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HEEL SPURS - facsiitis

Posted by CHICOR on 2/10/05 at 18:10 (168858)

How are heel spurs treated?
If an injection is needed, how is the injection inserted? Is there an anestetic used or local numbing agent used? Is the procedure painful?
Bill

Re: HEEL SPURS - facsiitis

Dr. David S. Wander on 2/10/05 at 19:33 (168860)

There are different techniques and preferences regarding injections. Some doctors prefer injections in the bottom and some doctors prefer injections in the side of the foot. In either case, if these injections are done properly, they do not have to be painful. Naturally, there is some discomfort associated with any injection, but if done properly, either technique can be done with minimal discomfort, depending on the location of the discomfort and the preference of the doctor. The injection usually contains a mixture of local anesthetic and cortisone and the doctor usually sprays the area with a topical spray that temporarily freezes the skin to minimize the discomfort of the needle stick.

Re: HEEL SPURS - facsiitis

Robert B. on 2/11/05 at 15:38 (168910)

My experience with the injection was alittle worst than the Dr. discribed. The shot hurt so bad that I've foregone the 2nd and 3rd shots until next week. The Dr wrote a prescription for Valium and instructed me to take it 1hr prior to going to his office.

The Dr also didn't mention anything about possible having worsening symptoms during the first 24 to 48 hours (and boy did I), this is related to a possible steroid flair.

After the 1st 48 hrs, it felt OK for about 2 days then after that, the pain was so bad I could not walk.

We'll see what happens next week.

Here is a link to a great article: http://www.aafp.org/afp/20031001/1356.html

Re: HEEL SPURS - facsiitis

Barko on 2/11/05 at 17:22 (168912)

Robert, I had three shots in my heel before I ruptured my plantar fascia. These where given to my by my pod. They werent any fun at all. I survived and even called him after it started hurting again asking for another shot. Thats when he told me that If a patient calls him asking for a shot then he knows their really in pain.

I had another shot in the same heel about two weeks ago after returning to work and standing for 10hrs a day. It became so inflamed that I couldnt stand on it. This one was given to me by my OS. I thought I knew what I was in for but oh boy was I wrong. I almost passed out. I've given birth twice with absolutley no pain meds and never at any point thought I was going to pass out.

I dont know if it was because this time he injected through the side of my heel as opposed to the bottom, or if it had to do with him using a different technique then the other Dr.

I had the same reaction to all the shots as you did. It hurt worse for about 48 hrs after the shot, then gradually improved. This last one also only lasted a few days and now feels just as bad but at least not worse. I just wanted to let you know your not alone in this and I hope it gets better for you.

Kathy

Re: HEEL SPURS - facsiitis

vince on 2/11/05 at 18:37 (168914)

Avoid the shots- they are very painful, highly overused, and can destroy the fat pad that cushions your foot as well as weakening the plantar fasica and causing it to rupture. Ask your doc why its never used for achlles tendinitis? The achilles and plantar fascia are similar structures.
Try anything else and when all else has failed go for High Energy ESWT. If your podie pushes cortesone go on out the door.

Re: HEEL SPURS - facsiitis

Dr. Z on 2/12/05 at 07:57 (168923)

Vince,

The plantar fascia and the Achilles Tendon are very different structures but I do agree with you 100% that local steriod injections should never be used on the achilles tendon and that a very limited amount if any at all should be used on the plantar fascia. The routine use of a 'series of injections for plantar fasciitis in my opinion should be re-evaluated in the treatment of plantar fasciitis. I have seen just too many side effects walk into my office. I would however in some cases apply local steriod injections it is the routine use that should be re-considered.
There is an article on this web site that talks about the local complication of steriod injections. I believe there was approximately 9% rupture rate of the pf for two local steriod injection. Just something to think about

Re: HEEL SPURS - facsiitis

Dr. David S. Wander on 2/12/05 at 10:52 (168926)

I agree with Dr. Z that injections of steroids/cortisone should be avoided in the Achilles. However, if my previous posting was carefully read, it stated that if performed properly, the injection for plantar fasciitis does not have to be painful. As with any profession, there are good doctors and bad doctors and doctors with good techniques and doctors with bad techniques. Unfortunately, on these sites you rarely hear about the successful cases, but you often hear about the poor results. After almost 20 years in practice, giving several hundred, if not thousands of injections for heel pain over those years, I certainly would not be performing these if the majority of my patients were getting worse. These injections MUST be performed with excellent technique to prevent discomfort and must be used cautiously since multiple injections in the same area can cause atrophy of the tissues, especially the plantar fat pad and can cause weakening of the tissue and/or rupture of the plantar fascia. Injections for heel pain are not my first choice but sometimes are necessary to relieve some of the symptoms. When these injections are indicated they can often provide significant relief, in addition to all the other important factors including ice/heat, stretching, support, proper shoes, weight loss, night splints, immobilization, rest, etc.

Re: HEEL SPURS - facsiitis

Barko on 2/12/05 at 11:50 (168929)

Dr. Wander- I couldnt agree with you more. I was one of the 'sucessful' injection patients. I had a series of three, the second 6 mos after the first then the last almost a year after the second. With all three the pain level was high but tolerable. Does the interval of the shots make any difference?

About a year after the last injection it ruptured when I slipped on the stairs. With my insurance since this was an accident I needed to see an OS instead of my Podiotrist. I was treated by him with a walking boot for several weeks then pt. I returned to work and standing/walking for 9hrs at 10wks. I could tell from the first day that something was wrong and after two weeks I almost couldnt walk. Not from heel pain but pain in the center of my arch. I saw my Os again and he suggested injecting my heel, since I had already ruptured it wouldnt hurt to try it. Either his technique was way off or the angle he injected from caused pain that I cant begin to describe. I only felt relief for a few days and am back to before. I return to him in a couple of weeks but I dont know what else can be done.

My Pod never explained any of the other things that would help with my recovery like stretching and ice. I received the first injection in my heel on my first visit to his office nothing else was done. What I've learned from all this is that as a patient I need to do more research into the treatment I'm receiving even if everyting is going well.

Re: HEEL SPURS - facsiitis

Dr. Z on 2/12/05 at 12:31 (168931)

Dr. Wander,
I agree that local steriod injections should and can be given without much pain. My concern is the routine series of injections that are given in the podiatric profession.
I also can tell of the hundreds if not thousand of patients that have obtained significant relief from a local single steriod injections, but what concerns me is again the multiple routine administration of a local steriod injection into the plantar fascia.

Re: HEEL SPURS - facsiitis

Dr. Z on 2/12/05 at 12:35 (168932)

Barko,
The question I have is what contribution did the three local steriod injections with regard to weakening the pf tissue. I have heard so many and seen so many cases just like yours. My heel feels great, and then down the road an injury that typical wouldn't have caused a rupture does contribute to the rupture. This why I don't like the three series of injections.

Re: HEEL SPURS - facsiitis

Ed Davis, DPM on 2/12/05 at 13:34 (168935)

Chicor:
There a a number of alternatives to injection of the plantar fascia but IF you are going to have it done, it can be performed in an almost painless fashion.

First the area is accurately located and an injection of a local anesthetic such as lidocaine used after the skin has been frozen with an agent such as ethyly chloride wich makes that injection close to painless. The doc then slowly injects the numbing medicine into the area that has been frozen. Then, once all the lidocaine/numbing medicine has been depositied, the needle is left in place and the doc changes syringes utilizing the needle that has already been painlesslessly inserted and the 'cortisone' mixed with a long acting anesthetic such as marcaine and the mixture released through a the needle into the numbed area.
Ed

Re: HEEL SPURS - facsiitis

Dr.Wishnie on 2/13/05 at 07:12 (168958)

I agree that too many injections can lead to complications. PF is usually caused by improper foot mechanics. This leads to a continuous pulling of the pf which causes inflammation. Many docs treat the inflammation and not the poor biomechanics of the foot or they treat the poor biomechanics but not the inflammation. You must treat both phases in order to get good results.

The best and quickest way to treat pf is to give the patient an initial injection on their first visit. This along with ice and taping will get the patient feeling much better almost immediately. The taping is temporay and helps with the foot function (the constant pulling of the pf). I kind of think of this injection as kindling when making a fire. In order to get the fire going you need the kindling. In order to get the pf better you need the injection to help the orthotics (usually the permanent soln in about 90-95% of the cases) work. Orthotics do not get rid of the inflammation and the injection does not help the mechanics of the foot. They need to be used in conjunction. Then at times you need a second injection. I never give more than three injections in one area. I have seen too many patients come in and tell me that their doc gave them 3 or more injections and maybe some pills but that is all they have done. This will never get rid of the pain permanently.

I rather have an injection than take meds especially since the Vioxx and Celebrex scares. The injection attacks the site of pain where the meds go through the whole body and must be taken for several weeks (in a lot of cases). The key is that one type of treatment will not help pf and you must treat both phases of pf at the same time. You can not piece meal the treatment, meaning you can not say let's do this this week and if this does not help we will then try this then that. Do the injection, the ice, the stretching, the proper shoes, rest and taping and then orthotics all at once.

Re: HEEL SPURS - facsiitis

Dr. Z on 2/13/05 at 10:06 (168966)

Dr. Wishnie,
I agree, but to add one more important point. Don't wait months to start this triad of treatment. The early you treat plantar fasciitis the better the chance of being in that 90% success group. When plantar fasciitis turns into plantar fasciosis which isn't an inflamation state but a degenerative state the situation changes.

Re: HEEL SPURS - facsiitis

Pat on 2/14/05 at 17:01 (169056)

I don't know how anyone can say a shot of cortizone is painless. Believe me, I'm probably the Queen of Shots of cortizone in different parts of my body as well as for PF in my feet (I recently had EPF surgery) and the shot of cortizone is the most painful thing I can think of. Granted, it may have something to do with the doctor giving the shot but you don't know how good he is at giving the shot until he jams the darn thing in your foot. And I had the freezing stuff they put on and last year when I had the shot I'm sure everyone in the hospital could hear every 4 letter word I was saying. It was so painful that I thought I was dying. When the PF came back I opted for surgery which was a piece of cake compared to the shot.