Plantar Fasciitis and Cortisone Shots: Email Correspondance

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I am so thankful to the Golden State Warriors for the great enjoyment they brought to the San Francisco Bay Area and fans spread around the world.

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!

Dr Blake's comment:

     Thank you so very much for your comment to the post on cortisone shots. After a cortisone shot, you must wait 2 weeks to see what the overall effect is. I always consider that I may have to do up to 3 shots minimum of 2 weeks apart in an effort to bring the pain level down to 0-2. Remember with each shot you can not do anything that hurt before the shot for 2 weeks. Then, at 2 weeks you gradually start adding what hurt before the shot and see where you stand. This is how you decide on the 2nd and possibly 3rd shot. Continue to ice 2 times daily because it really helps the shot (s). I have many patients in your boat to have to wear the boot completely for 3 months, with another 6 weeks of gradually weaning out of the boot. So, now that you put yourself in the Immobilization/Anti-Inflammatory Phase of Healing make sure you do it right!!! And, I always love MRIs to tell me where I am at, but you need to wait for 2 weeks after a shot to do the MRI. Good luck my friend. 

Cortisone Injections/Morton's Neuroma: Email Advice

After a cortisone shot, how long does it take for the cortisone to reduce the inflammation/pain from the nerve? I was given a mixture of short term and long term cortisone. I was told 2cc's (Kenalog Ten 1/2 cc & Dexamethiasone 1/2cc and 1cc of Litocane). 

Thanks, 
Paul (name changed)

Dr Blake's comment:

     Paul, thanks for the email. I am attaching a link that talks about cortisone shots. I am not sure how much the short acting works (not a big fan), but the long acting takes 3 to 7 days to begin to work. It can take up to 2 weeks for you to access the overall effectiveness. 

http://www.drblakeshealingsole.com/2010/08/mortons-neuromas-which-shots-to-get.html

http://www.drblakeshealingsole.com/2010/08/mortons-neuromas-which-shots-to-get.html

Dr. Blake,

Thank you for the response. I did go back and read your blog information as it relates to cortisone shots.

I assume then that the Lidocane 1cc was the short term and the Kengalog Ten and Dexa was the long term? With 1/2cc of each of the long term, how many mg's does that equal? Was my cortisone shot moderate in its dosage or more on the weaker & less potent side?

Thanks again,
Paul

Dr Blake's comment: Kenalog 10 is the long acting cortisone. It stands for 10 mg/ml or cc of the medication. So you had 5 mg total of long acting, which is a weak dose. Foot injections with long acting cortisone can take up to 30 mg total to get the relief everyone wants. The dexamethasone is short acting. The lidocaine is local anesthetic. I remember I once saw a patient for heel pain for a second opinion. She had told me she was unresponsive to 10 cortisone shots which were done over a 10 week period. I will floored that any podiatrist would do so many shots in so short a time. When we sent for the records, it turned out that she received 0.1 mg of Kenalog 10 with each shot. This means it would have taken 100 shots at this rate to equal one of my typical 10 mg shots. No wonder she was not better. I sure hope this helps you. Rich

Dr. Blake,

Thank you again. I wish your office was closer so that I can go and see you. I am located in the Phoenix, AZ area. I'm only 39 years old and my foot nueroma has left me in great pain. 

What do you think my next plan should be? Since I received the weak cortisone shot 3 days ago and still no real relief. Should I try and find another podiatrist or ask this current one to increase the dosage of long acting coritsone? How soon can I go back for a cortisone shot without risking complications due to scar tissue/over-injection of a site?
Dr Blake's comment: Do not consider the first shot weak, it is just his/her standard. Injections for Morton's Neuromas can be very irritative so health care providers have their standard injections that they feel comfortable with. You have to wait 2 weeks for another shot, by then you hopefully are feeling better from the initial 5 mg. I always give patients one shot at a time, knowing I can give up to 30 mg if needed. Most do not need that much. Hopefully, you won't. Remember that long acting cortisone lasts for 9 months. Sorry I implied that a 5 mg shot was weak. I should have emphasized how conservative and caring that doctor probably was being to help you. My bad!!!!!!!
I wonder what the reasoning is when podiatrists give such weak shots? At $100 per shot (ultra-sound guided), I would rather pay for the better shot upfront than keep going back numerous times for a shot that doesn't really help much. 

Thanks,
Paul