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Monday, May 3, 2010

Cortisone Shots: The Thought Process Behind


• Cortisone shots can be divided into short-acting or long-acting.

• Short-acting shots normally are beneficial for 3 days and are used to quickly reduce inflammation. They are commonly betamethasone (6mg/ml) or dexamethasone (4mg/ml) formulas. Since even short-acting cortisone can cause damage/weakness to tendons, if given into tendon sheaths the body part should be immobilized for the 3 days. It is the long-acting shots that are the true healers when the inflammation is out of control, and normally what people are talking about when it comes to a cortisone shot.

• This post shows that cortisone normally is not a quick fix as some athletes hope, but it can speed the return to a high level of athletic activities when given appropriately.


• Long-acting shots have a crystalline base which slowly dissolves over a 9 month period. They are commonly Kenalog (10mg/ml) or Celestone (6mg/ml) brands. Any shot after the first long-acting cortisone shot within the 9 month period is considered a booster shot.


• Long-acting cortisone shots are normally mixed with a 5 hour local anesthetic. This way the shot also becomes very diagnostic. The long-acting cortisone itself takes 3 to 7 days before it begins to work. This is why you wait 2 weeks to see its effectiveness. I ask the patient to tell me how much pain relief they received in the first 5 hours, and then over the next 3 to 14 days. The initial 5 hours tell me if the cortisone was deposited in the right place.


• Following a long-acting cortisone shot, and after the local anesthetic has worn-off, there can be a period of 2 to 7 days where there is more pain due to the added swelling produced by the shot. This is why patients are encouraged to ice the area of the shot 3 times daily during the first week, and twice daily during the second week.


• Patients are told to come back in 2 weeks if they have less than an 80% pain relief (normally no pain walking, greatly diminished pain from before the shot).


• Long-acting cortisone shots are given routinely to diminish inflammation for bursitis and neuritis situations.


Long-acting cortisone shots should never be given into tendon or tendon sheaths (the covering of the tendon) since they are associated with tendon ruptures. It is important to keep the cortisone as far away from the neighboring tendons as possible. 


• Long-acting cortisone should only be given into joints when MRI s (not x rays) have documented no bone/cartilage damage to be of concern, or when the only alternative is surgical treatment. An arthritic joint, for example, can have up to 5 injections per year to calm down the inflammation, but if the injections stop working, surgery in some form will be the only alternative. The patient must know this going forward with the shots.


• Long-acting cortisone is never injected into the plantar fascia itself, but into the bursitis under it. Tears of the plantar fascia can occur with injections into the plantar fascia directly.


• No running/high-demand/weight-bearing sports are allowed for 2 weeks after a long-acting cortisone shot is given. This is why athletes run from the thought of cortisone shots, even when they are limping, and vow they will ice hourly as long as they can still run. More realistic is to try 3 to 4 weeks of physical therapy to cool off the inflammation, then to maintain their relief with a daily icing regimen.


• Most foot injections are 10mg of cortisone each. Most knee injections are 40mg of cortisone each. Most epidurals (spinal) are 80+mg of cortisone each.


• Injections are given until 80-90% improvement is noted. Golden Rule of Foot: Never Give A Shot You Are Not Sure Is Needed. This may require 1, 2, or 3 shots, minimally spaced 2 weeks apart.

• What is an 80-90% improvement? It is crucial to understand this concept!! Golden Rule of Foot: 80-90% improvement is when full activity can resume with only mild symptoms easily maintained with non-invasive conservative treatments like icing, contrasts, activity modifications, stretching, anti-inflammatory medication, etc.


• Most of the time 2 injections are needed to bring about this 80-90% improvement (a month of no weight-bearing athletics). However, 20%+ need 1 injection, and equal number need all 3.


There should be no pre-determining how many shots are needed. The first shot is given and the athlete returns in 2 weeks. The area is evaluated, and the doctor and the patient independently give an estimate on what improvement (if any) has been achieved. It is crucial that the patient ice the area 3 times daily (see post on icing) during these 2 weeks. This can accentuate the anti-inflammatory aspect of the shot, hopefully eliminating any need for further shots.


• When patients call me wanting an appointment for another shot, I normally have them icing 3 times a day, if they have not, for 3 days to see if they really need the shot. Over 50% of the time, they do not need the next shot.


• If after the 2 weeks, it is hard for whatever reason to determine how much improvement was attained, before giving another shot, the patient gradually returns to full-activity with anti-inflammatory oral medicine (after, not before, activity), icing, stretching, etc. If full activity is not allowed, thus not a the 80% improvement level, a booster shot is given and the process continues for 2 more weeks. You can see how once Cortisone Injection Therapy is initiated, it can take a while to finish.


• In the worse case scenario, 3 injections may not bring the inflammation down to achieve this 80-90% improvement expected. The decision must be made on further diagnostic tests or removable casts for immobilization.


• But normally, 1, 2, or 3 shots do bring down the inflammation, coupled with the 3 times a day icing, and with the 80-90% improvement, weight-bearing physical activity can begin.


• Hopefully, during the time of inactivity, some level of cross-training has happened, so return to activity at a higher level will not be too stressful on the body.


• Once the initial 80-90% improvement is attained, I will see patients at 3 months, then 6 months. If a re-flare of symptoms occurs, and icing does not diminish greatly, booster shots can be given one shot at a time.

159 comments:

  1. Thank you for posting this information. I wish I had seen it before I went to the orthopedist this morning. I am a middle-aged dancer with chronic tendinitis in my achilles tendons, and what the doctor gave me this morning was (apparently) a long-acting cortisone injection into the tendon sheath....and I have a major dance performance in three weeks! He told me to "take it easy today." I am not a happy camper. In Japan, the doctors don't actually tell you what they are giving you/doing to you, so I am basing the assumption that it is long-acting on your statement that they usually contain a local anesthetic. This one obviously did. My dance instructor is not going to be happy either as she uses the same doctor and recommended him to me, and she thinks he is wonderful because the pain disappears "immediately." (I had a look at the vial, so I know there was Lidocaine involved, but she doesn't.) I am glad to have the information, even though I am not sure how to solve the problem...rehearsal tomorrow...

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  2. Thanks for the comment and I understand your frustration. You really need to call and find out if it was long acting cortisone or not. Long acting should not be used near the achilles, but if used, 2 weeks of activity modification (nothing ballistic/explosive) is mandatory or the risk of injury is greater. The vial looks cloudy in long acting cortisone due to the crystalline nature. Did the vial look clear or cloudy? Local anesthetic is used in both long and short acting cortisone shots, so not a good indicator that long acting was used. Hope this helps. Dr Rich Blake

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  3. Thanks for this thread! I got a cortisone shot yesterday for greater trocanter bursitis (sp). I'm pretty sure it was the long acting shot. It still stings. Doc didn't say anything about applying ice but I still have my anti-inflammatory. I was trying to figure out if I should opt out of my group walk/run this weekend. I think I will.

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  4. I REALLY DONT WHAT TO SAY I HAVE CALCANEAL SPUR I THE DR.HAVE GAVE ALREADY 2 CORTIZONE INYECTIONS AND RIGHT KNOW I'M WITH PHYSICAL TERAPY WITH CORTIZON IN PADS AND I STILL HAVE THE PAIN THAT I CAN'T HARDLY WALK RIGHT NOW I'M WITH A BOOT THAT WEIGHTS MORE THAN MY POOR LEG SOME TIMES IT GOES WHILE I'M WITH THE BOOT BUT THE ONLY THING THAT I WANT IS JUST TO LIVE MY LIFE BETTER I'M VERY ANSIOUS FOR THAT CAN SOMEBODY TELL WHATS THIS =(

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  5. The fact that you can not walk means you need an MRI to decide what it is. There is a wide variety of boots also, some weighing a lot more than others. You probably should also be using crutches and/or RollABout to take pressure off the area and create that pain free environment so crucial to healing. Dr Rich Blake

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    1. I had a cortisone shot at 2:30 p.m. and it is now 7:30 p.m. and I am in extreme pain. I read all of the comments, so I do believe what I have may have been a long-term cortisone shot and yes it was cloudy but however the doctor did tell me that it may take up to 3 days before I feel the results of the cortisone working it feels like my ankle is broke all over again! I am about to ice It. I was trying to elevate it but the pain is so intense and throbbing that I can't do anything but toss and turn. I can barely pick it up and I can't walk at all. I've took a pain pill and nothing is working. PLEASE DR.give me a suggestion!

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    2. I had a cortisone shot at 2:30 p.m. and it is now 7:30 p.m. and I am in extreme pain. I read all of the comments, so I do believe what I have may have been a long-term cortisone shot and yes it was cloudy but however the doctor did tell me that it may take up to 3 days before I feel the results of the cortisone working it feels like my ankle is broke all over again! I am about to ice It. I was trying to elevate it but the pain is so intense and throbbing that I can't do anything but toss and turn. I can barely pick it up and I can't walk at all. I've took a pain pill and nothing is working. PLEASE DR.give me a suggestion!

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  6. I got a long acting cortizone shot 2 days ago for plantar fascitis went to PT for 6 weeks with no mayor improvement thus the injection now. My OS recommended i used a boot for 3 weeks so I don't injure my tendons my only issue is pain and weakness my ankle feels really weak and i think I got a flare from the shot because the area is a bit swollen and red.

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  7. Hi...had a big PF flare this past Monday 9/24/12. I received a Kenalog injection at the insertion of my PF near the calcaneus.. 10mg. mixed with Bupivicane, later that day
    I am training for the NYC marathon .. its on 11/4 .. six weeks
    I have trained all summer so I have a good base..
    My heel and foot felt immediately better for 3 hours till the bupicicane wore off.. Now slowly feeling better on Day 3.. but I have only been doing elliptical and ERG to maintain cardio.
    Given my marathon training schedule, etc, when do you think I can return to running.. I was hoping within 7 days.. I would have skipped one of my planned 20 milers.. Thanks

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    1. Hey Ted, There is no messing around with cortisone and running. If you get a cortisone shot, you need to take 2 weeks off impact. So elliptical is fine, running and jump rope is out. Try to stay in shape with cycling, but it is even risky getting off the seat. The first week back running should be as flatfooted as you can, with no emphasis on pushoff--so no hills or speed work, just distance. By the 3rd week, if all feels fine, running back to normal. Hope this helps. Rich

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  8. Hi. I developed bad heel pain on one of my runs 9 weeks ago. I pulled up sore and limping from that run. I had severe difficulty just walking around. I stopped running and managed to see a sports doctor 2 weeks after the onset of pain and had an ultrasound scan - it was diagnosed as retrocalcaneal bursitis and I got a cortisone shot under ultrasound guidance into the bursa. The pain decreased significantly after about 2.5 weeks so I tried a little 5 minute pitter-patter but I still felt something was not right in the heel. I went to see the doctor again 2 weeks after the injection for a follow-up and he said to get an MRI done to rule out a calcaneal stress fracture just in case. Unfortunately, the MRI showed that I had a significant high grade calcaneal fracture. The MRI was done 6 weeks after I first developed the pain and I had done absolutely no running during this time (except for 5 minutes to test out the foot after I got the cortisone injection). By the time of the stress-fracture diagnosis (3 weeks ago), I was already walking pain-free, yet the MRI showed that there was a huge crack in my calcaneus! I just have a few questions:
    1. Is it possible that the cortisone shot is masking the pain from the stress fracture? I am getting rather worried because the break in the bone looks very big on the MRI and yet I'm not feeling any significant pain, and I'm afraid that I am unknowingly putting more stress on the bone with my daily activities.
    2. Will the cortisone shot significantly delay the healing of the bone? I did receive the injection directly into the bursa under ultrasound guidance but will the cortisone "leak" out of the bursa and affect recovery of the stress fracture?
    Thank you :)

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    1. Hey Sarah, thank you for the email.Here are some general guidelines I can give you now based on the information you have given me. First of all, the cortisone shot could only affect the fracture by small amounts getting into the blood stream and giving you some anti-inflammatory effect. It will have no negative impact on the healing of the stress fracture. You probably felt better since you were good to it and the irritation across the fracture line calmed down.
      Calcaneal fractures are delicate beings, and it the risk of breaking into the joint above, I overprotect my patients. I place all my patients in removable boots for 3 months with some off weight bearing padding. We probably reduce the pressure on the heel by 50%. Then 1 month or so is used to wean off of the boot and into a supportive shoe and an orthotic device that can protect the heel and place the pressure at impact on the arch area. I counsel the patient about VitD3 and Calcium, any issues with bone density/diet, get them riding a stationary or road bike as much as possible for conditioning, and have them ice twice daily and contrast bath once daily. A Walk/Run Program can be started around 4 to 6 months based on the extent of the injury. When you walk your body has to absorb 1 to 1.25 times body weight. When you run, your body has to absorb 2-5 times body weight. Sure hope this helps. See my blog post on calcaneal fractures. Rich

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  9. Drs! Can't live w/o them though. MRI showed torn menicuse . Had already been repaired in 2008. Dr. In CA did arthoscoptic surgery. Came to Vegas to my own home & to do therapy. This ortho surgeon said he would have never done surgery but agrees I am not ready for joint replacement. I know I have arthritis & cortisone shots have always helped me. My surgery was Jan 4, 2013. March 14 I had a cortisone shot in preparation for a week long trip March 25. I am 50%. Should I ask for a booster?

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    1. The thing with cortisone at your stage is that everyone of them puts you closer to getting a knee replacement, but allows you to reduce your functional disability. There is no right or wrong answer. Every doctor has their protocols, though it can be tailored to the individual patient's needs. Dr Rich Blake

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  10. Hi, I have had a cortisone shot 2 weeks ago in my shoulder for subacromial bursitis, and have iced on and off daily, with no results. After my first shot my doctor sent me for an mri to rule out frozen dhoulder, and it showed I have fairly acute bursitis, subacromial and subdeltoid, and tendonitis of the rotator cuff. I am going for another cortisone shot on Friday, what should I do if I have no imptovement after then? Thanks.

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    1. I am sorry but I am a Podiatrist so can not give advice on shoulders. I hope is going much better. Rich

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  11. In the last few years I've increased my activity level significantly, taking up running and power lifting. After about a year of running, I started having horrible pain in my heel and achilles, which my PCP and Chiropractor diagnosed as Plantar Fasciitis. I spent about six months doing everything I could to take care of it. Icing, massage, rest, adjustments, you name it. In this time, my physical activity has been extremely limited, as I haven't been able to put any weight on my heel without pain.

    I finally saw a podiatrist today, who decided to do a cortisone injection and gave me a boot to wear for the next three weeks. Somehow, with all of the questions I had, I forgot to ask what has been at the forefront of my mind for the last six months. I imagine that I should ease back in to physical activity, but how soon? I'm willing to do whatever I need to prevent future injury, but am REALLY missing all of the activities that I had grown to love. Any suggestions for the best way to get back to normal? Thanks!

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  12. Beth, will answer on my blog tonight 5-23-13. Thanks and good luck. Rich

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  15. I was given a dexamethasone shot today in my foot close to my pinkie toe due to a tailors bunion but I recently had a cyst removed on July 24 same foot. My question is why my doctor did no realize I also have a bunion when my foot was just.basically split open? Also I've had no xrays or MRI to prove it's a bunion. I've just recently went back to work after my surgery and can not stand for more than hour and half without extreme pain and discomfort. Any advice or.recommendations?

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  16. Randy, there are so many reasons you are hurting. Definitely, getting a workup to diagnosis the source of the pain is in order. X rays are normally done first. When someone is in extreme pain, and the clinical exam suggests looking deeper, I love to get an MRI. Experiment with the types of shoes you wear (perhaps a wider or lower heel will help you). Ice 2 to 3 times a day for 10 minutes to see if you can get relief from the pain. See if you recognize all of the pain risers, and eliminate most of them. I hope this helps. Rich

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  17. I got two shots in my knees. The stuff looked like milk so am also assuming that it was longa acting. One was for a 20 year old ACL recon gone bad (artritic and basically no meniscus left, needs surgery), the other was quad tendonitis. Both injections were in roughly the same spot in both knees. I happend to mention I was going to wrestling and Judo and jiu jitus that same day and only then was I told to "take a day or two off". Guy is a renowned surgeon but apparently due to being double booked every 15 minutes doesn't to into the details.What is the minimum time I can be off the mat and can I go back if I go light?

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    1. Hey Scott, unfortunately I am a podiatrist, so can not speak about knee injections. And, I am very cautious, so I have a strong bias. I tell my patients that for 2 weeks they should not do anything that normally would produce pain before the shot. Hope this helps you. This is the time to ice your knees next two weeks for 30 minutes 2-3 times a day to help the cortisone work. Rich

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  18. I had a cortisone shot 5 days ago for a neuroma between two toes. My podiatrist said I would be able to resume normal functioning by the following day. I was NOT told to stay off the foot, so I stood and walked (hobbled) for most of the evening. Well, I couldn't even walk the following day the pain was so intense. I iced my foot the first day and was taking 400 mg ibu 3xday for 4 days. Pain is pretty much gone in that area, but I am concerned that I did more damage by walking and not resting the foot that first night. After reading your column here I am going to start icing again, any other suggestions?

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    1. When you have a steriod reaction like that, it can last for 4 days to 2 weeks, but typically 4 days. I call them the assault and battery days. The rule is that you can do anything post injection that you could do before the injection pain free for the first 2 weeks. At the 2 week point, the decision on whether you need another shot to reach the 0-2 pain level, or whether you can increase your activity. Keep icing 2 weeks longer than you think you need to, but definitely for one month following the shot. Rich

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  19. I had an injection of 1 mL of Depo-Medrol to treat a neuroma. At the time I was also having 2nd MPJ pain, but it was not the primary issue. I retuned for a second shot 3 mos later and received 1 cc of Kenalog in the 3rd interspace to treat the neuroma. The neuroma pain finally resolved; however, a month after the last injection my 2nd MPJ pain became severe. I have since seen a new MD and diagnosed w plantar plate tear. Rec surgery. Did the Kenalog cause the tear? Was the tear inevitable since I had been suffering on and off for 10 mos? When will the Kenalog get out of my system?

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    1. Allyson, Thank you for your email. Please let me know if I am hearing this correctly. The two cortisone shots were in the 3rd interspace, and the plate tear is under the 2nd joint. If that is true, there is no correlation between shot and tear. It takes 9 months for the Kenalog to get totally out of your system. I had a patient/friend who I thought had a neuroma 2nd space, gave a shot which helped, but 6 months later had a 2nd hammertoe. In retrospect, she had an inflamed 2nd plantar plate and my cortisone just speeded up the inevitable. However, my decision to inject, which lead to hammertoe surgery, since haunts me. Rich

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    2. How sucessful is the hammertoe surgery

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    3. Hammertoe surgery is one of the simplest, and best results, with over 90% success rate. If you ask patients, probably over 50% would say the toe is still too crooked, or too straight, or some other reason to not rate the surgery excellent, only good. The failures in this world tend to be flail toes, or in layman's terms, toes that after surgery move too much, and are too unstable. So, the more pins or implants that are used in hammertoe corrections, when the toe is already out of place, the better results in my mind. Hope this helps. Rich

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  20. My first injection was 10 mos ago in the actual 2nd MPJ due to painful MT pain from heels. I returned 2 wks later and received Depo Medrol in the 3rd interspace to treat a suspected neuroma. I received a third shot 3 mos later in the 3rd interspace for neuroma. The neuroma pain finally ended after that shot, but the 2nd MPJ pain returned w a vengeance about 3 wks later. My MD suspects plantar plate tear and rec surgery. Mild hammer toe and dorsal laxity.

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    1. Probably, but not certain, the 2nd joint was becoming a problem and the cortisone only masked the pain for a few months. Why go from symptoms directly to surgery. Spend the next 2 years wearing Budin Splints in all your shoes to hold the joint down and use icing to continue to calm the joint inflammation. If there is a local expert on prolotherapy, it is definitely worth a discussion. Surgery sounds like a quick fix, but not always successful. I like to avoid the first surgery if possible, if the disability part can be minimized. Rich

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  21. Agreed--would like to avoid sx. Thank you for recs. One last question--this past week in the walking boot (this will be week #3) I've started to experience pain at the very base of my third toe on the plantar surface. Now I'm nervous I'm dealing with another plantar plate tear at the 3rd MPJ since I've had 2 injections in that area to treat supposed neuroma. Recs?

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    1. Allyson, the plantar plate may be stressed, so I would loop the Budin splint over the 2nd and 3rd toes together. Keep it loose until you get used to it. Rich

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  22. I had a cortisone shot in my spine today. If I take it easy, can I run tommorrow? I'm in a running group that just started and want to run with them.

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  23. Hi, sorry I am not a back person. For feet and ankles, we do not allow impact running for 2 weeks post shot. Dr Rich Blake
    Not sure if it applies to you, but the principle is sound. You will have medicine on board that influences your ability to feel things.

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  24. Hi i have plantar fasciitis in both feet and have been told i need injections but i am terrified of needles. I was wondering how much it actually hurts, and whether you can return to work the following day?

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    1. Shots for Plantar Fasciitis are normally done from the side of the foot where the skin is softer. So, it would be more painful if injected from the bottom of the heel. I use Biofreeze skin coolant to numb the skin before the actual injection, and that typically helps alot. You should ice for 20 minutes just after the shot and several more times that day. People go back to work after the shots, but no running for 2 weeks. You can inject long acting steroid into the bursae under the heel, but typically not into the plantar fascia itself. All these fine points are really up to the doctor, and most based on what he/she finds and is trying to accomplish. I have had heel shots feel like a little prick to sharp pain, so have someone hold your hand, and definitely do not look. Bring music and earplugs so that you can relax before/during the shot. I pray you will not feel it at all. Rich

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  25. Hello. I just had a cortisone injection (yesterday) for what I believe is a callus (dead skin from rubbing against badly designed shoe - had it for years 8+) located at bottom of my foot, by the heel towards the left. I was not given any direction on how to treat the area after the shot. Today (2nd day) the affected area is a little swollen, painful (cannot walk/ put my foot down), and under the callus I see alot of black/dark matter. I have some pain but it also feels like something is eating my skin inside the wound. Is this normal? Should I ice? When is the pain going to go away? Most importantly how exactly the healing process works - is the callus actually going to fell off? am I going to have a hole left in the bottom of my foot? Thank you so much for taking the time to post this thread and answering our questions.

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    1. Katy, Thanks for the comment. It is odd to have a cortisone shot for a callus, but it may have been a wart that had medicine injected beneath. Hard to say. The black and blue is normal for a shot near the skin. Ice massage by melting an ice cube for 5 minutes 3 times per day. Without a clear idea of what your diagnosis is, it is not possible to know about it's future. Let me know if changes occur. And you could always send a photo. Rich

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  26. I have been receiving kenalog 40mg in right under my big toe.. well he pulls my big toe and goes right into that dipped area... I have a sesamoid that split in 2.. and a cyst of some sort in metatarsal head? I was told it is a tough thing to fix... If the take sesamoids out I will get a bunion.. If the take both out I risk getting hammer toe over time. I am in severe pain after this last injection (3rd) in less than 3 months. I don't know what to do. Please help!

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    1. First of all, I am sorry for the delay in my response. I seem to be saying that alot. Please try to limit shots of cortisone if possible, since it can slow bone healing and weaken tissue. You are now in the immobilization phase so you should be in a removable boot with accommodation to float the big toe joint and drive the pain down to 0-2. This is typically a 3 month committment and I would get several 2nd opinions on what to do. But, establishing a protected weight bearing situation is crucial right now. Hope this helps.

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  27. Hi, thanks for the great post and all the responses to comments which I've read with great interest. I had a cortisone shot yesterday into heel bursitis. Doc went through the achilles at one stage (I was led to believe) but I was very clear prior in requesting he be cautious in relation to the tendon given a history of prob's and utter paranoia about the possible consequences. Wasn't told whether short or long but since it had the anaesthetic (which took good effect), I'm guessing long. The ultrasound showed a pretty gnarly achilles tendon and lots of old scar tissue on calf including a probable tear of the plantaris tendon(???). I have always dealt with a degree of pain which makes me even more nervous about resuming high impact as I may not have a great sense of any pain beyond the norm. Anyway, my sport is squash at a high level, which is obviously pretty ballistic. I conclude from this post and others I must endure 2 weeks of no weight bearing or ballistic cardio, (maybe cycling without raising from seat) , then building from slow to faster running. Any views on sprints and bursts of fast stop start? When and how do you recommend that be started? Am for once willing to be conservative and would welcome any thoughts. Thanks in advance!

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  28. Here is my response. Hope it helps you. Rich
    http://www.drblakeshealingsole.com/2014/11/heel-bursitis-injection-near-achilles.html

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  29. I had a shot today in my perional tendon sheath!!! It hurts so bad I'm in tears. I have been icing. I don't know how much more I can take it hurts So bad!!! And I'm supposed to work tomorrow.

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  30. Hello, I have had cortisone shots on my right foot due to plantar fasciitis, then my ankles had some weakness so cortisone shots were put on my ankles, this set went very well 4 weeks later I Jane had a second set of shots and I am in a tremendous amount of pain. I can hardly walk if you can call that I can bear allot of pain but this is horrible.. Is this normal, will the pain go away? My doc is great, but I am in some major pain she did give me ibuprofen but even that had not helped, I did not feel like this with the first set, this is very painful please help any suggestions or help will be greatly appreciated.. In advice thank you, Nora

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    1. Nora, I am late with my response, so I apologize. 1 out of 20 cortisone shots produce this flare. You have the patients ice, and take a pain killer, typically lasting 3-4 days, but up to 2 weeks. Hopefully, it is feeling a lot better by now. Dr Rich Blake

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  31. I found this post while surfing the net lyrics. Thanks for sharing will be sure to follow this blog regularly.
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  32. Just want to say thank you for the amazing forum! It has been very helpful and informative.

    I am currently a basketball player that's been dealing with hammertoes/corns for about 12 years now. Couldn't really deal with the discomfort and pain anymore so I decided to get the hammertoe/corn removal procedure done about 2 months ago on all 8 toes except my two big toes (yeah I know, brutal).

    It has been exactly 2 months since the procedure and a month since PT and I can do slight running and jumping but with pain in my toes, which I do believe isn't a good sign. I consulted with my podiatrist and he told me that the pain was originating from the inflammation of my toes from the procedure. He recommended cortisone shots to eliminate problem.

    Is the cause of my problem from a slow healing process or is it just the inflammation that's causing the pain? Are the cortisone shots a good idea? Will it better or worsen the problem? Are there any substitutes besides the injection? What would you recommend?

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    1. Thank you for your comment. I will post a full comment on my blog today. Cortisone, especially the long acting, can weaken the issue. Surgeons forget to say that the bell shaped curve for running on procedures like this is 3-9 months. I would avoid shots, and go back to physical therapy. They can shorten the time to full actitivity greatly. Hope that helps. Rich

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  33. I am on my feet for around 12 hours daily,I have today had the injection to help my plantar problem,should I rest or resume work? Thankyou,Tina

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    1. You should be able to resume work as normal as possible. Rich

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  34. Hello,

    I came across this.post today after a google search for a procedure I had earlier in the day---a dexamethasone injection below my lower left ankpe bone. I have had several different diagnoses & am becoming very frustrated as the pain continues to increase, despite ice baths, stretching, and physical therapy. Pain began 12 weeks ago on a distance run and initially felt like tightness in my arch of left foot. I briefly stopped running and stretched my foot and calf. Pain returned quickly & then radiated to my left ankle....pain so strong that it made walking difficult. Took 2.weeks off and did swimming workouts which were pain free. Tried to resume running & pain returned. Saw an ortho who said it was a torn ligament & put me in a boot & referred me to a specialist. Specialist said it was plantar fasciitis....which I am positive it's not & described my ankle pain to him. He said plantar fasciitis can manifest in ankle?? Began physical therapy & they diagnosed as posterior tib tightness & did a variety of work with it that actually made things hurt more.but I thought perhaps it was working the injury out. Running was still painful so I stopped all exercise & went to a podiatrist who diagnosed with tarsal tunnel and/or tendonitis. He prescribed an anti-inflammatory & said to.stop with the PT as it could be making it worse. Pain continued even with anti-inflam & no exercise. Fast forward to today....12 weeks after initial injury & 3 weeks of absolutely no exercises, other than stretching. The podiatrist gave me a dexamethasone injection at approximately 4 pm. Everything seemed ok (had localized soreness which I assumed was from the injection) but my ankle has gotten progressively more painful as the night has gone on. Abour 4 hours after injection i can barely put weight on my left foot, and it is extremely painful even when not standing. Pain is mostly in my achilles and ankle area, and moving my big toe causes extreme pain. I will be calling doc tomorrow, but any insight as to what this may possibly be would be so appreciated. I am a high school cross country coach and ran myself both in hs and at the DII college level. I have never experienced a severe injury before and the fact that I have gotten numerous diagnoses---and nothing to "fix" the problem---has me very frustrated! I am scheduled to run the Chicago Marathon that is 11 weeks away, but that is very much looking like a long shot now!

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    1. Thanks for your comment and I am sorry for your troubles. Cortisone can irritate an area, and typically it lasts 4 days. Ice, ice and ice, and place yourself in a removable boot to rest it. It may actually help when the irritation runs its course, but the boot may also help. Avoid moving the ankle. Send me a photo of the exact spot on your ankle at drblakeshealingsole@gmail.com that the injection was given. Rich

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  35. Hi, i had a kenalog-10 injection 3 weeks ago and have been suffering some side effects including depression, head aches, heart palpitations and digestive issues, my questions are, 1) how long until this is completely out of my system? 2) is there anything i can do to flush ot out faster? Everything i have read says it takes about a month but your blog is the only one i have read that says 9 months. I am a bit confused at how long i am going to feel this way.

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    1. I would try contrast bathing. You can find the procedure on my blog. Do it one or two times a day. A 20 minute procedure. The cortisone that gets into your blood system should be less and less each day. I am not sure when however your symptoms will stop.

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  36. Plantar fasciitis is a very painful condition where at the bottom of the foot’s plantar fascia becomes inflamed due to a number of reasons.

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  37. Wow glad I read this, even tho it's a few years old. It's updated with answers which hats off to you Doc. Long story so I got hurt at work back in April 2015. Went to my doctor he next day with severe pain sent me to local hospital for Xray. Xray lady came out I was holding my foot in pain and I was waiting for digital cd for my doc I asked what's wrong. She states nothing is wrong foots fine. Just sprained! Ok don't feel like a sprain anyways doc tells
    Me stay off few days blah blah(basic sprain info). I worked on it for 5 weeks in so much pain on certain days. (Ladder days). So after a little over a month I went back to my doctor stated how bad the foot was still doing. He referred me to a podiatrist. The pain was not only on that outside it was In The heel,middle of the foot but that outside pain was e worst. So he looks it over (top notch doc) says thinks the sprain went away and I have planter faistias (spelling is Terrible sorry) he took me out for a few weeks due to type of work and put me in a boot. After about week and a half I could feel relive from the planter and still had that burning,stinging pain running up my outer left foot. The pain was basically unbareable so I went back. He sent win for an MRI (thank god). I have a Hairline fracture in my cuboid bone. He said he don't see this much. So out for few months. Still in a lot of pain he gives me a awcond opionion which is his teacher. Guy is awesome 5 star kind of foot doctor. He looks at it etc seems still broken and some nerve pain, maybe a pinched nerve. Why getting suck a stinging,burning in my pinky toe. After 3 weeks I went back Tuesday. Still in the boot,crutches and still in a lot of pain(not like before but still a good amount of pain) I stay off it AS MUCH AS I CAN ( have a two year old and wife works full time) I also am 45 days in on the bone stimulator. So he says it's been months the first 5 weeks didn't heal due to working on it but sense I have had the boot it's been sense may. So he says I believe it's a pinched nerve and he fratuced is prob healed. I'm Gg you a cortisone shot. Will take about 3/4 days to feel relieve in the foot. So that was Tuesday tonight is Friday. It feel BETTER but I still have a weird stinging pain into pinky toe and right about an inch after toes is still a very hard,dullish pain. If I walk in my boot it's seems WORSE. I have to go back in two weeks. I am going to continue to baby if and hope for the best. just hope that this don't mess with the fracture if it's still my healed. Thank doctor!!

    Also read I should be eating like 5000 caliores a day where I'm lucky to get 2000 with my nerves!!

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    1. Thanks for the kind words, and I am sorry for your predicament. Typically with the cuboid fracture you need an orthotic device and some form of taping that stabilizes the area. I recommend 3-6 months off ladders since that places the stress right on the cuboid. There are many treatments from the nerve pain (oral meds, topicals, warm soaks, avoiding pressure, etc). Read some of my posts about nerve pain. You may need to see a nerve doc to rule out S1 nerve root involvement. Hope this helps some. Rich

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  38. I definitely will read some of your info on nerves. Thank you so much for the info!! Awesome blog! Stay blessed Doc

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  39. hi, I hope that "I can take no new questions" is not applying to this thread because I'm a bit desperate for help, and docs keep downplaying my problem. I've had metatarsalgia on my 1st metatarsal head for over a year and a half after I hit a curb with my big toe. Tests showed I tend to bear my weight on the forefoot, so it seems like the trauma initiated the inflammation, and my foot imbalance is keeping it alive (X-rays and ultrasound scans showed nothing relevant). I've been put on orthotics but lately they've started to feel uncomfortable, so after over a year and a half I'm resorting to a cortisone shot, which should be administered in a few days. Have already tried a few kinds of NSAIDs and ultrasound therapy to no avail. Question is, waiting a year and a half to have a shot is it a good or a bad thing? Does it affect those chances of improvement you mentioned?

    thank you

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    1. Anto, sorry I was on vacation, and this email went unanswered. By now you have had the cortisone shot, so hopefully you are feeling better. With your situation, and length of time, I would see if you can get an MRI to give more solid inflammation on the injury. Rich

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    2. hello dr. Blake,
      unfortunately my little odyssey is still going on. I had a MRI which highlighted nothing else than a 'modest capsulitis in the 1 mtp joint and a minimal thickening of the plantar plate'. Problem is, the pain is not really in the joint, it's a bit more towards the toe - I realized that because I had a cortisone shot in my joint 3 days ago and no effect whatsoever has been felt (not even side effects). Also, the pain is triggered by pressure on the spot and I can flex my big toe just fine, so a diagnosis regarding the joint doesn't make much sense to me. But if that's so, what else could it be then? Last year's ultrasound scan talked about tenosynovitis, but since flexion of the toe was fine it was ruled out. Sometimes I experience a somewhat burning sensation caused by things which have nothing to do with the joint (e.g. wiping myself sitting on the toilet, sorry for the example but that's precisely what triggers it). I'll have to book another appointment and hope they can address the exact issue, but in the meantime would you happen to have any ideas on what's going on here? I've been dealing with this problem for 19 months now and it's getting to be really depressing...thank you

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    3. Anto, sounds like nerve pain. Are you wearing anything to protect the area under your foot? You can try NeuroEze topically, or get an Rx for topical nerve creams/gels. You can have the doc injection the local nerves to see what the response is, and if favorable, inject again with cortisone. Focus now on the nerves and mechanical off weighting of the local area. Hope this helps. Rich

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    4. hi again,
      thank you for your reply. I forgot to add the neurological part of the MRI scan, which reported "no perineural fibrotic thickening nodular morphology of the interdigital nerves in the inter-metatarsal-head spaces" (I'm translating from Italian I hope it's clear). Would this rule out any neurological issues? looks like it refers to interdigital neuromas but the problem is mainly on the metatarsal axis, between the joint and the first phalanx. I find this all very puzzling. I was also thinking it could be a problem with the tendon, as the discomfort spreads longitudinally, but in that case I guess I would have had problems flexing my big toe. I'll speak to my GP about those gels you mentioned and see how it goes in the meantime.

      thank you very much for your time

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    5. The MRI basically states you have no neuroma (mass), or excessive scarring, but does not rule out the most common type of nerve pain: neuritis (simply inflammation or hypersensitivity of the nerve). Sorry. Rich

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    6. hi again,
      I was wondering whether the culprit could be the 'minimal thickening of the plantar plate', as described in the MRI scan. It doesn't sound as much, but all these months I've noticed that my big toe sometimes deviates slightly towards the 2nd toe, and I recall reading that this symptom could have something to do with plantar plate problems (though it seems I don't have damage or ruptures). The pain is dull, not sharp. Also, judging from the site of injection I doubt the cortisone reached the plate, as there are at least 2 full inches between the site and the sore area.
      Another doc on the internet told me that in general there's a correlation between the pelvis floor and feet, though I haven't inquired whether it has to do with nerves or else

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    7. Anto, definitely the plantar plate can be involved, but the I find minimal thickening of the plantar plate in 100s of patients over the age of 30. So, it is not that helpful. How are you feeling now post shot? Rich

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    8. I felt no effect whatsoever (not even side effects) from the cortisone shot. I suspect I received it too far from the painful area, as the needle penetrated the skin from the opposite side of the joint, and I didn't feel the slightest pain (no anesthetic was used), the only annoyance was provoked by the needle piercing my skin. Also, as subjective as results can be a correctly placed shot should have produced at least a few days of relief, I guess, given the modest entity of the capsulitis. I'm enclosing a pic of my foot for the sake of clarity, hope you don't mind :) http://i66.tinypic.com/fmkzm8.jpg Would it be possible to place second shot nearer to the sore area? say, roughly on the same horizontal axis? I've booked another appointment for next week and would like to get things right as I don't think it's a good idea to have my foot pierced several other times

      thank you again

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    9. Definitely, you can inject in the joint (typically like you had it) or outside the joint (as close as possible to the sore spot).Rich

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    10. hi again,
      I've discussed the matter with my doc and asked him whether he didn't believe that the shot was given too far away from the sore area and he told me that the cortisone in any case spreads through the tissue and so it wasn't necessary to inject it right into the spot. Therefore he refused to prescribe a second shot and referred me to an orthopedist. Does that make sense to you? I still can't come to terms with the fact that a steroid shot may not produce the slightest effect for a problem which everyone describes as not severe. I highly doubt this new orthopedist will prescribe a second shot, he'll most likely want me to start again with a new pair of orthotics.

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    11. Sorry Anto, yes cortisone can be given to spread out, or into a specific spot (like a joint). When given into the soft tissue, it does have the ability to spread out. See what the orthopod has to say. Hang in there. Rich

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    12. the problem is that I got handled by two different docs, doc 1 prescribing the first shot, and doc 2 administering it. But since the MRI scan read only 'joint capsulitis', both took it for granted that the problem lied within the joint, so doc 2 injected the cortisone into the joint (he assured me so, it was ultrasound-guided).
      Also, is limited joint range a necessary requisite for a capsulitis diagnosis? My range of motion is perfectly fine, and I've read on the internet of docs ruling out capsulitis because of that. Maybe it's a sign of its mildness? (my capsulitis was described as 'modest' in the MRI). sorry for all my questions but after 20 months of highs and lows one starts worrying it'll never go away

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    13. No, most of my patients with capsulitis have no joint limitation. Rich

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    14. saw a new orthopod this morning, he ruled out the second shot option and told me go back to wearing orthotics (just like I expected). I told him that after months of wearing them the metatarsal pad had become quite uncomfortable but he just wouldn't listen. Could shoes be the issue here? for months I wore 3 different pairs (sneakers, leather shoes, basketball shoes), the first two of which didn't have a removable insole, and so with the added orthotics they felt a bit too tight. Now I'm resorting to buying a new pair, would you have any suggestions about what to look for? I understand that rigid sole shoes are preferable, but sneakers on the other hand usually have a removable insole and thus allow to create a bit more space

      thank you!

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    15. Anto, you can consider a New Balance 928 with the removable insert, and rocker style. Also, it comes in widths, so you can go a little wider than normal. But, make sure you power lace your shoes. Rich

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  40. Hey Dr. Blake I wanted to ask. I had experienced some strain on my left foot and saw a podiatrist today. According to the doctor it was deemed a congenital left sinus tarsi syndrome. I had been experiencing a strange pain on that area for 2 weeks. Its like tender muscle which wouldn't go away and hurt with my work shoes which are slip-resistant rubber-soled shoes provided by the company. I have a job that consists me of being on my feet a lot. I know for a fact that the work shoes I had 2 weeks ago on a Tuesday was the cause of the strain on my left foot and that weird pain because the shoe got wet by the rain and the work shoe I had was of the steeled-toe kind which is a bit heavy. I hadn't had my superfeet inserts in them because I hadn't gotten pain before only when the shoe got wet. I initially had seen a general doctor 2 weeks ago and was given a ankle boot, a soft shoe and 800 mg ibupropen to be taken 3 times daily as needed with pain. Still the pain came. So now today Friday 10/2/15 I was able to land an appt with a podiatrist to get a thorough observation. She gave me a cortizone shot which at first relieved me of the pain when I walked but in the afternoon around 3pmish, I felt my left foot inflamed due to the shot I think. I even had lunch and took one tablet of ibupropen and I still feel it. I had tried to ice the area for 10 min and I still have it. I was told I'd be fine to return to work normally but I feel like the shot made it worse seeing that it feels more painful to walk. I was also given a new ankle brace to wear to replace the old one, but again feels like I can't walk a normal stride on that left foot. Do you have any recommendations? I did email the doctor about this too. Thanks.

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    1. Kathryn, it can take the cortisone up to 2 weeks to really work (if given in the right spot). Unfortunately, the shot can be irritative and cause more pain for awhile (typically only 4 days). Ice for 4 days post shot, and see how the symptoms go. By the time you read this you should be at the 2 week point, so I hope you are doing much better. Sinus tarsi is a pronation produced problem, and many braces are actually designed to pronate us. So, if the brace does not feel great, remove, and find another or just limit your activities. Hope this helps some. Rich

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  41. I injured my ankle approximately 2 years ago and after many visit to urgent care and primary care doctor visits I finally got a referral to see a podiatrist. He sent me for an MRi which showed a complete rupture of the peroneus brevis tendon. The injury had taken so long to diagnose and I was able to walk normal with minimal pain so he made a custom orthotic and said to come back if I started having pain again. Fast forward a year and trying to increase my activity level (just finished my second triathlon). I am having pain and swelling of my ankle and foot. I got a cortisone shot yesterday and was told no running for two weeks. My question is what else can be done to fix the tendon since it is completely ruptured? What other non-invasive things should I consider?

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    1. The peroneal tendons can only be fixed with difficult surgery requiring long rehabilitation. That being said you can help your body deal with a torn peroneal tendon by finding out what that tendon did, and then designing a program to help it out. There are 2 peroneal tendons, the longus and brevis. Both do different functions, so first of all I need to know which one you tore. Rich

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    2. I tore the brevis tendon

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    3. The peroneus brevis is a lateral (outside) ankle and foot stablizer. Of the 2 tendons, it is the best one to tear (not that any one is good to tear), since ankle braces all protect that tendon. Gradually you try to work on Single Leg Balancing to strengthen the ankle to not roll with every crack in the street. Orthotic devices can be designed to fight against lateral roll (supination), but any arch support has a possibility of rolling you outwards. Keep the achilles tendon super flexible since it works to supinate you when tight. When on uneven terrain, wear braces, tape or high top shoes (when you can find for your sport). Strengthening the peroneus longus to help can be very crucial since they both stabilize the lateral ankle and cuboid. With exercises, like theraband, you can gradually make the longus 3 times stronger than it ever was, and that should be a goal. Hope this helps some. Rich

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  42. This I one great website!!!! Thank you

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  43. I have pain in my heels on and off from last 2 years. But from last 3-4 months it has gone too much. I can merely do household work. There is too much pain and inflammation. I went to a doctor and he gave me short cortisone. It didn't help me at all. Then again he called me 2 weeks later and again give another shot. That also didn't help me at all.

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    1. I would place yourself in the Immobilization phase with a removable boot on one side (half day on each side), and a clog on the other side. Ice 3 times daily for 15-20 minutes and take an oral medication (NSAIDS or oral cortisone burst). After 4 weeks, let me know if this has helped. Also, I assume you have considerable pain even in clogs. Let me know if you have no pain (like a Dansko clog). Rich

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  44. Hi there, Thanks for the time and advice you provide here it is very useful. My running has unfortunately been curtailed for the past four months as I try to recover from a t6/7 thoracic sprain.
    My condition is somewhat unusual. I had prolotherapy 20 years ago using Phenol that was injected into a healthy t6/7. I spent the next year having cortisone shots to loosen it and although it was too tight I dealt with the chronic pain for 20 years and was able to run freely. Unfortunately through being too tight I tore it in an accident 4 months ago. I had some cortisone into the facet joint 7 weeks ago and it gave me some reduction in tightness but I will need to go back for more to loosen things. I think I picked up more scar tissue with the sprain and it's now tighter than ever. My ribs on either side go out and t6/7 just jams, it can't move 100% without pain. My excellent doctor who first helped me 20 years ago to get things functional again has waited to see whether the sprain would come right on its own, but no luck unfortunately.
    I have never seen anyone else who has had this problem. I had the Phenol in c6/7 and t3/4 and the doctor I see now had to use the cortisone to loosen those but they seem to be okay now.
    Anyway, any thoughts much appreciated. Thank you.

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    1. Sorry, but I am a podiatrist. Try to see an osteopath, physiatrist, or chiropractor. Good luck. Rich

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  45. Dr. Blake - These season I have done 2 Olympic and 1 Sprint distant triathlons. About 12 weeks ago I fractured my clavicle while training for my half ironman. At the 8 week mark the orthopedist gave me the green light to start running again. Just prior to my injury I was running 20 -25 miles a week with no issues. When he gave me the green light to start running again I was so excited and started out I thought slowly running a mile and working my may up to 4 miles over a 2 ½ week time frame. Other than running pretty slow for the first week I felt I really did not overly push the run distance but I’ll take ownership and say I ramped up the distance to quickly. I have flat feet and the Brooks Adrenalin 14 sneakers have completed my feet for years. I have 4 pairs of the same sneakers and rotate them regularly. Well, my left foot developed an inflammation near the center about a ½ inch from the ball of the foot. Planters fasciitis….. It appeared to be getting better after starting a series of exercises, message and icing but it took a turn for the worst and became painful in in the morning time. I just had a follow with my Orthopedist on Wednesday 11/11 for my clavicle and decided to let him do cortisone shot which has relieved the inflammation. I still feel a little swelling (like a small lump) and continue to message, ice and exercise the area a couple times per day.

    Given you have the little background above I am hoping you can give me a general range of the time it takes for the small lump to go away completely and the general rule getting back to running after the cortisone shot?


    I appreciate your reply very much!

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    1. Thanks for the post. Typically, we do not allow our runners to return to running for 2 weeks post shot to give any weakness time to heal. The lump should be massaged daily 2-3 times if possible to see if you can break down. If not painful, you can massage with creams or oils. If painful, use an ice cube to massage comfortably. See the post on ice massage. Hope this helps. The lump itself is not a problem and should resolve over the next month. A painful lump may require more investigation like an MRI, but that seems overkill for now. Rich

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  46. I just received a cortisone injection in my ankle. My Doc believes it is tendonitis (had X-Rays and will soon have MRI). Shot seems to have taken effect this morning, Have been icing and resting. My question is when I resume physical activity at the gym? I do Pilates, Zumba and Spin (Cycling) each 3 times a week. Also, in cycling class should I get off the saddle when I resume?

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    1. Typically, no hard impact like long distance running for 2 weeks. If you are only doing activities that were not stressful before the shot, then it is okay to do right after the shot. You should be able to get off the seat in cycling class if the shot was in the ankle, and if that activity was fine before the shot. After 2 weeks, all these restrictions go away and patients are asked to gradually test out the ankle for the next two weeks, perhaps at the 80-90% level initially. If all is well, back to 100% function at 3-4 weeks to get a feel if another shot is necessary. Hope this sort of makes sense. Happy Thanksgiving. Rich

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  47. I have an odd question but I found this site trying to find the answer to it. So I received a cortisone injection to relieve inflammation in my knee. Not sure what kind of shot it was but I'm assuming long lasting. 2 weeks after that, I underwent post exposure rabies vaccine for possible bat bite. I told the doctor about the shot but they didn't seem concerned. Now I read that steroids can interfere with vaccines. So I am trying to figure out how long the medicine actually stays in the blood stream? If it is gone from the blood stream, how does it continue to relieve pain for several months? Do you think there is an issue with my vaccine from receiving the shot 2 weeks prior? Thanks for any help you can offer.

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    1. Thank you for your question, and I am sorry for my delay in answering. This is a question for a pharmacist, or an expert in rabies vacinations. Sorry. Rich

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  48. Hello Dr. Blake. 17 months ago, I gave myself two longitudinal tears in peroneus brevis tendon by turning my ankle while running down a rocky ski mountain. I had been experimenting with running without my lift: I have a 0.6 inch LLD which I had been correcting with a lift in all my shoes (long leg has the torn tendon). A costly experiment! Thought it was a sprain and kept running and racing ultras for 6 months. Got MRI #1 and learned of condition. Put valgus wedge in all my footwear. Biked and ran alternating days once swelling was gone. Biking never bothered it. 5 months later, after work with PT, DO, acupuncturist, and using TCM, TENS, and Dit Da Jow, MRI #2 showed "no change." Got long-acting cortisone shot, stopped running, and did only biking 4 more months. Stopped above treatments and used arnica. MRI #3 showed a complete healing of the tear that was close to the toe but "no change" in the tear directly under my ankle bone. Just got cortisone shot #2. I was counseled to continue biking but to begin running with much slower build-up than last time: adding 1 minute of running every other day, running on treadmill with 0* gradient in shoes with 8mm heels--4mm higher than most of my shoes to stop ankle from flexing--and going slowly, also to keep ankle from flexing (as this would "stretch out the tendon"). Still using valgus wedge. Am hoping to make it back to my pre-tear condition: was a national-class runner in 100-150 mile races. Is this realistic without surgery? For that matter, is it realistic with surgery? Thank you.

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    1. Thank you so very much for your comment. Typically most of the peroneal tendons can function well with split longitudinal tears, once the tendon has healed. I can not comment on the cortisone shots, since it is my rule never to inject long acting cortisone anywhere near a tendon. Surgery should not be needed unless it tears into 2 pieces. You are smart to keep the valgus wedge, gradually increase motion with ankle dorsiflexion (flexion), and get the peroneals as strong as possible. If you are using theraband, I would be curious at what strength (level 1-6) and how many sets and reps you are comfortably doing each day? Rich

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  49. Dear Dr. Blake,

    I am an active 69-year-old tennis player who plays competitive USTA singles 4X/week.

    About 5 years ago I strated having pain in ulnar side of right wrist, diagnosed as synovitis/arthritis. I started getting cortisone shots every 7-8 months or so which worked great and kept me playing tennis. The relief times have been getting shorter, however, and shots have been every 4 months or so. My hand doc says he would not give shots more than 3X a year, and said that there were surgical options, but nothing guaranteed that would work and keep me playing tennis.

    The doc says there is very little cartilage left in wrist. My question is, what is down side in having shots 4X or 5X a year if that will keep me playing, as there is little cartilage left anyway, and surgical options are dubious? Thanks in advance for you help...

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    1. Sam, since I am a podiatrist, I really can not reply to a question about your wrist. However, if it was your big toe joint, we do the shots until they stop working and then surgery is done. Since surgery may be the end of tennis, and the shots help you continue to play, I think it is a no brainer to an athlete. However, the conservatives would not want you masking pain and playing, since theoretically you will be better off in the long run after your playing days are over. There are no good studies. Not how I want to live my life. Every athlete risks some permanent damage every time they step on the court. Good luck. Rich

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  50. Rich, thanks for the reply. I didn't realize you were a podiatrist until after I posted.

    The hand doc rationale is that the cortisone weakens the muscles and tendons which could compromise future surgery. My thinking is that I could have shots more often and delay surgery. I think three a year should not be maximum, but 4 or 5. Your thoughts?

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  51. I have been diagnosed with a fibroma on the plantar fascia. It was seen on an MRI and is deep in the heel. My foot doctor says it is in an uncommon location. He can't feel it. He offered a shot, but seems like that would only be a temporary solution, if it even helped. I am almost unable to put any weight on it and limp when I walk. I feel I need a more permanent solution, so we talked about surgery. I've researched the surgery online and am terrified of the possible complications and high recurrence rate. I must do something, as it is difficult to live a normal life at this point. The fibroma measures 1.8 x .8 x 1.1 cm. I would appreciate any advice, as right now none of my options sound good and I'm depressed. I'm a 61 year old female in otherwise good health and want to be active and travel in my retirement. Please help.

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    1. I agree that it is in an uncommon place, and therefore may not be the type of fibroma you are reading about in the midarch. Could you take a photo of several of the MRI images that show it. Email them to me at rlb756@gmail.com. Rich

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  52. Rich, I know we are talking about different joints (mine is the wrist), but do you have any guidlines as to how many cortisone shots/year are OK, especially if major surgery is the only alternative?

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    1. Try to limit to 2-3 in the foot, and this is only for joint injections. You want to avoid cortisone near tendons. Rich

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  53. I am in extreme pain!I got cortisone shot at 2:30p.m, and it's now 8pm and the numbing medicine wore off. I'm in extreme pain! The doctor did warn me that once the numbing medicine wore off I would be in pain, I wasn't expecting it to be this painful. The shot was cloudy I do believe it was a good long-term cortisone shot. I asked the doctor would it be okay if I received a cortisone shot and he said yes as long as I wasn't getting it on a regular basis it should help the tendonitis and the pain and inflammation that I had. Now I'm in even more pain and I can't move my ankle it feels as if it is broken. My entire ankle is swollen throbbing and hurting. I'm going to ice it and I've taken a pain pill and its not helping at all please tell me what can I do and what to expect in the next couple of days or weeks. Before I read all the comments and my ankle first started hurting I was trying to massage my ankle hoping that will relieve the pain I hope I didn't do anything for the damage. Please give me a suggestion of what I can do at this point.

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    1. Tracy, sorry to see your dilemma. Hopefully, now 2 days later, you are beginning to feel better. This reaction is common in about 1 in 20-25 cortisone shots. It is called a steriod flare. It typically takes 4 days to calm down, and does not mean that there is any damage. The skin can get a little red. Yes, you ice 20 minutes every few hours and put in a call to the doctor's office for advice. If the redness is dramatic, and the doctor not around, go to the ER, since it could represent rarer conditions like CRPS. Sorry for my delay. It was my birthday yesterday. Rich

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  54. Great blog. Tremendous information.

    Thank you for sharing your knowledge and expertise.

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  55. Hi Dr. Blake, I have been having back of heel pain that is warm to touch, red and swollen for about 3-4 months. The NP at my GPs office said it was plantar fasciitis and referred me to podiatrist. He said it was achilles tendonosis, gave me a dexamethasone injection and referred me to PT. I have received no relief at all and now the bottom of my heel gets very painful if I stand for any length of time. The podiatrist is now saying I need surgery for bone spurs and may or may not need to reattach the achilles tendon. I am not 100% on board with this. Should he have tried a long acting cortisone injection before recommending surgery or any of this other stuff? The dexamethasone injection did nothing, but sure hurt like heck when he gave it to me.

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    1. Angela, the long acting cortisone near the attachment can cause tendon injury so avoid. The treatment for the next month is to create a pain free environment with a removable boot and get an MRI to look at the tissue. Surgery is very uncommon for this condition in our practice, but you still have no 3D imaging to help make a diagnosis. Also, Ice pack 10-15 minutes 3 times per day to reduce the inflammation. Possibly gout?? Any blood work? Rich

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    2. I recently had routine lab work done for my thyroid and see my GP on Monday to go over results. I do have a history of kidney stones also. I was on oral Voltaren and now am using the gel to the area. I have used ice intermittently, but will try your recommendation. This has been going on for so long that it is now affecting my gait and daily life. I will also ask my GP about an MRI on Monday as well. I was also curious as to why some form of testing had not already been done. Thanks for taking the time to respond and your suggestions.

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  56. Hi Dr. Blake,
    I have had reaccuring tendonitis diagnosed in various tendons in my lower leg and foot over the past 2 years. Started with overuse sesamoiditis, posterioal tendonitis and peroneal tendonitis. MRIs of foot, knee and even back after an EMG because of calf muscle atrophy. I am a climber so this constant injury is very frustrating to not be able to walk lain free, let alone climb. A podiatrist and now an orthopedic surgeon recommend a tendon sheath injection for the Peroneal tendon issues. I have pain at attachment under arch and at side of calf below knee. Weakness and increase pain wih movement. Also tendon pops at ankle. I have done pt and various therapies only to platue. Do you thimk the shot is best way to go? What questions do I need to be asking to make sure it is safe?
    Thanks, Sarah

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    1. Sarah, sorry for my delay in responding. I am assuming that the MRIs only came back with tendinitis and no tears. The PRP injections are gaining popularity, make some sense, but I just have no experience with it to recommend clearly. Definitely no cortisone into the muscle, tendon or sheath for fear of rupture due to transient weakness (which could last up to 9 months). Review the blog article on BRISS for tendinitis. See if there is anything missing in your treatment. Have you been adequately immobilizing in a below the knee removable boot for up to 3 months? Do you then to supinate excessively even with orthotic devices? When you return to activity, do you just go back to an overuse situation? Sounds like unless you can not get the tendon strong, it will be permanently the weak link for activities. How can it be made stronger? Or why haven't the PTs been able to make it strong? Sorry more questions than answers. Rich

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    2. Dr. Blake,
      Good afternoon. I am emailing you about a frozen ankle injury after a bad sprain. That is the subject of the email incase it goes to your junk folder. I hope to hear from you soon. Laura Chapman

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  57. Dr. Blake,
    Good evening. I just emailed you about a frozen ankle after a bad sprain. That is the subject of the email incase it goes into your junk email. Thank you in advance for any help you can provide. Laura

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  58. Good evening,
    I just want to thank you for taking your time to respond to so many people's concerns and questions. I emailed you about a frozen ankle injury after a sprain. That is in the subject of the email, incase it goes to your junk folder. I have an appointment Monday, February 22nd. I would love to hear what you think about my situation. Thanks again in advance. Laura Chapman

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    1. Laura, there are some types of bad ankles sprains with bone injury that occasionally lead to frozen ankle syndrome. Because xray will not show the subtle bone reactions, I love to get an MRI. This will help me decide on bone vs soft tissue vs both, and how to treat accordingly. Rich

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    2. Dr. Blake,
      Thank you for responding. So, if I had soft tissue damage, would it look cloudy in the MRI from the scar tissue? Or could it still be bone or both? I guess I have a lot of questions for my doc on the 1st. Thanks again. I also got the cortisone shot last week. They gave me the booster, as you call it, because they want to see if I get any relief before attempting the stronger one. I'm not sure how well it worked or is working, but I guess it could still take time to work its magic. ;) I haven't tried running on it yet, so I might try that this week since its been a week to see what happens and how my ankle feels. Thanks again. Laura

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  59. On the MRI, soft tissue injury looks like inflammation gone beserk, or thickening of the normal tissue. The cortisone shot takes up to 2 weeks to work, so I typically tell my runners no running for 2 weeks, then another 2 weeks of easing back into it. After 4 weeks, the overall effect should be obvious, and that is when a booster is considered. Never heard of a booster give first, probably more of a small dose??? Rich

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    1. Dr. Blake,
      Good morning. I know my pt doc explained the shawdowing that was there as the gooey stuff, meaning scar tissue, which shouldn't be there, and it was everywhere in my joint. I definitely have a lot of questions for my doc tomorrow. Ok, so I won't try running yet, but physical therapy is ok, right? Yes, I got a 6ml shot vice the 10ml shot. I was talking about the booster while i was there and he didn't really know what i was talking about either. Maybe i explained it wrong or read it wrong in here. He said it isn't that the shot is weaker than the 10ml dose, just a smaller dose and they all do the same thing, just this one may not have as much side effects as the 10ml shot. The doc did say to check back in 4 weeks and see how I feel and if I will get the bigger dose or not. Since I got a smaller dose, would it still take 2 weeks to feel the full effects of the shot? Thanks again. Laura

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    2. Yes, that is the time no matter the amount they inject. I typically give 2ml of Kenalog 10 if I am using long acting steroid into the joint. With more volume, it will take longer to dissipate, so it will take alittle longer to feel better. However, the opposite is sometimes true where the volume acts as a spacer and decreases the pain overnight. Rich

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    3. Dr. Blake,
      Good evening. He gave me 2 - 6ml shots in my joint. I did notice that the swelling went down the first day. In the morning, my ankle is pretty stiff until I walk around for a few minutes, but the following morning I didn't have that. Now, I'm not in pain but there is still a little swelling and the mornings are back to being a little stiff. I guess we'll how it feels next week, since that will be 2 weeks since the injection. I go to a deep water swimming class 2x a week. I didn't go last week, but I went today. Do you think swimming is ok since there is no direct impact? Thanks again. Laura

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    4. So Laura, sounds like things are better, and definitely the swimming is wonderful for a frozen ankle. Love the no impact, but no fins for now. Rich

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    5. Good morning, Dr. Blake. Great, I will definitely keep up my swimming and stay away from the fins. So, I had my 4 month follow up with my doc. He did confirm that he only scoped the front of my joint. He said he felt that my range of movement was moving well enough and didn't feel the need to scope the back of my joint. Now that I know that I'm not losing my mind and my foot isn't moving because I have almost year old scar tissue in the back of my joint, is a relief and a disappointment at the same time. I'm most likely going to need to have surgery again and start physical therapy all over, so the last 4 months will be like nothing happened. My doc brought up going in and scoping the front again and cleaning the back and putting in an external fixator halo device to stretch my joint to give it the space and keep that on for 2 weeks. I talked to my mom, she is a nurse, and feels like that is a bit aggressive and usually only sees that for breaks and such. She feels that isn't even something he should have even mentioned as an option. I'm not sure I need something that extensive as well. I just need my joint cleaned up of the scar tissue and I believe I will be fine. The doc I had a second opinion with said he would scope my joint and then put in an amniotic pad in my botton joint to have a cushion and help with range of movement after surgery. What are your thoughts? I talked to my pt doc and she said I should do the pros and cons of each procedure and pick one doc to continue treatment with. I'm going to schedule a follow up with the doc I had a second opinion from and see how he feels as well. Any help /advice would be greatly appreciated. Thanks again. Laura

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  60. Dear Dr Blake, I started getting very sharp pain on the bottom of my foot when walking, in a spot where I have a small scar from a surgery to remove a plantar wart. The scar is 25 years old and I never had any pain from it. The position of the scar led the first orthopaedic surgeon to diagnose plantar fasciitis. The stretching and rolling exercises left me in agony. Second orthopaedic surgeon referred me for an ultrasound which showed inflammation around the scar tissue which is in the shape of 2 pointed 3mm deep. I had a cortisone shot 19 days ago and managed to put some weight on the foot 3 days ago, but also bought a walking stick a week ago. Have you come across foot scarring getting inflamed and what is the success rate for softening old scars with cortison shots? Many Thanks, Jelena

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    1. Hey Jelena, I suppose an old scar can get irritated, but I have never seen it. I would probably try all the great PT techniques first. Typically a physical therapist would know how to break down the scar tissue or inflamed tissue. Rich

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    2. I appreciate your prompt reply. The spot was extremely tender that it was in fact PT who referred me back to the first surgeon questioning the diagnosis of plantar fasciitis. She thought it was way too tender for her to manipulate. It is less tender 3 weeks after the cortison shot, I can touch the skin and press around, I don't know if cortison is still hard at work in there as I don't know which type of cortison was administered. There is still some pulling sensation and pain when I try to put weight on the foot and redness has come up to the surface of the old scar (the scar had normal colour before the cortison shot). Would this be a positive sign of scar tissue softening and healing or if this is ripe for surgery? The progress seems to have stalled in the last couple of days. 2nd surgeon suggested that if cortison shot failed the other option was surgery for scar revision. Are there any other diagnostics apart from ultrasound you would recommend for scars on feet, MRI perhaps? Many Thanks, Jelena

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    3. MRI is helpful if the lesion is large, which seems to be suggested by the ultrasound. The sensitivity is probably nerve, but why now? Sure, I would get an MRI, and if the lesion seems large enough, have it removed. If the lesion seems small, go back to the PT. PTs should know how to desensitize a scar, if that is what it is. Maybe they can get at it now better. With the skin change, I would avoid more shots for now. Good luck. Dr Rich Blake

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  61. Hi Dr. Blake, I had (have) a plantar fibroma. Between pea and marble size, left foot. Podiatrist recommended surgery: cutting out fibroma and cutting fascia at heel; post op treatment long & extensive. I opted for cortisone shot (his 2nd recommendation). About 3 weeks after 3 sores have appeared and quite sore. Almost look like burns and they are right next too the fibroma, which has been reduced (shot has been about 7 weeks ago). #1 should I ever consider surgery and if yes, is cutting the fascia something I should do? and #2 have you evr heard of sores after shots in feet? I also have one in my right foot but the shot hurt so bad, I declined doing both and now I'm not so sure. Thank you. Tracy

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    1. Hey Tracy, send me a photo of the sores. Surgery is not recommended unless it is your only option due to severe disability. Cortisone shots, if placed too close to the skin, can temporarily weaken the skin and create sores. A wound care specialist may have to help you avoid infection, and they they do tend to resolve over a 9 month period. Keep some antibiotic cream over them at all time for now. Those shots are painful, so I doubt it was worse than my shots! Sorry. I await your photo. Rich

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  62. Tracy, also some cross frictional massage, avoiding the sores if possible, from a good physio can help. You can start with 5 minute ice massage across the grain of the fascia, or in circular motion, 3 times a day to help. Rich

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  63. I had plantar fasciitis a long time ago and will do anything to prevent it from ever happening again.

    I myself have never had cortisone injections to cure it. I did take lots of rest, roll a ball under my feet, and stretch them. Once I was able to walk again, I made sure to get good supporting footwear. I was nuts to walk around on worn out sneakers for as long as I have.

    With my own treatment plan, I also noticed significant improvement in the first few days, just like with these injections. Would these cortisone injections have given me an additional speedup in my recovery process?

    Sincerely,

    Brian

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  64. Richard Blake, The podiatrist I've been seeing recently looked at an x-ray of my left foot and determined that I have arthritis in a number of spots. She believed a cortisone injection would decrease the pain so I told her okay. A few minutes later she began to inject my foot. She didn't use any equipment to guide her. What's your opinion? And, how long should I wait to have my foot massaged? Sincerely, Terry Heller

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    1. I was also not trained in ultrasound guided injections, and feel good that it is unnecessary in most cases. Typically you avoid someone working on the injected areas for 2 weeks. Dr Rich Blake

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  65. Dr. Blake, I've had 4 cortisone shots in my right foot during the course of approx 7 - 8 months. The 1st two were Sept/Oct 2015 and they were 2 - 3 weeks apart. Than one in early January, than one in early April 2016. I had what I call "normal" plantar fasciitis. Morning pain, pain at the beginning of my run, etc. from when it began in late August until January 2nd when I did a 12 mile hike/run and it started to hurt like he!! about half way in to it (of course I continued). I could barely walk for several days. Than doc gave me injection and taped me up. I had some EPAT (shockwave) treatments in Feb & Mar where it started to feel *ok*. I than tweaked it a tiny in early April so I went to see a new doc (ortho this time) and he gave me my 4th injection (yes I told him a podiatrist gave me 3 already). Since then it hasn't been the same. While there are some good days it seems there's nearly a constant pain around the injection site AND oddly enough on the other (outside) of the heel - especially bad when squeezed. If I walk a lot (like a museum) I'm limping by the end of the day. I just finished 8 PT sessions where he did Graston but still the same. I stretch all the time. Any ideas?
    RD

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    1. Forgot to add: I haven't run AT ALL since Jan 3rd. I do however ride a recumbent bike most days and swim laps. Also, I feel like I'm regressing rather than improving. No joy!
      Thx!

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    2. RD, sorry I did not see your comment. I definitely would get an MRI to see if there is a tear or stress fracture. That could require 3 months in a removable boot. Let me know in an email to drblakeshealingsole@gmail.com what the results of the MRI are. Rich

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  66. Dr. Blake,
    My wife received a long-term cortisone injection for plantar fasciitis 1 week ago. The first 3 days she was nearly pain free, but each day afterwards the pain in her foot has returned more and more back to the point where she is back to hobbling around the house. I'm just curious if this is normal and her pain will slowly go away, or if it means the cortisone injection had little to no effect.
    Thanks,
    Anthony

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    1. 2 things I failed to mention in my first comment.
      This is her first cortisone injection she has had.
      Her doctor unfortunately did not say anything about icing her foot (after reading this blog I suggested she start icing 3 times a day until her 2 week follow-up).
      I'm not sure if the lack of icing her foot caused the pain to return faster; but as I said earlier, instead of getting better, she's getting worse.

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  67. I'm so happy to have found this site. I have had plantar fascitis for about a year with a"ginormous" heel spur. I was given a cortisone shot 11 days ago which provided some relief for 3 days, then symptoms have been increasing until now the bottom lateral side of that foot is numb and I can barely walk on it due to pain. Help! Is this a normal reaction?

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    1. Jann, sorry this comment was buried. If you need some help, you can email me at drblakeshealingsole@gmail.com and I will try to answer as complete as possible. Rich

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  68. Hello, first of June, I injured my foot at work. Xrays were clear. After 3 months of pain and decreased function, I was given a CT -bone scan- 3D imaging. I was sent to an Ortho Surgeon. It showed a major mid foot fracture. I was imobilized and informed a block fusion will probably be the end result because I had been walking on it for 3 months. Cast removed in October and still in boot cast. Then yesterday, my xrays were clear ( no MRI or CT done) I am unanle to kneel or get up from kneeling, and unable to walk down stairs. Also, my foot wont roll properly upon walking and has pinpoint pain and occasionally snaps above the 3-4 metatarsal. Its extreme pain when I do these activities. Well, at my appt ortho surgeon yesterday, suddenly surgery is back burnered and cortosone shots are being scheduled. In your opinion, is these shots used post fracture with possible damage to tens and ligs?

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    1. First of all, I am sorry for your problem. This area called Lisfranc is very common for negative x-rays, but big issues. Yes, cortisone can weaken tissue, so has to be evaluated carefully pros and cons. I will place your question on the blog next few days with a clearer answer. Dr Rich Blake

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  69. I had 3 shots in one foot and 2 in the other for pf. For the most part the pf pain is gone but I developed a new problem. After the 2nd shot in my left foot, I developed pain in a spot on the edge of my heel About 1 inch behind my ankle bone. I think it's at the site of the last injection. It's very painful to walk. Only hurts when I'm on my feet although sometimes after I get off my foot, I'll have a shooter pain. The sore spot is right on the edge so a little on the side and a little on the bottom. It's hard to wear close heeled shoes now as they rub on that spot and cause pain. When I went back to my doctor, he thought it was a nerve problem and gave me another shot just below my ankle bone. The shot didn't help at all with that pain. I sent to see a new doc for another opinion and he is stumped. Took new xrays and doesn't see anything. He said I don't have pf anymore. Very frustrating as it's almost impossible to walk sometimes.

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    1. Kim, thank you for your comment. It does sound like the shot hit the nerve, and they are very sensitive. Go on the blog for types of dealing with nerve pain. Nerves love massage (as long as it is not painful), motion (do not hold the plantar fascia stretch), neural flossing, avoiding anything that can irritate the sciatic nerve, also try Neuro-Eze which is an online treatment. Hope some of these things work. When was the shot? Is there any physical signs of injury? Rich

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    2. Thanks. My shots were from the end of August through the end of Sept. for the bottom of my feet and then the shot just below my ankle bone was in December. No signs of physical injury. Update, my left foot is still so painful on the bottom of the heel again. I did have an MRI and still have pf and I had a bone bruise. I tried night splints and then was put into a hard cast for 2 weeks and now going through physical therapy. I have good days and bad days but it's not going away. The pain on the very edge of my heel where I though the injection was is better but not all they way normal.

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    3. Also I have been getting massage twice a month and she has really been working on my lower leg and foot muscles.

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  70. Dr. Blake,

    I know you are a foot specialist, but would you say the above information about cortisone shots could apply to an arthritic/synovitis in my wrist? I have been getting cortisone shots in the wrist for years, they have worked well (I'm a 70-year-old competitive tennis player)but doc is reluctant to give more. He wants to do major surgery, I refuse. thanks for your help...

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    1. Sam, Happy New Year. I turn 63 and want to stay very active, so you are my role model. I always tell the patients with arthritis that I am giving cortisone, when the cortisone stops working, it is time for the surgery. The cortisone does rob you of some pain indicating you are hurting the joint, so your doc may be getting nervous about that. And, there is always the chance a cortisone shot can leak out and injure surrounding tissue. I would always get one or two more opinions to see why, at this time, the cortisone shot is off limits. Does not totally make sense for sure, and if the alternative is major surgery, it has to make sense to you. Rich

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  71. Rich,

    Thanks so much for the reply.

    You might be interested, the cortisone shot used to last for 7-8 months, now only 3-4 months, but getting a shot 3-4 times a year seems less risky than major surgery which may or may not work and I feel would surely end my tennis career.

    The shot needs to be placed in exactly the right spot in the joint, and is better visualized with X-Ray or ultrasound. I've had some docs who casually injected into area, with no affect whatsoever.

    All hand docs have different opinions on this, one says every 6 months is OK, another says I am at risk for "ruptured tendons" but reluctantly does it every four months. I think my wrist is fine if there is no pain, which comes from continual impact of racquet and ball, with very little cartilage between the bones in the synovial joint. I've been getting shots since 2011 and I play high-level tennis, I use special racquet and strings to minimize impact.

    I play tennis every other day - need a day off to recover - but will continue as long as cortisone shots keep working.

    I appreciate your feedback! Your blog is terrific and serves your patients and others well.

    Sam
    www.keyboardcollective.com
    (212) 684-3304

    Photo Gallery:
    http://skanter.smugmug.com/NYC-Street-Photography/








    On Jan 1, 2017, at 10:06 PM, Dr Richard Blake wrote:

    Dr Richard Blake has left a new comment on the post "Cortisone Shots: The Thought Process Behind":

    Sam, Happy New Year. I turn 63 and want to stay very active, so you are my role model. I always tell the patients with arthritis that I am giving cortisone, when the cortisone stops working, it is time for the surgery. The cortisone does rob you of some pain indicating you are hurting the joint, so your doc may be getting nervous about that. And, there is always the chance a cortisone shot can leak out and injure surrounding tissue. I would always get one or two more opinions to see why, at this time, the cortisone shot is off limits. Does not totally make sense for sure, and if the alternative is major surgery, it has to make sense to you. Rich

    Post a comment.

    Unsubscribe to comments on this post.

    Posted by Dr Richard Blake to www.drblakeshealingsole.com (Foot and Ankle Problems) at January 1, 2017 at 7:06 PM

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    1. Thank you Sam, and good luck with the sport that you love!!! Rich

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  72. Hi Dr, i got injured at work bout 5 months ago, a heavy metal object fell on my foot, first dr i saw told me it was a contusion of the bone, he said contusions usually heal in 10 weeks, well ita been 5 months and i still feel pain, so i got a cordisone shot like a month ago, i was painless for 1 week and the pain came back, i saw a different dr today and he says that my damage is on my talus joint, so the first cordisone shot was given on my ankle joint, hes recomending another cordisone shot on the talus joint, what are the risks if i have a ligament or tendon damaged, wat can be affected with the cordisone shot.

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  73. I have really bad plantar fascitis and went to my orthopedic dr because I've gotten a cortisone shot there for my knee before. I had to see a different doctor this time because it was for my foot instead of my knee. I was told that you can only get a cortisone injection in your foot once in a life time. Is there any truth to this?

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    1. My foot doctor gave me 3 shots in my feet about 2 weeks apart. I was told no more than 3-4 but don't know whether that was a year or lifetime. Told by another doctor the shots could disintegrate the fat pad on your heel and then it would be really painful to walk.

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  74. I have a chronic fracture in my fibular sesamoid with avascular necrosis. I've tried a boot, lidocaine/diflonec, anti-inflammatory drug and completely stopped running, jumping, lunges, etc. It hurts to put pressure on ball of foot, forcing me to walk on side of foot. My dr. recommended an injection as well as PCP injection. Last option is surgery to remove bone fragments. I guess my question is, will these injections actually heal the bone or is it just going to make it "feel" better for a bit. I'm looking to permanently fix the problem as I am a very active person. Any suggestions?

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  75. I had chronic case of retro calcaneal bursitis and insertional tendonosis for nearly 2 years, lived on nsaid all the time. I got a shot of 2ml depomedrol in the bursa on 30th Dec 16 in India(home) when i was on vacation and now i am in Hong Kong(work) and my pain has subsided considerably, can i resume some running activity and will i need a booster shot soon?
    thanks
    Raja Kailas
    67755101gonk@gmail.com

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  76. I ran my foot over with a pallet jack at work the beginning of November. I didn't think it was a huge deal i knew it would hurt for a few weeks. when it never stopped hurting i went to the doctor mid to late Jan. most of my pain comes from the base of the 5th metatarsal.
    my doctor did a x-ray saw no fractures gave me a anti inflammatory went to my follow up the medicine hadn't helped.

    he did a ultra sound saw small amount of fluid built up so he put me on a steriod told me to wear a air cast for a month. neither helped at all.

    went back had a MRI (showed nothing) then at next appoint . he gave me a steriod shot my foot was numb all night other than that no relief. as well went to physical therapy for a month.

    when i went back that none of the above had helped he sent me to see his partner who has 20 more years of experience. when I saw him he wanted to give me another injection but this time at both tendons that attach to the 5th metatarsal base this was 4/19

    he said if this didn't help then he would have to do surgrey to remove a extra bone i have in my foot there. and told me to wear my air cast again.

    I call my doctor this morning 4/24 because the pain is unbearable. my job modification due to the boot hurts my foot more then my regular job.

    as well my foot was not numb for near as long as it was last time. which he is concerned about?

    my next appointment has been moved up to next monday the 1st of may. and he doesn't want me working until we can sit down and figure out a game plan???


    I dont even understand what is going on now. I thought we had figure out that it was most likely the extra bone cause my pain now I feel like we don't even know what is wrong and I am just sicck of the pain!!

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    1. Stacey, so sorry for my delay. Typically these crush injuries can get the nerve. With negative xrays and MRI and injections, begin to address the nerve in the area of your pain. I have a lot on basic treatment, like warmth, massage, topical or oral meds, off weight bearing padding, etc. I hope the injection pain has died down by now. Rich

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  77. This comment has been removed by the author.

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  78. I had a cortisone injection in my heel for plantar fasciitis and dealt with a flare up for over a week. I spent most of my time limping and putting all my pressure on the ball of my foot. Now, about 2 weeks after the shot was administered, the heel pain was gone but now I have sesamoiditis in the ball of my foot. Is it possible that limping and putting all the pressure on the ball of my foot caused it? I got a 2nd cortisone injection yesterday for the sesamoiditis and will be resting several days.

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.