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Plantar Fascia Rupture from Cortisone Injections?

Posted by JB1947 on 2/19/05 at 20:07 (169461)

I have had two cortisone injections for plantar fasciitis on Dec.8,2003 and March 1,2004. My podiatrist injected the cortisone over a ten minute period in a sewing type motion to 'break up scar tissue'. It was extremely painful, on the first one, I jerked my foot out of the needle and he had to start all over. I ask for the March injection because the first one which helped started to wear off and I was leaving for Rome for a week on the 12th of March. When I came back from Rome(lot's of walking)...my foot progressively got worse and I had a MRI on May 04, 2004 which showed 'plantar aponeurosis, fasciitis, severe, advanced with tear'. I went into a boot and crutches for a month, then the boot for another couple of months, then PT for 2 months and slowly improved. I did the exercises, icing, have great orthotics. Now, I want to exercise and when I walk on the treadmill it starts to flare up on the site where my injections were given. Any comment?

Re: Plantar Fascia Rupture from Cortisone Injections?

Scott R on 2/19/05 at 22:00 (169471)

It's been known for at least since 1997 that injections increase the chance of rupture and may result in a long-term negative impact. See the link below:

http://www.aaos.org/wordhtml/97news/plantar1.htm

Not increasing activity immediately after an injection would seem wise.

Re: Plantar Fascia Rupture from Cortisone Injections?

Dr. Z on 2/19/05 at 22:10 (169473)

Hi

The use of a trendmill isn't good for the plantar fascia. It can even cause plantar fasciitis. How is your foot when you don't go on the trend mill. Do you have pain when you first get up in the morning or after sitting for any length of time?

Re: Plantar Fascia Rupture from Cortisone Injections?

Dorothy on 2/20/05 at 00:18 (169479)

Dr. Z - While I love your term for the exercise equipment you call a 'trend mill', the equipment is actually called a 'treadmill.'

I do not own a treadmill, but I would be very interested in one of those trend mills! :-)

Re: Plantar Fascia Rupture from Cortisone Injections?

Julie on 2/20/05 at 02:37 (169483)

Dorothy, you could then start a trend! I can't wait to see what it will be. :)
.

Re: Plantar Fascia Rupture from Cortisone Injections?

Julie on 2/20/05 at 02:39 (169484)

JB, you would do well to listen to what Dr Z has said about the treadmill. While your feet are healing - and it is going to take time, given the condition you describe - you really should avoid weightbearing exercise, particularly the treadmill. As you feel you need cardiovascular exercise, see if you can't switch to something that doesn't stress your feet and exacerbate your injury and impede your healing. Swimming is probably the best choice.

Read the heel pain book. Try taping. Look at the yoga foot exercises and the plantar fascia stretch. And good luck.
.

Re: Plantar Fascia Rupture from Cortisone Injections?

Dr Ben Pearl on 2/20/05 at 05:13 (169486)

sound as if you euther developed more scar tissue orhave more tearing
an ultrasound test could shed some light

Re: Plantar Fascia Rupture from Cortisone Injections?

Dr. Z on 2/20/05 at 09:05 (169489)

You are right. Either way stay off anything with a mill Thanks

Re: Plantar Fascia Rupture from Cortisone Injections?

elliott on 2/20/05 at 09:31 (169491)

Scottr, the wording in your link seems rather poor, suggesting an alarming rate oof rupture by not stating the sample size receiving injections. In reality, it's more like between 6 and 10%,

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

of course still high enough to tread cautiously.

elliott

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Re: Plantar Fascia Rupture from Cortisone Injections?

Dr. Z on 2/20/05 at 09:48 (169492)

Another important point is that a rupture of the plantar fascia can leave
the foot worse off. I have heard from my physicains that so what if it ruptures that is just like a pf release and it will heal. I have seen a few ruptures that don't heal leaving a foot with alot of pain. So yes tread carefully. The use of a local steriod injection should be used as well as taping, rest, orthosis, and with possible casting, not just alone. A local steriod injections is never to be used a singel treatment modiality.

Re: Plantar Fascia Rupture from Cortisone Injections?

elliott on 2/20/05 at 10:12 (169493)

Dr. Z, another point you might want to make is that a local steroid injection may result in inferior ESWT outcome, apparently yet another argument (besides rupture) to try ESWT before cortisone.

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

(Funny, after listing body weight and length of symptoms in the article title and Objective, it makes no further mention of them in the Results or Conclusion.)

Re: Plantar Fascia Rupture from Cortisone Injections?

elliott on 2/20/05 at 10:17 (169495)

Of course, which study one picks to make their case matters a lot too. :-) Check this out:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15681250

Makes it sound like a cortisone shot is great!

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Re: Plantar Fascia Rupture from Cortisone Injections?

JB1947 on 2/20/05 at 17:28 (169510)

1. My foot at the moment is still sore at the site where the injection was given(?) almost a year ago March 1. I think that is the site .....on the lateral side of the heel. I started the treadmill around the New Year only for 30 mins. at a walking pace of 2.0, 2-3 times a week, sporadically. I haven't done it much in February because I did notice increase tenderness. I try to do the stationary bike for 30 mins. now when I feel like it. I'm not a swimmer. I have started back to Pilates once a week on Jan. 25 and have noticed an increase of some soreness after each class. I wear my support tennis shoes with my orthotics during this....have to. Never go barefoot, always have my orthotics in my shoes.

2. I have almost no pain when I first get up because I am faithful at wearing my night splint.
The pain doesn't bother me so much sitting BUT if I take a nap on the couch without the night splint, it is tender when I get up. I have been icing about twice a day lately, massaging my foot with a ball. Bad about doing my stretching. I have done the toe curls twice this past week by picking up marbles. I tried massaging my foot by rolling the loose marbles under it but once in awhile a marble hits 'the spot' and it feels like I am getting another shot in my foot. Something is going on there! If my foot hurts to bad, I put my walking boot back on and it helps.....maybe I should use it more often for a while???

No one on the board has addressed the 'sewing method of injecting the cortisone over several minutes.' I was personally surprised that it was done this away.....I thought one would just inject the needle in one place and that would be it. Do other podiatrist like this method?

Re: Plantar Fascia Rupture from Cortisone Injections?

Mike C on 2/20/05 at 20:12 (169518)

Swimming results in the calf muscles becoming tight because of foot position and the increased tone of those muscles.
You can do whatever cardio exercise you prefer - cycling, rowing, eliptical trainer. If you have pain, however, you should back down a notch on the intensity.

KEEP STRETCHING THE CALVES AND WORK AT INCREASING YOU ANKLE MOTION.

Re: Plantar Fascia Rupture from Cortisone Injections?

Mike C on 2/20/05 at 20:15 (169519)

What is the range of motion of your ankle when your knee is straight?

Re: Plantar Fascia Rupture from Cortisone Injections?

JB1947 on 2/20/05 at 21:18 (169525)

Excellent range of motion,why?

Re: Plantar Fascia Rupture from Cortisone Injections?

Mike C on 2/21/05 at 05:34 (169538)

If you don't mind my asking, your age?
Can you feel knots or bumps along your facsia?
Is the pain you appreciate on the treadmill different then what you experienced before the injections?
How far can you dorsiflex your ankle when you knee is straight?

Re: Plantar Fascia Rupture from Cortisone Injections?

JB1947 on 2/21/05 at 11:09 (169564)

I am a 57yr. old female. I can't feel any bumps or knots along the fascia now but when I was in PT this past June/July the therapist could and I could then. The discomfort of the treadmill is felt after I get off in the injection site. It is different than before the injections. I am not sure of the degree of dorsiflex but I think 25-30%.....looks normal to me and the PT didn't think it was abnormal. I can squat fine.....but try to avoid this position.

I must tell you that I have had 2 torn menicus removed from the opposite knee (Nov.2002 and Sept.2003) and it was Oct./Nov. 2003 when I developed acute plantar fasciitis. My first steroid injection was on Dec. 8, 2003. At that time, I thought it really helped and ask for another on March 1,2004 before we went to Rome(12 days later).....that probably was a BIG mistake! I will never get a steroid injection AGAIN!!!

Re: Plantar Fascia Rupture from Cortisone Injections?

Ed Davis, DPM on 2/21/05 at 22:07 (169599)

Dr. Ben:
True. A tear can be like a plantar fascial release but their is no assurance that a tear (like a break) is clean and either improvmement of further scar tissue could occur. I would watch the tear healing, monitoring for excess scar tissue formation, being ready to deal with that as we would deal with any
scar tissue excess problem.
Ed

Re: Plantar Fascia Rupture from Cortisone Injections?

Mike C on 2/22/05 at 21:10 (169664)

Unfortunately, a tear except for rare circumstances is very similar to a release. The plantar fascia is very prone to scar formation whether it tears or it is released. Under the best of circumstances it heals without incident before one develops significant pain and deformity. The downside is the pain (plantar fasciitis) often recurs.

Re: Plantar Fascia Rupture from Cortisone Injections?

JB1947 on 2/22/05 at 21:47 (169668)

Are you suggesting another MRI?

My orthotics are specially made from Langer....I have to wear a hard shell plastic because I am allergic to leather adhesives. I was just recast this past July 8, 2004. It is a 3/4 orthotic.
Are you suggesting that I have them made in a full orthotic now?

Re: Plantar Fascia Rupture from Cortisone Injections?

JB1947 on 2/22/05 at 21:56 (169670)

I won't massage with the marbles anymore but I'm sure it is still OK to pick them up with my toes......a standard exercise for range of motion of the foot.

I too thought there might be some nerve damage but no tests have been done.

The 'sewing method of injecting the steroid' is something my podiatrist uses and calls it this method because, while the needle is still in place (under the skin), he takes it and zig zags or pulls up on the needle to move it into different areas to break up scar tissue and thus injects the steroid into different areas of the fascia. I was surprised at this method myself and do not ever plan on another INJECTION! I do believe this was the cause of the rupture. I am gun shy about going back to this particular podiatrist.

I live in Houston, Texas.

Re: Plantar Fascia Rupture from Cortisone Injections?

Ed Davis, DPM on 2/23/05 at 16:10 (169719)

You could do an MRI but since you know the specific area involved sonography (ultrasound) is more cost effective. All orthtotics end where your's end, some orthotics have full length cushions. Such cushions can be made out of many materials. Also, one option is to use the orthotic without a glued cushion but palce an insole over it. Graphite makes a much thiner orthotic than plastic so you feel the edges less and have more room for the cushion.
Ed

Re: Plantar Fascia Rupture from Cortisone Injections?

Ed Davis, DPM on 2/23/05 at 16:13 (169720)

Mike:
That is exactly why we discourage plantar fascial releases. A clean tear or cut (surgical) always has the potential for less scarring than a tear although neither is desirable. The more irregular the tear, the more gapping thus the body is forced to lay down more scar tissue to bring the live ends together.
Ed

Re: Plantar Fascia Rupture from Cortisone Injections?

Mike C on 2/23/05 at 20:58 (169751)

Ed,
Ultrasound is a great idea if the tech is good and whom ever is reading it is sharp. With regard to orthotics I regularly prescribe full length inserts made of three lavers of varying density foam. Not all orthotics are 3/4 length. As a matter of fact 3/4 rigid orthotics can actually CAUSE forefoot problems. The truth is that 3/4 rigid orthotics are very inexpensive to make and those making do very well with the margin. I recommend seeing a reputable orthotist after obtaining a prescription from a specialist.

Re: Plantar Fascia Rupture from Cortisone Injections?

Mike C on 2/23/05 at 21:00 (169752)

if you release is and walk on it, it will gap, the integrity is lost and you are compromising the alignment and function of the foot.

Re: Plantar Fascia Rupture from Cortisone Injections?

Ed Davis, DPM on 2/24/05 at 20:07 (169840)

Mike:
That is true both for ruptures and plantar fascial releases and is another reason we discourage the releases...
Ed

Re: Plantar Fascia Rupture from Cortisone Injections?

Ginny P on 3/02/05 at 20:44 (170331)

In 1990 I had problems with my left heel. The Podiatrist I went to gave me two injections just as you described. He didn't call it the sewing method and not knowing any different I assumed that is how they were done. He would put the needle in a little at a time and while it was under the skin, he'd move it around to different areas, futher in and off to the sides. I remember wanting to crawl out of my skin. The good news, it worked.

I now have plantar fasciitis on my right side. I went today for my third shot and still no long lasting relief. This doctor does not use the same method as the first one did, he just injects it in the same place each time, thus making the bruise at the site, bigger and sorer.

My insurance does not pay for the shock wave therapy so my next step is Physical therapy and the night splint along with the anti-inflammatories.

Good luck to you.

Re: Plantar Fascia Rupture from Cortisone Injections?

JB1947 on 3/03/05 at 08:35 (170344)

Thank you so much Ginny for your response. None of the podiatrists/doctors on the board want to address this method. The first injection I had on Dec. 8, 2003 worked like a miracle. I think I was 75% improved. By March 1, 2004, my R heel was starting to flare up a little and I asked for the second shot because we were leaving for Rome, Italy in 12 days and I was concerned how I would do on the trip....since I knew we were going to be walking a lot. That was a big mistake getting the shot and all that walking,I think. One thing, my feet were so swollen from the 8hr.flight and stayed that away for the whole trip. My feet were not like that before the flight nor were they that sore. I think I lost 8 pounds from all the walking. 8-)Unfortunately, my plantar fascia ruptured(when, I don't know). I continue to wear a night splint every night now....it really HELPS.

I have stopped the treadmill and decreased my exercise for now. My foot feels better but different than the well L. foot. It will have to be something I monitor, I guess for the rest of my life.

Good luck to you, also.