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cortisone shot

Posted by Karen W. on 8/19/03 at 22:31 (127364)

I was diagnosed four months ago with plantar fasciitis and a bone spur. The podiatrist wanted to give me an injection of cortisone. I resisted as I had heard negative reports about the shot. My pain has not let up and I am now rethinking about whether I should get the shot or not. Has anyone had relief from the shot or otherwise? Also, if you have the shot do you have to stay off your feet for a period of time following the injection? Thanks to anyone who can give me advice on this. Karen W.

Re: cortisone shot

R C on 8/20/03 at 09:24 (127383)

I've had cortisone shots for PF. They provided no relief. There was pain from the shot itself for 2 or 3 days. Whether you should elect one depends on a number of things. What else are you doing for your PF? Is the pain so bad that you cannot go about your day?

Even if the pain goes away after the shot, the injury will not have healed completely. Thus there is risk of aggravating the condition if you return to full activity without addressing root causes (e.g., by finding effective orthotics).

Re: cortisone shot

Kristen on 8/20/03 at 09:29 (127385)

Hi Karen. I have the same problems as you do, and I just got the painful cotizone shots 3 days ago, and I personally do not recommend them. Sometimes they can cause you more pain like in my case. Before I got the shots I asked the doctor if I would be able to be on my feet afterwards because I was supposed to start a new job the day that I had them. Needless to say an hour after I had the shots I was in more pain than I was before. Now the doctor said that this tends to happen to some people, but I wish I had known this before I had the shots or I would not have had them at all. Has your doctor given you anything in the last couple months to try to fix this?

Re: cortisone shot

Kathy G on 8/20/03 at 12:34 (127403)

Hi Karen,

I've never had a cortisone shot for PF but I had several for a Mortons Neuroma in my foot. I also had a shot of cortisone in my CMC joint (base of thumb) for osteoarthritis recently.

The shots I got for the neuroma worked but after about four of them, at least I think that's about how many I had, the cortisone became ineffective. That's when I broke down and went with custom orthotics which helped the neuroma but haven't done a whole lot for my PF.

The shot for the arthritis provided minimal relief and I probably won't have another one.

As a longtime reader of these boards, I'd say that the majority of people have found that the shots don't help them a whole lot. I'm sure there are some people who have found relief but it seems to me that it is always short-lived. Of late, my PF is the worst it's ever been, and I wouldn't dream of attempting a cortisone shot based on what I've read here.

Just my two cents worth :D and it may not be worth that!

Re: cortisone shot

francesc on 8/20/03 at 15:51 (127424)

hi karen,

well, i guess i'm one of the few people who have found some relief from the pain with the cortisone shot. :-) i had the cortisone shot about 2-3 weeks ago. i was in a lot of pain and i was compensating so much for the pf in my right foot that i was starting to develop pain in my left as well!

i also have a heel spur in my right foot. i got the shot and it was more painful than i thought it would be. i had to try to stay off my feet for the following 3 days. the podiatrist also had me wear heel cups because my heel was tender from the shot.

i went back a week and a half later and got fitted for custom orthotics. he told me not to do any running, sports, or high impact activities until i get my orthotics.

i have to say that a week after my shot, i was pain-free when i woke up in the mornings. my right foot had been so inflamed for so long that i had forgotten what it felt like not to think about it all the time.

the cortisone shot definitely doesn't 'heal' the PF but, it does ease the symptom of inflammation which can get pretty painful.

so i would say getting the shot depends on how much pain you feel now with your pf and how much it is impeding on your life. now i can walk around and stand and not be in pain afterwards. i still do stretching and icing and wear my NB running shoes and Birks. but, i believe the shot helped out of that intense pain faster than if i had just taken the anti-inflammatories.

just my 2 cents...

frances

Re: cortisone shot

john h on 8/20/03 at 18:50 (127458)

I do not know but guess the time for a cortizone shot for PF would be in it's early stages before it becomes chronic. I have several post from people who got a shot and there problem just went away. They were not people who had PF for a year or more. If I were starting this all over I would surely try a cortizone shot right out of the shoot and not wait two years like I did.

Re: cortisone shot

Ed Davis, DPM on 8/20/03 at 21:03 (127494)

Karen:

This is an area in which there is a lot of misinformation. The first thing to consider are the three 'legs' of PF that I have discussed here---
inflammation, biomechanics and tissue quality. All three areas need be addressed in the majority of PF cases.

Cortisone is a means to address one of those legs -- inflammation. If it is going to help, it is more likely to be of use early in the process when the inflammatory component is larger. The shot is minimally painful if properly delivered. Unfortunately poor technique or rushing of the shot can make it painful. A local anesthetic such as lidocaine is mixed with the 'cortisone' so the area is numb after the procedure. Once the numbness dissipates in several hours, the area will temporarily become more sore for a couple of reasons: 1) the presence of fluid pressure in an already painful area (an injection of water would so the same thing) and 2) steroid flare - a short term inflammatory reaction to the 'crystals' of steroid. We advise patients who get such injections not to return to work for about 12 hours after such an injection and, most importantly, to place some ice on the area as the numbness recedes.

The downside to trying such a shot is relatively small. The amount of steroid used in one shot is very unlikely to cause side effects. Most of the negatives are due to long term steroid use. Many patients get very good results from such shots. Sometimes the shots work too well leading patients to gain a false sense of security and causing them to ignore more comprehensive treatment of the problem. Such patients may get worse in the long run and that can be a source of negative stories.

The bottom line is that such shots, properly administered, have done a lot more good for patients than bad.
Ed

Re: cortisone shot

Karen W. on 8/20/03 at 23:16 (127501)

Thank you so much for your input. I am inclined to think I will give the shot a try. I have done everything else. Am taping my foot, using ice, NASAIDS, New Balance shoes, Berkies for times at home I am not in too much pain, a night brace, stretching exercises etc. Just got custom orthotics which have helped to an extent. So it seems to me that the orthotics will hold the foot in the proper position while it heals after the cortisone shot. I will request the shot be given sloooowly and with lidocaine. Will make the appt. and hope I can get in soon. I am on my feet a lot and climb ladders ( I install wallpaper) and also have to lift heavy buckets of glue and a table....up stairs etc. Some days it is worse than others....I have not had the luxury of just staying off my feet for more than a weekend and being self employeed makes me push myself hard as I have to sick leave, dissability etc. I can't imagine how people with this in both feet survive. And how many get it in the other foot after compensating for the first pf foot? How long does pf go on before a podiatrist will go for an MRI? And does arthritis have the same symptoms as pf? In other words how do you know for sure it is pf and not something else?
This board is great....many thanks

Re: cortisone shot

Dorothy on 8/20/03 at 23:45 (127502)

I read your post and your description of what you are doing and what you are going through and I wish I could adequately tell you how amazed I am. I hope so much that you find good improvement. Take good care on and off ladders and all good wishes to you.

Re: cortisone shot

BrianG on 8/21/03 at 20:27 (127595)

Hi KarenW,

If your Pod is like most docs, I doubt he'll just automaticlly schedule you for an MRI. In most cases the doc's can diagnose PF by feel, and by your description. I wanted an MRI, and had to fight my HMO for one. I had to appeal to the highest level, but I won, and had it. In my case I just wanted to rule out anything else that may have been going on, as well as my PF. My Pod did tell me that a bone scan would show more, and cost less.

Good luck
BrianG

Re: cortisone shot

Ed Davis, DPM on 8/21/03 at 23:42 (127617)

Karen:

The main purpose of an MRI may be to look for something else that amy be causing pain. As such, the propensity of your doc to order that test may be related to his/her level of suspicion that there is something else to look for.

Occasionally, MRI may be used to document thickening of the plantar fascia as a potential diagnostic marker of PF. I recently had a patient in which Mutual of Omaha (sort of a goofy company in my opinion) claimed that I had not provided sufficient proof that a patient has PF. I advised them that I could order an MRI of both feet for further evidence. Of course, that would cost them almost as much as the ESWT they are refusing to cover on the basis that I had not offered them sufficient proof of my patient's PF.
Ed

Re: cortisone shot

francesc on 8/22/03 at 16:05 (127702)

hi karen,

when i got my cortisone shot, it didn't hurt at all until afterwards when the numbness wore off! i got a local anesthetic, a shot in my ankle to numb the heel area, and then the shot in the heel area.

my podiatrist took x-rays to make sure i didn't have any fractures and discovered that i also had a bone spur in my heel. i think the doctors go by the symptoms that you describe and by feeling and looking at your feet. in fact, i already diagnosed my problem BEFORE i even went to see a doctor because i knew so many people who had already had the problem (i exercise a lot).

i have had PF for less than a year so maybe that is why the cortisone shot has been successful for me...

best of luck and let us know how it goes!

frances

Re: cortisone shot

Judy R on 8/22/03 at 17:08 (127713)

Karen..you and I have had PF for about the same amount of time. My Pod gave me 2 injections - 2 weeks apart. It has helped..it did not hurt and I am glad I had them. He was going to give me one more in 2 weeks if the pain did not subside, but it did..so he released me last Friday and told me to call him if the pain came back. I am in a little pain today, but nothing like before and I know it will work itself out by morning..I played golf today. There is hope...don't give up! Take care...

Judy