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previous cortisone shots stop ESWT from working?!?

Posted by elliott on 11/19/02 at 15:26 (100658)

Check out the abstract below:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12428828&dopt=Abstract

It looks like they were so excited with their findings that they forgot to even follow up and state whether body weight had any bearing. While the study was for subcalcaneal spur, since around 1 in 4 ideopathic PF sufferers have that too, it could affect a sizable chunk of this group as well.

I wonder if orthotics and night splints also negatively affect the ESWT results. Regardless, I must concede, Dr. Z, that anyone who wakes up one day with a drop of heel pain should head straight to your office for ESWT. Do not pass Go, do not collect $200--doing so may negate the ESWT. :-)

[]

Re: previous cortisone shots stop ESWT from working?!?

Dr. Zuckerman on 11/19/02 at 15:35 (100659)

Elliott would you help to drive these patients to my office . I will provide the limo.

Seriously I have no idea what they were trying to prove. It is a know fact that local steriod injection may have a negative effect on ESWT. Do you know of any studies that prove this?

Where do you get these abstracts from?

Re: previous cortisone shots stop ESWT from working?!?

elliott on 11/19/02 at 15:51 (100660)

Dr. Z, I will drive them to you if I get something for it, like a mug. :-)

I thought the study I just supplied claims to prove this negative correlation.

Bookmark the link provided. See the search box at top? When it's a slow day, type in buzz words like eswt and do a search. It will bring up abstracts of all the latest and greatest articles from journals tied into the system.

[]

Re: previous cortisone shots stop ESWT from working?!?

Ed Davis, DPM on 11/19/02 at 16:31 (100667)

Elliott:

Since they performed 3 treatments consecutively one week apart, I would assume the study was performed with low energy ESWT. Did they mention which machine was used (not that it matters that much but it would be good to know for the benefit of some posters)?

Also: Did the lost the type of steroids injected? Frequency of cortisone injections. We would expect repository steroids to have a more significant long term effect than soluble steroids (cortisone).

A particularly problematic category of patients are those in whom cortisone was 'abused.' Patients on occasion can get dramatic pain relief with cortisone injections and can get 'fooled' into thinking they are cured, leading to overuse and further injury. (Professional sports is a notorious area for abuse of such drugs). I, Dr. Z and numerous other practitioners who have seen many a patient hobble into the office after recieving numerous cortisone injections while the biomechanics were neglected. That group can be tougher to heal even with older methods, often are a large part of the surgical group that fails.
Ed

Re: previous cortisone shots stop ESWT from working?!?

Ed Davis, DPM on 11/19/02 at 16:33 (100668)

Correction: Did they list the type of steroids injected?
Ed

Re: previous cortisone shots stop ESWT from working?!?

Mar on 11/19/02 at 17:38 (100677)

Dr Z --

As you know I had ESWT on May 22 and Aug 14. The doctor gave me cortisone shots in both heels at the insertion point of the fascia on Sept 3. Why did he do this if it is known that cortisone has a negative effect? I had had previous cortisone in heels on March 2 and 3 other times in toe joints for sesamoid pain. Could this be why ESWT isn;t working for me? Have I ruined my chances??? This is upsetting... Mar

Re: previous cortisone shots stop ESWT from working?!?

john h on 11/20/02 at 11:52 (100745)

Dr. Ed I was one who got fooled with a cortisone shot and overused my feet. Pain went to zero for about a week and in between I acted foolishly.

Re: previous cortisone shots stop ESWT from working?!?

Dr. Zuckerman on 11/21/02 at 10:20 (100789)

There have been times when local steriod injections post ESWT can help remove excessive swelling and thus move the healing forward and reduce your pain.

Dr. z

Re: previous cortisone shots stop ESWT from working?!?

Jean P. on 11/21/02 at 16:24 (100827)

This sounds just like me. Too many cortisone injections that worked for a while and when they wore off I was worse off. ESWT still worked well for me - perhaps that is why I still have pain in one foot - because of all those injections.

Re: previous cortisone shots stop ESWT from working?!?

Dr. Zuckerman on 11/19/02 at 15:35 (100659)

Elliott would you help to drive these patients to my office . I will provide the limo.

Seriously I have no idea what they were trying to prove. It is a know fact that local steriod injection may have a negative effect on ESWT. Do you know of any studies that prove this?

Where do you get these abstracts from?

Re: previous cortisone shots stop ESWT from working?!?

elliott on 11/19/02 at 15:51 (100660)

Dr. Z, I will drive them to you if I get something for it, like a mug. :-)

I thought the study I just supplied claims to prove this negative correlation.

Bookmark the link provided. See the search box at top? When it's a slow day, type in buzz words like eswt and do a search. It will bring up abstracts of all the latest and greatest articles from journals tied into the system.

[]

Re: previous cortisone shots stop ESWT from working?!?

Ed Davis, DPM on 11/19/02 at 16:31 (100667)

Elliott:

Since they performed 3 treatments consecutively one week apart, I would assume the study was performed with low energy ESWT. Did they mention which machine was used (not that it matters that much but it would be good to know for the benefit of some posters)?

Also: Did the lost the type of steroids injected? Frequency of cortisone injections. We would expect repository steroids to have a more significant long term effect than soluble steroids (cortisone).

A particularly problematic category of patients are those in whom cortisone was 'abused.' Patients on occasion can get dramatic pain relief with cortisone injections and can get 'fooled' into thinking they are cured, leading to overuse and further injury. (Professional sports is a notorious area for abuse of such drugs). I, Dr. Z and numerous other practitioners who have seen many a patient hobble into the office after recieving numerous cortisone injections while the biomechanics were neglected. That group can be tougher to heal even with older methods, often are a large part of the surgical group that fails.
Ed

Re: previous cortisone shots stop ESWT from working?!?

Ed Davis, DPM on 11/19/02 at 16:33 (100668)

Correction: Did they list the type of steroids injected?
Ed

Re: previous cortisone shots stop ESWT from working?!?

Mar on 11/19/02 at 17:38 (100677)

Dr Z --

As you know I had ESWT on May 22 and Aug 14. The doctor gave me cortisone shots in both heels at the insertion point of the fascia on Sept 3. Why did he do this if it is known that cortisone has a negative effect? I had had previous cortisone in heels on March 2 and 3 other times in toe joints for sesamoid pain. Could this be why ESWT isn;t working for me? Have I ruined my chances??? This is upsetting... Mar

Re: previous cortisone shots stop ESWT from working?!?

john h on 11/20/02 at 11:52 (100745)

Dr. Ed I was one who got fooled with a cortisone shot and overused my feet. Pain went to zero for about a week and in between I acted foolishly.

Re: previous cortisone shots stop ESWT from working?!?

Dr. Zuckerman on 11/21/02 at 10:20 (100789)

There have been times when local steriod injections post ESWT can help remove excessive swelling and thus move the healing forward and reduce your pain.

Dr. z

Re: previous cortisone shots stop ESWT from working?!?

Jean P. on 11/21/02 at 16:24 (100827)

This sounds just like me. Too many cortisone injections that worked for a while and when they wore off I was worse off. ESWT still worked well for me - perhaps that is why I still have pain in one foot - because of all those injections.