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Plantar Fascia

Posted by Teri W. on 6/16/03 at 15:14 (122013)

I have Plantar Fascia and I am considering to have a cortisone shot. I have tried stretching exercises and ice on my heel but it doesn't work.
My question is how painful is the shot? It is a big concern of mine since I have a low tolerance to pain(or just call me a big baby). But I have heard rumors it's very painful. I want to know the facts and the truth about the shot. Thank you for answering my question.

Re: Plantar Fascia

dave r on 6/16/03 at 15:20 (122015)

Teri, cortizine can be very helpful in resolving plantar fasciitis. I believe that 50% of all cortizone shots cure pf very quickly. Cortizone can also be very harmful. It weakens tissue which can lead to a rupture or a tear. be sure you have a very good doctor.....
I had cortizone shots which made my condition alot worse.

Re: Plantar Fascia

Molly H on 6/16/03 at 22:28 (122062)

I had 2 rounds of cortisone shots and they did not help me at all! Most people I know that have had them have all said they helped temporarily, but that's it. I ended up having ESWT on May 14. I am very happy and seem to be improving daily. I have had PF (bilaterally) for 9 mos.
As far as pain goes my POD says the slower they give the shot the less it hurts. All in all I was expecting much worse...it was NOT that bad!

Re: Plantar Fascia

Dr. David S. Wander on 6/17/03 at 19:05 (122162)


Despite all the negative remarks, cortisone is often very helpful in alleviating heel pain. Many patients have long term relief after having an injection, in conjunction with other treatments such as taping, orthoses, anti-inflammatories, ice, therapy, stretching, night splints, etc. It is generally recommended that no more than 3 cortisone injections be given in an area within one year, because the cortisone may atrophy the tissue or cause a partial tear. When given by an experienced and caring doctor, the injection should not be that uncomfortable. The injections are given by some doctors in the bottom of the heel, and some in the side of the heel and this is the doctor's preference. If done correctly, EITHER method can provide relief with minimal discomfort. Discuss your concerns with your doctor.

Re: Plantar Fascia

elliott on 6/18/03 at 13:07 (122249)

Dr. Wander, can I ask further about the reasoning behind the rule of thumb of 3 cortisone shots max per year? Does that imply that as long as the shot is applied by a pro in the right place and one does not get shots too frequently, the affected tissue or bone sort of re-grows itself, or at least strengthens or whatever to minimize the harmful effects of tissue or bone atrophy? Perhaps 1.5 years ago I had just one cortisone shot for a possible Morton's neuroma (crushed feeling from too-tight a post-surg cast; it's now 4 years later) as the last of a series of 5 nerve blocks (the other 4 lidocaine/marcaine only). The cortisone shot did nothing at all. This year I had 6 more shots (again, lidocaine/marcaine only), which seemingly has me up to 60% relief, so far permanent. One reads about how a whole area of the foot can irreparably collapse from a cortisone shot, and that has me worried. (Note: unlike some others, temporary pain from a shot, even if severe, does not worry me at all, only permanent problems do.) So how risky is another cortisone shot a couple years later next to the 4th metatarsal? Thanks.


Re: Plantar Fascia

Dr. David S. Wander on 6/18/03 at 16:53 (122273)

Elliot, the answer to your question is actual more complicated that you may think. Due to some of the effects of cortisone, it has been time tested that generally, more than 3 shots of cortisone in a given area may cause more harm than benefit. Due to the properties of cortisone, it can cause atrophy of tissues and weaken tissue, therefore it may cause partial ruptures of tendons. For example, it is contra-indicated to inject a tendon with a partial tear or suspected partial tear with cortisone, due to the high probability of a rupture. This also depends on the type of 'cortisone'. There are short acting (phosphates) and long acting (acetates) steroids, so it is generally prudent to use a phosphate if given a series of injections in close proximity. You state that 'one reads about how a whole area of the foot can irreparably collapse from a cortisone shot'. That is a statement that I find completely blown out of proportion. In 18 years of practice, I have never seen this type of reaction to cortisone administered by myself or any other doctor. Therefore, if you haven't had a cortisone injection in a couple of years, I certainly would not worry about 'too much' cortisone in that area. Just make sure the doctor avoids injecting the joint capsule or capsular ligaments of the joint, to avoid problems.

Re: Plantar Fascia

elliott on 6/20/03 at 10:44 (122433)

Dr. Wander, thanks for replying. Here are a few examples of where things went way wrong with a cortisone injection for Morton's neuroma:



I'm not saying it's likely, but a doc typically will not say how likely it is. My doc is cautious in general and is leaving it up to me. I guess you're saying it's very unlikely, so probably worth a 'shot'. OTOH, one can find studies saying curing (as opposed to temporary pain reduction) a neuroma with a cortisone shot is also unlikely...


Re: Plantar Fascia

Dr. Z on 6/20/03 at 11:46 (122440)

I have also seen dislocated toes from just one local steriod injection
The Fat atrophy as you pointed out is another problem that one will encounter with local steriod injections.

Re: Plantar Fascia

Judy R on 7/17/03 at 12:40 (124637)

Hi Terri..came across your note this morning..am new to PF..but after almost 6 weeks of stretching, taping, etc., my pod said time for a cortisone shot..I almost screamed...no, no, no..! But he convinced me that it would not hurt. I asked if my husband could come in the room with me (I wanted to hold his strong hand)..he said o.k. and after he came in the room with me I told him to go ahead. He sprayed something out of a can which was like ice and proceeded with the shot. I kept waiting for severe, like labor pain to begin, but IT DIDN'T...! I could have another one today if I needed it and would not be afraid. However, I have to admit that the effects did not last long..about 6 hours the next day I felt wonderful..but now yesterday and today I am feeling some pain, but not all that bad...don't know if I'll get another one or not since it did not last that long. But all people are different and it could be that yours would last forever..write to me and let me know..

Take care...Judy