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Tuesday, January 9, 2018

Cortisone Shot #1: Patient Feedback

After I give a cortisone shot, in this case for a left foot third intermetatarsal space Morton's Neuroma, I tell the patients that they may need 3 in total. We have to wait 2-4 weeks to get a strong sense of what each shot does, and then make our decision. The Golden Rule of Foot: Cortisone shots if attempted to bring down pain and inflammation should be done until 80% improvement is noted. This means you have accomplished the 0-2 pain level. You should not give more than what achieves that 80% relief. If the first shot gives you 20-75% pain relief, a second shot should be considered. If 0-20% relief is attained, you probably should not give any more, as it only works on pain produced by inflammation. 
     If you give a second shot, you can use the same rationale for determining if you need a third shot. Rarely, if ever, will you need a 4th shot, and I think 4-6 months should be the delay in deciding on that 4th shot. Typically, you get to 80%, and rest of the inflammation is helped with PT, daily ice or contrasts, NSAIDS, or topicals like arnica, etc. I am only talking about long-acting Kenalog 10 or Celestone Acetate. Never use Kenalog 40 in the foot. 

Hi Dr. Blake,
I think it's been almost two weeks since the cortisone shot. I will say that I think it's helped but not nearly as much as I had hoped. If I had to put a number on it, I'd say it feels around 60% better.  It's hard to say because one day it'll feel quite good, but it takes so little for it to start hurting again. One small misstep sets me back quite a bit. What I have noticed is that the little lump I can feel in the neuroma area seems smaller but is still there and causes nerve pain upon pressure.  In addition, I often sense a general tingling throughout that area and in my third and fourth toes.

Also, there is something weird on my right foot I'd also like to talk to you about. I feel a similar little lump under the second space and have felt zinging a couple of times.

In any case, should we try another cortisone shot or move onto the next step?

Thanks much,

Dr. Blake's comment: Please schedule to see me for a second shot. See you soon. I will also look at the right foot. 

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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.