Thread: cortisone shot for plantar fasciitis? Yes/No

Posted on The Padded room but I am trying here sorry for the cross post.

cortisone shot for plantar fasciitis? Yes/No
My pain is a 10 in the am and I have tried most other thing to try to heal the planter fasciitis. I work at the Y so I am near many MD's. I have one that will give me the shot for a very good price as well as a great deal on some custom foot beds. He has been helping me for the last year and last night at work he about made the appt for me. He is adamant that is the next step for me.

Has anybody had the shot and did it help. I am playing in a Rball tourney next weekend and want to be able to play hard and not let down my new open partner.

I have not played any sports for 4 months to try to help but it seems to always be present.




Thanks Dan

maybe try prolotherapy?
cortisone has its place, though, so it may be the right move, but don't do it too much!

guess i'll vote no given the info thus far.


the shots didn't do me any good, and i kindda felt it may have done harm. and they for sure didn't help for the pain.


i was in dire straits and was so painfull i couldn't even hardly walk. the doctor i went to was a crook and trying to milk me for everything he could before addressing the actual problem.


i lucked out and my boot store directed me to a place that made custom orthotics.


the orthotics fixed me right up!

Platelet rich plasma is the new cortisone.
It makes much better biological sense and is more effective.

Originally Posted by drmark

Platelet rich plasma is the new cortisone.
It makes much better biological sense and is more effective.

I've heard a bit about this. Could you speak more about it, Doc?

To get the plantar fascia, or a tendon, to heal requires cells that have potential to morph into tendon or fascial cells which are tenocytes or fibrocytes respectively.

The cells are the same stem cells that everyone has been talking about for years.
And we have them in our blood stream. They just arent in a high enough concentration in any spot.

The process of creating PRP, concentrates these cells from our blood. Usually about 20 ccs of blood is necessary.

This is what is injected into the painful area.

By contrast cortisone is a corrosive to these same tissues we are trying to get to heal.

Any doc who injects cortisone into the plantar fascia in this day and age, needs some CME fast.

i've been getting prolo for my shoulders, had 4 treatments each.
i am getting prp in the shoulders in 3 weeks. it is apparently prolo times 3.
i hope it works!

Have you tried a night splint yet? PRP does look promising for lost of things including plantar fasciitis.

So, I've had this for a month. How long 'til it heals, if I don't run/jump/ have fun? Or, how long should I wait before i see my doctor?

For the first time in 3 years I am Pain free in my feet.

Next day after the shots I could walk normal.

Dan

how long has it been since the injection?

from dr mark
"Any doc who injects cortisone into the plantar fascia in this day and age, needs some CME fast.
__________________

what is CME......Continuous Money Extraction ?

I had one cortisone shot in longstanding plantar fasciitis and it CURED it. It worked fast, and has remained fine for many years. and the cost of the steroid was less than a dollar.

Save your expensive platelet "theory" for those who have failed simple far less costly effective treatment

You must be lucky.
Everyone I ever injected cortisone into their plantar fasia either didnt' get better or got worse. Cortisone is a corrosisve agent, and one of my patients later ruptured their plantar fascia. The peer reviewed medical literture no longer supports this method of treatment.

In: Shock wave therapy for chronic proximal plantar fasciitis -
JA Ogden, R Alvarez, R Levitt, GL Cross, M … - Clinical orthopaedics and related research, 2001:
"...biomechanical changes would be expected to follow after rupture of the
plantar fascia, whether spontaneous or consequent to cortisone injection"

In: Shockwave therapy for chronic proximal plantar fasciitis: a meta-analysis
JA OGDEN, RG ALVAREZ, M MARLOW - Foot & ankle international, 2002:
"... and may be preferable prior to cortisone injection,
which has a recognized risk of rupture of the plantar fascia"

In: Plantar fascia rupture: diagnosis and treatment
C Rolf, P Guntner, J Ericsäter, I Turan - The Journal of Foot and Ankle Surgery, 1997:
"...a degenerative rupture in a 72-year-old man after he received
a cortisone injection to treat a suspected condition of plantar fasciitis."

Achilles tendon rupture following steroid injection.
M Kleinman, AE Gross - J Bone Joint Surg, 1983

In: Complications associated with the use of corticosteroids in the treatment of athletic injuries -
AW Nichols - Clinical Journal of Sport Medicine, 2005:
"Tendon and fascial ruptures are often reported complications of injected corticosteroids"

The list goes on and on, if you care to inform yourself before you rush to open that mouth to acuse others of avariciousness when they are only offering their free, highly educated and experienced advice.
And I hope you understand the term "risk" when citing your case as evidence against what has been reported in the medical literature for decades, now.


And here's more, for your education:

(From: http://webdoc.nyumc.org/nyumc/files/...Terms_3-05.doc)

Continuing Medical Education (CME): Continuing medical education consists of educational activities, which serve to maintain, develop, or increase the knowledge, skills, and professional performance, and relationships that a physician uses to provide services for patients, the public, or the profession. The content of CME is that body of knowledge and skills generally recognized and accepted by the profession as within the basic medical sciences, the discipline of clinical medicine, and the provision of health care to the public.

A broad definition of CME, such as the one found above, recognizes that all continuing educational activities, which assist physicians in carrying out their professional responsibilities more effectively and efficiently, are CME. A course in management would be appropriate CME for physicians managing a health care facility; a course in educational methodology would be appropriate CME for physicians teaching in a medical school; a course in practice management would be appropriate CME for practitioners interest in providing better service to patients.

Not all continuing education activities, which physicians may engage in, however, are CME. Physicians may participate in worthwhile continuing educational activities that are not related directly to their professional work, and these activities are not CME. Continuing education activities, which respond to a physician’s non-professional educational need or interest, such as personal financial planning, or appreciation of literature or music, are not CME.

-

Here's a good general paper on plantar fasciitis. It's already 8 years old, but covers a lot of the basics. It's from "American Family Physician" and is a free-access paper:

http://www.aafp.org/afp/20010201/467...f=SevSevil.Com

chillydog
of course there are potential problems with steroids, but none of your references point to PSP for plantar fasciitis .
your 2 posts since joining today suggest that with your vast knowledge you can provide one controlled study in an orthopedic journal showing that PSP is superior to a much cheaper treatment.

here is one from oct 2009 am acad ortho surgeons suggesting there isnt much evidence yet for 2 other conditions, but "as the marketing increases....."
"Although minimal clinical evidence is currently available, the use of platelet-rich plasma has increased, given its safety as well as the availability of new devices for outpatient preparation and delivery. Its use in surgery to augment rotator cuff and Achilles tendon repair has also been reported. As the marketing of platelet-rich plasma increases, orthopaedic surgeons must be informed regarding the available preparation devices and their differences. Many controlled clinical trials are under way, but clinical use should be approached cautiously until high-level clinical evidence supporting platelet-rich plasma efficacy is available.

The good evidence from platelet rich plasma is not yet available. The checkered record of steriods injected into the pllantar fascia are well known. The absence of serious complications from PRP is known.

A shot or cortisone is about 100 bucks. PRP is about 400 bucks. You have to ask yourself what you life is worth to you.

from dr mark

" The peer reviewed medical literture no longer supports this method of treatment.
__________________
drmark
Mark Sanders, MD FACS

so where is the peer reviewed literature that shows a controlled study of PSP for plantar fasciitis?

Go the the Journal of the American Academy of ORthopaedic Surgery October or November 2009

There is a review article on PRP and that will be a good start.

dr mark....that is exactly where my quote above is from. i can only access the abstract online.
it does not apply to plantar fasciitis,and says that although it may be promising,and is being increasingly marketed, there are NO GOOD STUDIES YET.

There isn't enough peer reviewed literature out yet on PRP for plantar fascitis.
There is more than enough negative literature on cortisone.

If it were my foot, I would have the PRP injection.

I think I have this plantar nonsense--for a month or so??! (cant remember exactly) I noticed a particular problem after starting up running outside again (didnt happen running on treadmill). One day in particular I ran outside for a few miles and then ran stairs--skipping steps--in an arena. I could just barely make it to the second step because they were big steps and of course I was running with someone with extra long legs who had no problem. I think I overstrained or something and this seems to be when problem started. Then I tried running a few days later and was in a bit of pain. My heels hurt every morning when I get up. It goes away during the day but I still kinda feel it all day. Then, every once in a while my big toe feels like its pulled. I have no pain in arches though. Hurts to jump rope (or just jump in any way) and I definitely cant run. I have self diagnosed after reading "ask the dr" in the paper. So, I guess I need to go to the dr. huh? What is this night brace vinman speaks of? I definitely sleep with my feet pointed down.

Sorry for the thread hijack!