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Tuesday, December 24, 2019

Plantar Fasciitis and Cortisone Shot: Email Advice

Hi Dr. Blake,

Love your blog.  Two questions:

(1) Is stretching still allowed and/or recommended for a patient that receives steroid shots for plantar fasciitis?  I have had bilateral heel pain/PF for a year?  I'm going to keep working at rehabbing, but I am often tempted to try the shots -- if only to give myself a break from the pain.  However, I would like to continue the stretches.  I assume the calf stretches are still safe, but what about the wall stretch that directly pulls on the plantar fascia?  Also, are strengthening exercises still allowed for someone who has received the steroid shot?
Dr. Blake's comments: If you get a steroid shot for plantar fasciitis, you temporarily weaken the tissue at the heel attachment, so stretching is not recommended for at least two weeks. Calf massage is okay and most strengthening like metatarsal doming and single leg balancing is fine. Please do no work at all with the heel not in contact with the ground, like heel raises, during this time. Remember long acting cortisone shots are the ones we worry about. Some doctors place their patients in removable boots during this two weeks, others just tell the patient to be careful. I have been burned with the plantar fascia tearing post injection that I want to see what an MRI shows first. If the fascia looks very degenerative, then I discourage a cortisone shot completely. Have you done an MRI? What about PT? Rich 

(2) I am going to try to start the contrast baths.  I see from your blog that it starts with warm water immersion.  Which bath should I finish with -- the warm or the cold?  I would like to end on the warm so that my feet are warmed up enough to do some stretching immediately afterward.

Also, for someone who doesn't have all the required tubs, can I use warm water in the bathtub and then just use frozen water bottles for the cold contrast?  The swelling/pain is specific to my heels, so I'm hoping this could work in lieu of cold immersion.
Dr. Blake's comment: No, you need at least 10 minutes to unthaw after the contrast bathing to do stretching. Submersion is the best, but if you have to roll on frozen sports bottle double the time to 2 minutes ice. Good Luck Rich
Thank you and happy holidays!

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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.