back to causing as much trouble as it had been before that shot. (No, I wouldn't say that problem is CURED -- there's still one fixed spot on my heel that is sensitive to pressure -- but the only time it throbs these days is when I've been on my feet WAY too much.

I totally agree with you about not running; I love to walk and when the injections made me feel better, I did quite a lot of walking, delighted to be able to do it again without major pain... and I think that was a mistake. When the pain came back, it came back with a VENGEANCE... I think I may have done myself some injury in my enthusiasm for being able to do 'normal' things again.

-- Sharon

Re: statistics

Pauline on 7/15/02 at 11:51 (089680)

Are the injections given? Are they into the nerve or into the tendon or do they aim for one and get the other by accident? Are they hoping for pain control or inflammaton control or both because besides the steroid an
anesthetic is also used.

Re: statistics

Sharon W on 7/15/02 at 12:47 (089683)

Pauline,

The steroid is not supposed to be injected directly INTO the nerve; the way I understand it, the idea is to inject it immediately NEXT TO the nerve, thus reducing the inflammation and swelling around it, and therfore relieving the pressure on the nerve that causes pain and other symptoms.

Whenever injections are done into tissues immediately next to nerves, blood vessels, or tendons, there is a risk of injecting the wrong thing and causing problems. That's why nurses don't do these types of injections (well, maybe a nurse practicioner would, sometimes... I don't know about that). It requires the detailed anatomical knowledge and special skills of a practiced and careful physician do this type of procedure. But, it CAN provide considerable pain relief, if it is successful.

-- Sharon

Re: Cortisone for tts?

Jean P. on 7/15/02 at 17:08 (089709)

Dear Sherry,

I have had cortisone shots several times. My pod told me about possibility of rupture but not of thinning of fat pad. While several of the shots worked and the pain was gone a couple of times I had no relief and one time my foot was swollen and very painful for two weeks plus. The worse part is now I feel like I am walking on bones. I am not saying don't get it -nthe relief from pain is bliss - but don't get too many.

Good Luck - I hope one is all you need.

Re: statistics

Pauline on 7/16/02 at 09:25 (089764)

I would think steroid injected into a nerve might kill it. I can understand it's use for inflammation control. Sounds like you want the right person doing this injection.

Re: "Curing" TTS by reducing inflammation?

Sharon W on 7/16/02 at 15:20 (089792)

Pauline,

As for the issue of steroid injections 'curing' TTS: I imagine that could happen when the (remaining) problem within the TTS is residual inflammation/swelling, after the original problem that CAUSED the inflammation/swelling has been successfully dealt with. For example, if a biomechanics problem has caused swelling in the tarsal tunnel, and orthotics have successfully resolved that problem, but the inflammation remains -- then a steroid injection to reduce the inflammation might well 'cure' that person's TTS... But I don't know how often that occurs.

-- Sharon

Re: Cortisone for tts?

wendyn on 7/15/02 at 07:04 (089651)

Sherry, in case the doctors don't answer in time....

My doctor explained that there is a potential risk of rupturing the post tib tendon from the shot. I don't think it's a high risk but it's there. If you have the shot in your plantar fascia - you can have a rupture there.

Please discuss the potential risks with your doctor. Some people have had some relief with the shots - but you'll probably want to be quite careful for a few weeks afterwards (i.e. don't go jogging).

Re: Cortisone for tts?

Pauline on 7/15/02 at 07:44 (089654)

Wendyn,
I know we've all heard about the rupture risk, but do you know if we have actually seen any statistics on the degree of risk that actually exist?

I have never seen anything posted, and wonder what the studies show. Have you seen any actual figures?

Since we hear so much about this risk, maybe one of the doctors has the actual stats. and could post them.

I'm wondering if the risk is on the first injection or the ones that follow and how much it might increase per injection.

I know many doctors use them---so I'm beginning to wonder just how much must be used in order to see a rupture, and if that quantity is so small why do so many doctors still do it? Why would they want to risk a rupture on a patient. What purpose would it serve to do so?

Here we repeat the story about a potiential risk factor, but doctors out there don't seem to be telling their patients about it.

If the risk is as high as we think then maybe the various medical societies should set guide lines for their members. This way all the doctors would be on the same page when it comes to using injections for P.F.

Would appreciate your thoughts.

Re: Cortisone for tts?

Pauline on 7/15/02 at 07:46 (089655)

Meant to say TTS not P.F., although P.F. I think should also be included.

Re: Cortisone for tts?

sherry l. on 7/15/02 at 07:47 (089656)

Thanks Wendy I will discuss this with the doc. I have had 2 treatments of active release technique for pf and tts and are in more pain than before the treatments, I've read posts that said that the art showed good results fast and now i am scheduled for it today but i am cancelling for fear i will have severe pain afterwards. Have you had the coritsone for tts, i'm ever in fear of that. i don't need any added pain! Thanks, Sherry

Re: Had cortisone in arch last week!

sherry l. on 7/15/02 at 07:53 (089659)

Hwy Pauline, I had a cortisone shot in my arch last week for pf and the doc did not mention any risk. Of coarse the shot did not help but I quess it was worth a try.He wanted to do it for the tts but I asked to try art first, but now that I am hardly walking i am considering the cortisone for the tts. Do you know if there is some sort of brace for tts or is a custom made orthotic better? Can anyone answer that one? Sherry

Re: Cortisone for tts?

wendyn on 7/15/02 at 08:26 (089663)

I had one pod who wanted to do it. He did not discuss any risks with me whatsover - and it was actually his 'no big deal' attitude that made me decide not to do it (I didn't trust him). A sports med doctor suggested that I might try it - he explained the risks though.

Once they found out for sure what I had - weak post tib tendon, TTS, RSD - my orthopedic surgeon said 'absolutely not' to the shot.

In my case - I was probably really lucky that I didn't do it. But, I do know that it can be used to help diagnose TTS (real relief means you've identified the source of the problem). And some people here have found it helps a bit.

If anyone tried ART on my inner ankle - I would go through the roof, even now.

Re: Cortisone for tts?

wendyn on 7/15/02 at 08:29 (089664)

Pauline, I don't know about the statistical risks for TTS in particular. I only know what I've been told by my doctors, and what I've heard from other people here.

I do know that most of the doctors here talk about the risks from the PF injection - even after the very first shot. When my first pod briefly discussed cortisone for my PF - he said the only risk was a thinning fat pad on the bottom of the foot.

It amazes me that there isn't more consistency in what doctors tell patients.

Re: statistics

elliott on 7/15/02 at 08:45 (089665)

Check out the links below. Based on one set of docs' results, seems like the risk of PF rupture due to cortisone is around 10% (12/122), probably more reliable a figure (and interestingly higher) than 44/765 = 6%. Of course, throw in doc variability, patient base (all runners?!), etc., and you know next to nothing.

Interestingly, another link claims that around 50% eventually did very well post-PF rupture (of course, 50% didn't), and yet another that over 50% with PF rupture who had surgery did very well, even returning to previous sports level (of course, if that's walking to the fridge, it may be less impressive :-)).

I thought I recall once seeing a PF cortisone rupture figure much higher, but maybe I'm mistaken.

My quick search couldn't quite pin down a stat on posterior tibial tendon rupture; one link addresses it without giving a figure. You could track down that article, but it looks like the sample size of those who had injections and rupture is too small to be meaningful anyway. The PTT case associated with TTS is a little more tricky anyway, e.g. one may or may not have associated PTT dysfunction (sometimes a contributing factor or even the cause) accompanying the TTS.

What I'd really like to know is, what's the success rate of cortisone shots curing TTS?

Re: links

elliott on 7/15/02 at 08:46 (089666)

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9498581&dopt=Abstract

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8122010&dopt=Abstract

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1349292&dopt=Abstract

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11070802&dopt=Abstract

Re: statistics

Sharon W on 7/15/02 at 09:02 (089670)

Elliott,

I don't know any numbers for that -- and I kind of doubt if anyone DOES, although one of the doctors might be able to offer some info based on his own clinical practice. My pod said that steroid shots for TTS (which I've had) don't usually cure the condition but they often provide relief for a period of time.

TTS itself really isn't that common and it's HARD to find good information about it (-- so thanks for the links, Elliott!)

In my case, I had two shots (the first one was also used as a diagnostic block) and between them, they relieved my pain CONSIDERABLY for a total of about 7 weeks. There were no ruptures or any other complications. The injectionsw were painful, but my pod used lidocaine and marcaine to help numb the area, and it wasn't bad AT ALL complared with the amount of relief it provided me!

Most doctors seem to have a limit on the number of steeroid injections they will do in a year -- my pod won't do more than 3.

-- Sharon

Re: statistics

elliott on 7/15/02 at 09:17 (089673)

I had a total of I believe 3 in my right foot. Didn't do much, if anything. Done by someone competent, I don't think someone should panic about a shot, especially since for TTS all options likely to help are limited, and definitive diagnosis upon which subsequent treatment depends (e.g. surgery) may be aided by it. I'd still like to know what the odds are of at least partial but permanent relief. I think even two shots in short succession are OK, but probably not at the same location. In retrospect, I wouldn't have tried to run for a few months after the shots (not that I ruptured anything, just that I perceive a greater risk than the docs talk about).

Re: Cortisone for tts?

Sharon W on 7/15/02 at 09:20 (089674)

Sherry & Wendyn,

I had the steroid injections for TTS (2 of them). Between the two injections I experienced a REMARKABLE level of relief -- I felt really good for about 7 weeks -- and NO problems with ruptures or nerve punctures or anything like that. Personally, I am much more worried about other types of complications. (I would have had another shot if I could -- but I have a lifelong problem with high blood pressure, and with the second shot my blood pressure went up so much I had to take another medication for it for a while.)

On the other hand, although I do have plantar facaetis, I WOULDN'T allow my pod to inject my plantar facia. To me that sounds like a much riskier thing than the TTS injection... And I've read personal stories on these boards from people who had their PF rupture because of steroid injections; it sounds really awful! I've never seen a post talking about damage to the posterior tibial tendon from a steroid shot, though... had ANYONE here actually had that happen??

-- Sharon

Re: statistics

Sharon W on 7/15/02 at 09:35 (089676)

Elliott,

Actually, in my case the two shots were NOT in exactly the same place. She was using the first one, at least partially, as a diagnostic block to identify the location of my entrapment(s). The first was lower down on my ankle, and it helped to relieve the pain from my lateral plantar nerve, which was causing a lot of burning and shooting pains toward the outer bottom of my foot near my last two toes. The second was higher up, because in my case the calcaneal branch of the posterior tibial nerve splits off higher up on my leg, and she suspected (correctly, I think) an entrapment of that sensory nerve branch, or perhaps even a very small neuroma. It was causing pulsing, throbbing pain in my heel -- which was almost completely relieved by the steroid shot, and that nerve has NEVER gone back to causing as much trouble as it had been before that shot. (No, I wouldn't say that problem is CURED -- there's still one fixed spot on my heel that is sensitive to pressure -- but the only time it throbs these days is when I've been on my feet WAY too much.

I totally agree with you about not running; I love to walk and when the injections made me feel better, I did quite a lot of walking, delighted to be able to do it again without major pain... and I think that was a mistake. When the pain came back, it came back with a VENGEANCE... I think I may have done myself some injury in my enthusiasm for being able to do 'normal' things again.

-- Sharon

Re: statistics

Pauline on 7/15/02 at 11:51 (089680)

Are the injections given? Are they into the nerve or into the tendon or do they aim for one and get the other by accident? Are they hoping for pain control or inflammaton control or both because besides the steroid an
anesthetic is also used.

Re: statistics

Sharon W on 7/15/02 at 12:47 (089683)

Pauline,

The steroid is not supposed to be injected directly INTO the nerve; the way I understand it, the idea is to inject it immediately NEXT TO the nerve, thus reducing the inflammation and swelling around it, and therfore relieving the pressure on the nerve that causes pain and other symptoms.

Whenever injections are done into tissues immediately next to nerves, blood vessels, or tendons, there is a risk of injecting the wrong thing and causing problems. That's why nurses don't do these types of injections (well, maybe a nurse practicioner would, sometimes... I don't know about that). It requires the detailed anatomical knowledge and special skills of a practiced and careful physician do this type of procedure. But, it CAN provide considerable pain relief, if it is successful.

-- Sharon

Re: Cortisone for tts?

Jean P. on 7/15/02 at 17:08 (089709)

Dear Sherry,

I have had cortisone shots several times. My pod told me about possibility of rupture but not of thinning of fat pad. While several of the shots worked and the pain was gone a couple of times I had no relief and one time my foot was swollen and very painful for two weeks plus. The worse part is now I feel like I am walking on bones. I am not saying don't get it -nthe relief from pain is bliss - but don't get too many.

Good Luck - I hope one is all you need.

Re: statistics

Pauline on 7/16/02 at 09:25 (089764)

I would think steroid injected into a nerve might kill it. I can understand it's use for inflammation control. Sounds like you want the right person doing this injection.

Re: "Curing" TTS by reducing inflammation?

Sharon W on 7/16/02 at 15:20 (089792)

Pauline,

As for the issue of steroid injections 'curing' TTS: I imagine that could happen when the (remaining) problem within the TTS is residual inflammation/swelling, after the original problem that CAUSED the inflammation/swelling has been successfully dealt with. For example, if a biomechanics problem has caused swelling in the tarsal tunnel, and orthotics have successfully resolved that problem, but the inflammation remains -- then a steroid injection to reduce the inflammation might well 'cure' that person's TTS... But I don't know how often that occurs.

-- Sharon