Cortisone Injections

Cortisone injections treat the short-term pain caused by plantar fasciitis. This course of treatment is not recommended for all cases of plantar fasciitis and an evaluation by a podiatrist will determine if this treatment is preferred. The injection will help minimize the pain by injecting cortisone directly into the plantar fascia.

Cortisone injections – a non-surgical option for treating heel pain.

Some patients might be leery of an injection in their foot. Many people avoid injection treatments for foot related issues because of the perception of pain that would be involved. However, the Seattle Heel Pain Center utilizes a Transcutaneous Electrical Nerve Stimulation (TENS) unit. The TENS unit works by sending stimulating pulses across the surface of the foot and along the nerve strands. The stimulating electronic pulses help prevent pain signals from reaching the brain so a patient doesn’t even feel the injection as it is happening. This allows for virtually painless cortisone injections for heel pain and plantar fasciitis sufferers.

The goal is to decrease the inflammation directly at the site of the problem. When an oral anti-inflammatory medication is taken, it has to go throughout the whole body. Cortisone injections often use the same dosages; however the cortisone is delivered directly to the source of the pain. High Resolution Ultrasound Imagining is often used to provide visual guidance so injections can be precisely delivered. The use of ultrasound imaging provides several benefits; we can use a lower dosage by having it exactly where it is needed, we can avoid injecting into areas where it’s not as effective and avoid puncturing undesirable areas. For example, an injection for plantar fasciitis in the heel is most effective at the layer between the plantar fascia and the fat pad. If we inject into the fascia directly there is a higher risk of the fascia will weaken and even have a partial tear. If the injection was done into the plantar fat pad and this could thin the fat pad out (especially with repeated injections). But if it is injected between the 2 layers, then the potential for these problems is minimized.

FAQ’s about cortisone injections.

How quickly will the cortisone injection work?

Typically it takes 2 or 3 days before the injection really is effective. This is partly because the longer acting component of the cortisone is in a crystalline form and requires time after the injection to become usable by the body (the crystals need to “dissolve”). During this time the pain may be slightly greater than before the injection. However, once the cortisone has passed this initial threshold time, there is usually dramatic reduction in pain and inflammation.

How long will the cortisone injection last?

It should last for least 3 weeks but sometimes can last 2 or 3 months, or even longer. Results will vary depending upon the cause of plantar fasciitis and severity. Many problems with the foot are mechanical in nature. Therefore, there is often both an inflammatory component of the problem and a mechanical component to the problem. If we are able to address the mechanical dysfunction then the cortisone injection can effectively address the inflammatory issue. Depending upon each patient’s unique case additional recommendations for treating plantar fasciitis will be made. Particular stretching exercises, prescription orthotics, or other recommendations may be made by the doctors of Seattle Heel Pain.

Can I resume exercise right away?

It is recommended that you take it easy for least 2 or 3 days after a cortisone injection. It is recommended that you discuss with your Doctor any special plans for high-impact exercise such as running.

Are there any risks with an injection?

There risks are minimal. There is a slight risk of infection related to the injection. Therefore the injection site is prepped with alcohol to help minimize this risk. There is also the risk that some the underlying structures are weak prior to the injection and will become further weakened with cortisone. As mentioned, a cortisone injection directly into the plantar fascia is commonly done. But this increases the risk of partial tearing of the fascia. Therefore at the Seattle Heel Pain Center, we prefer to inject at the interface between the fascia and the fat pad to help minimize this risk. To further minimize any risks we utilize high resolution ultrasound imagine guiding injections.