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Saturday, May 21, 2016

Plantar Fasciitis Post Cortisone Shot Advice

Love your info! I received a celestone 5mg. injection into the spot that hurts me the most(from plantar fasciitis) in the center of my left heel on Tues.May 17th (Dr Blake is reading this on 5/21). I have had pain since Sept. 2015 (over8mos.)! I am an avid speed walker, zumba dancer, and tennis player at the ripe old age of 76 years old! Guess I wore my thin narrow feet out walking 5 miles a day on the beach along the waters edge for the past 35 years (plus all my other activities)! I had an MRI done in Dec. 2015 that showed "mild Plantar Fa sciitis". I then went to PT for several weeks and do many stretching exercises AM and PM every day icing  for 15 to 20 minutes after each session.
                               I had no  pain after shot for about 3 hrs (Dr Blake's comment: This tells you that the shot was in the right place). Then bad pain till late AM next day. No pain Wed. PM until Fri. Pm. Then slight tinge lasting into this afternoon(Sat.= 4th day. I am icing it as you said! My Dr. never told me to ice it! I am doing this 3 times a day for 15 to 20 minutes after reading your info.
Dr Blake's comment: This bad pain is unfortunate, but can happen and typically lasts for 4 days, so you were lucky. Celestone is a long acting cortisone that can take up to 2 weeks to completely start working. 
Can I start the PT stretching now 2 times a day (icing after)??? Dr Blake's comment: I would do no weight bearing stretching for 2 weeks. You can do active range of motion stretch by pulling your toes towards your nose non weight bearing. You can massage your calf. You can do the frozen sports bottle roll for 5 minutes from the heel into the arch with progressively more pressure over that period.
When shall I try walking and tennis??? Dr Blake's comment: You can walk, but no impact activities for 2 weeks like running, tennis, basketball. 
When shall I contact my Doc again???He said shot should last 2 to 4 mos.? I'm to get appt. after that time if no problem. I am seeing a Sports Medicine Ortho Doc. who has helped me with ankle tendinitis and sole problems with PT in the past!! I really trust him but am getting frustrated over my PF. Dr Blake's comment: The goal of cortisone therapy is to get the pain down to level 2, and then ice and physical therapy can take it from there. Typically you rest for 2 weeks, then spend a week or two testing it, and if you are not consistently between pain levels 0-2, get a booster shot. I do not like to give more than 3, and again, never get the shot where the plantar fascia attaches into the heel bone, just under the heel bone in the relatively fatty area. 
What else can I try before another shot or any drastic treatment? ( extracorporeal pulse activation treatment or ultra sound therapy)??? Dr Blake's comment: There are so many treatments that should be used before injections with plantar fasciitis: orthotic devices, taping, icing, sleeping splints, physical therapy, acupuncture, calf stretches, deep calf massage, topical creams, various shoes, no barefoot walking, boots, etc. So, without knowing anything else you have tried or are using, it is hard to advise you. Hope this helps. Rich
                                               Thanks so much for your time,
The patient's response:

Thank you so much for responding so quickly! Just some clarification. 1.  Does it sound like my shot was in the heel bone? I believe it was where my worst pain was and where the facials come together in the heel? Dr Blake's comment: Typically the shot is under the heel bone in the fatty area that can form a bursae. This is the safest spot to inject. See my video below.

 Is 2-0 pain very little pain on 0-10 scale?Dr Blake's comment: Yes, you are still smiling. 

 3.When should I go back to my full 11 stretch Pt program 2 times a day? Dr Blake's comment: You can do intense plantar fascial stretches starting at 2 weeks. 

 4.Can I use a towel and sit up on floor to do the toes to nose stretch you said? Dr Blake's comment: As long as it is gentle. 3 times daily for 30 seconds only---1 rep.
How many sets and how many times shall I do these? And how many times a day? I believe I should do this for 9 more days?
                                              Wish you were in Phila. area! I would certainly be one of your patients!!!
                                                           Thanks again,

Patient's comments:
Dr Blake,

Thank you SO much!  I feel a lot more confident about the future after reading your response.

I've been using your taping method on and off for months.  I've been doing a lot of resistance band exercises but after watching your video, I think I was letting the tendon on the front of the ankle do all the work.  I'm also doing a lot of arch exercises, picking up marbles, bands, doming my arch, etc.

How often should I use the tape?  I was a little nervous that I may have been weakening the PTT by wearing it too regularly.  Will the exercises offset that?
Dr Blake's comment: As long as you are doing the exercises, the taping is fine. Every 4th or 5th day go without the tape and see how you feel. Do it intentionally on days you will be alittle less active. 

Would you be able to recommend a podiatrist in New York City who has experience with PTTD?  As you can see, I haven't had the best luck here.
Dr Blake's comment: I would travel to Long Island to see my buddy Dr Karen Langone. She is wonderful

Again, thank you so much!  

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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.