Do you have foot pain, but are unsure what the cause may be? Have you tried everything to relieve your pain with no success? If so, then a cortisone shot in foot may help. For different purposes, cortisone shots can be administered as a treatment option. One such use is for the treatment of heel and arch pain, which often occurs when someone has plantar fasciitis. However, not all foot doctors recommend this procedure as there are some side effects associated with it. Learn more about cortisone injections here!
What is a cortisone shot?
A cortisone shot is a medication that is injected into the body to help relieve pain and inflammation. It contains a type of steroid, for example, triamcinolone or dexamethasone, which is what helps to reduce inflammation. The steroid is usually mixed with a local anesthetic which increases the volume of medication to be injected and there is also a beneficial effect from the local anesthetic too, providing almost immediate relief until the cortisone kicks in.
Common areas that are injected are joints (like the ankle or the great toe joint) and the plantar fascia (with recent-onset plantar fasciitis). Another common area that is injected is a Morton’s neuroma.
How long does the cortisone shot last and how effective is it in treating foot pain?
The amount of relief and for how long depends on what the injection is being used for. For foot pain, it is usually effective for a few months, but the duration of relief will depend on the individual and the underlying cause of their pain. For more acute injuries there is typically more inflammation and it is expected to see more beneficial relief with the injection. Conversely, if the area has been painful for a longer period, there typically is not as much inflammation, so the cortisone injection tends to not be as effective.
Are there any side effects associated with the shot and are they worth the risk for some people who suffer from chronic foot pain?
The dose of cortisone shot used in the foot and ankle is pretty small compared to what would be injected into a larger joint, like the knee or hip. Also, the amount absorbed into the body is much less compared to taking a steroid medication by mouth. As such, the potential risks are smaller but the procedure and medication are not completely risk-free.
One of the major risks associated with cortisone is the possibility for rupture of a ligament or tendon. This is the reason why multiple cortisone injections are discouraged because you can end of with a rupture. Multiple injections into the plantar fascia can lead to a complete rupture of the plantar fascia ligament which can have significant biomechanical consequences like flattening of the arch.
It is also not advised to inject into or around the Achilles tendon with cortisone. A rupture of the Achilles tendon is a devastating outcome and treatment can be complex and would likely require a surgical procedure.
Another issue with repeated injections of cortisone is the effect of decreasing the fat content in the foot. This is called fat pad atrophy. The two major fat pads on the bottom of the foot are under the heel bone and in the ball of the foot. With the loss of the fat pad, there is less cushioning between the floor and bone which can make it very painful to stand or walk.
Another problem that can be seen with cortisone is damage to cartilage cells. Cartilage is what lines a joint. Healthy cartilage has a beautiful, white, pristine, shimmering appearance to it and glides smoothly against the other bone, also lined with cartilage, involved in the joint. When damage occurs to cartilage, this is called arthritis. Cortisone can hasten the damage to cartilage cells, leading to the more rapid development of arthritis. This is the reason why cortisone injections into more arthritic joints are preferred, where the cartilage cells are already quite degraded and it would be a good option for a patient seeking relief to buy time before a surgical procedure can be performed.
So, although cortisone injections have been around for many years and are considered a relatively safe procedure, some potential risks should be taken into consideration before having an injection. For some people with chronic foot pain, the benefits of the shot may outweigh the risks for certain conditions. But it is important to discuss these with your health care provider before making a decision.
Does cortisone help reduce inflammation in the foot and provide relief from pain symptoms immediately after the injection is administered, or does it take time for the medication to take effect?
The steroid in the shot does not take effect immediately. Depending on which steroid is used in the injection, it might take a few days to see the maximal benefit. Usually, if the correct spot was targeted with the injection, the local anesthetic will cause some numbness and relief to the painful area but this will wear away with time and the steroid will gradually take effect.
With more chronic conditions, like chronic plantar fasciitis, the relief attained from cortisone is pretty short-lived if any relief is even seen at all. With more chronic soft tissue problems, like plantar fasciitis, there is less inflammation seen and more degeneration of tissue, thickening, and tearing. Since there is less inflammation, and steroids act by decreasing inflammation, it makes sense that a steroid injection would not work as well. In these more chronic cases, a regenerative option like radial shockwave treatment or a platelet-rich plasma injection is more appropriate.
What are some of the pros and cons for foot pain relief?
- May relieve pain immediately after injection is administered because of the local anesthetic (lidocaine) before the cortisone shot kicks in for the foot issue
- Can be used as a diagnostic tool to pinpoint the area of pathology. If the injection does not work very well then an alternate location for the source of pain should be considered
- Non-surgical and minimally invasive technique to offer relief
- Useful for more acute injuries
- Results in some cases can be unpredictable
- The injection may hurt and there can be some soreness that lasts for a few days
- Can damage cartilage and lead to further deterioration of arthritis
- Can cause ruptures of tendons and ligaments
- Not as useful for more chronic conditions (like months or years worth of plantar fasciitis). In these cases, radial shockwave or PRP (platelet-rich plasma) is more appropriate and the medical evidence does support a longer-lasting effect with these options
When is the best time to get cortisone for foot pain – before or after an injury occurs?
Cortisone shot injections should not be used for injuries. If you have an injury, like a sprain or fracture, it is normal for the body to go through an initial phase of inflammation, and giving a steroid during this critical period of healing will impede it.
Steroids should also not be injected before an injury because an injury can never be predicted. It should not be used as an option to preemptively get you through the 10K or marathon.
In conclusion, based on the evidence available, cortisone shots do seem to be effective in treating some conditions but not for others. The medical research does support that they are more useful for acute injuries or conditions like gout pain or new-onset plantar fasciitis where there is a lot of inflammation present.
If you are looking for foot and ankle pain relief, call our office at (703) 832-9013 to schedule your consultation!