Cortisone shots

Corticosteroid injections, also known as cortisone shots, are often used in the treatment of foot and ankle problems.  A therapeutic cortisone injection consists of a combination of cortisone or other steroid preparation and a local anesthetic.  Cortisone as a steroid hormone that is made by your body to help handle stress.  The compounds used for these injections are man-made variations of cortisone with sees much greater than that of the body’s.

They are most often used to soften or break up scar tissue, decrease local inflammation and pain, free trapped nerve endings and/or shrink soft tissue masses.  Some of the most common conditions for which this treatment modality is employed include the following:

  1. Nerve entrapment.  This is a condition in which scar tissue chokes off a nerve, causing pain in the area where the nerve is being choked off, and extending along the course of the nerve beyond that point.
  2. Neuroma.  This is a condition where a nerve at the ball of the foot becomes enlarged and inflamed.
  3. Fibroma.  These are hard knots on the arch of the foot.
  4. Plantar fasciitis.  This is a condition where there is pain in the heel, especially after getting up out of bed or a seated position.
  5. Sinus tarsi syndrome.  This is condition that involves pain in a part of the ankle, usually occurs several months after an ankle sprain.
  6. Arthritis.  Pain in the various joints.

Cortisone shots are used as part of a treatment protocol.  Dr. Hoy will advise you when this modality would be helpful.

Some common questions that come up for this treatment modality include the following:

  1. Aren’t cortisone shots only a temporary fix?  No.  This is one treatment mechanism in a series, from the simplest to the most complex.  If there is inflammation or scar tissue suspected, the steroid that is contained in the injection serves to break that up and decrease pain.
  2. How long does the shot last?  For the conditions above and others, most people experience about 60% relief during a follow up examination three weeks later, and request a subsequent injection, which then provides lasting relief.  We do not perform more than three cortisone shots per year for a given area and move on to other modalities in the series if the treatment is not effective.
  3. Is the shot going to hurt?  Depending on the condition, the injection may not be felt at all, or it can be excruciatingly painful.  We mitigate the pain by using a cold spray, and release the medication as slowly as possible.
  4. What are the side effects?  As with all medication, steroids can have undesirable side effects.  When taken by mouth, cortisone could have some serious side effects.  However, when injected locally, most of the medicine remains local, as very little is absorbed into the bloodstream.  Some of the adverse effects that may have been are mild changes in women’s menstrual cycles and decreased effectiveness of oral contraceptives.  These effects are usually limited in duration to 1-2 weeks.  During this time if you are using oral contraceptives, he may wish to use an additional contraceptive.

Steroid flare.  A rare, local side effect that can be uncomfortable is called a “steroid flare reaction”.  It involves intense swelling, inflammation and pain at the site for about 48 hours after injection.  It usually begins after the local anesthetic has worn off.  The body is actually reacting to the medicine and treating it like a foreign chemical.  If a steroid flare reaction should occur, apply an ice pack to the site or rub it with an ice cube.  Limit your activities, and, if necessary, take an over-the-counter pain medication such as extra strength Tylenol.  Rest assured that this reaction will subside, after which the cortisone’s beneficial effect will begin.  If you do have a reaction please feel free to contact the office.

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