Juliana asks: What is your opinion on cortisone shots?
Posted by Guru
What is your opinion on cortisone shots and/or electrical stim for plantar fasciitis?
Juliana asks: “What is your opinion on cortisone shots and/or electrical stim for plantar fasciitis? My plantar fasciitis wasn’t getting any better with physical therapy (exercises, ultrasound, ice massage & electrical stim) so I decided to go for a cortisone shot. I thought the shot would give instant relief, but instead the needle and process made my foot hurt more. The doctor said to wait for 24 hours and expect a 20% reduction in pain. Then to come back for another shot next week and then more shots every two weeks. After the shot my foot hurt a great deal and also felt pins & needles all night. The next day there is some relief but also my foot is sore & bruised where he put the needle. I am wondering if I should continue these shots since cortisone can cause deterioration of the fat pads and the benefits seem not so great?”
Great question. And it’s one that I started dealing with about 12 years ago. Plantar fasciitis is a swelling and inflammation of the tissue at the bottom of the foot– insanely painful, particularly if you enjoy passtimes like running, walking, standing, sitting or sleeping. I suffered from it a while ago and it drove me crazy, and drove me out of a lot of the exercise that I enjoyed doing. I visited doctors, all of whom had their own particular way of dealing with it– including the one surgeon who was convinced it was bone spurs and he should operate (note to self:surgeons like to operate). Then I found an orthopedist who summed it up brilliantly: “your calves are ridiculously tight. Stretch your calves and the inflammation will disappear.” He had me Down Dog (see video below), a great yoga stretch, several times a day. At first, it was godawful. But slowly, my calves became more flexible and, lo, the inflammation disappeared.
As for cortisone, well, Juliana, I’m not a doctor, just a humble country Fitness Guru, but honestly I don’t like it. I could list the side effects (including but not limited to thinning of the skin, easy bruising, weight gain, puffiness of the face, elevation of blood pressure, cataract formation, osteoporosis, and a rare but serious damage to the bones of the large joints) but I won’t. My problem with it is that, by suppressing your immune system, it makes the pain go away. But it never gets at the source of the problem, the reason why the fascia is inflamed to begin with. So the cortisone shot acts as a crutch, a temporary relief of the pain. But as soon as you go back to your old behavior, the tension will build again and the inflammation will come right back, forcing you to go visit the doctor again and get another shot, thus increasing the risk of the side effects– urghhhhh! As for electro-stim, I would think that causing the muscles to contract would serve to created more tension and thus inflammation. I would think that ultra-sound, which is designed to reduce inflammation, would be the way to go.
So if the pain is THAT bad, by all means seek out the immediate relief (though I am more inclined to use arnica cream and find a good acupuncturist). But first and foremost, stretch your calves. Stretch them, and then stretch them again. The more flexible you become, the less likely the inflammation will sprout up again.
Check out the Quick Fix video that Josie and I shot ages ago. Try to ignore the fact that Josie curses like sailor and focus on the exercise. Even with my limited hamstring capabilities, you can see why this is so effective.
my podiatrist says to stand on the edge of a stair on the balls of your feet & drop each heel, hold for 10 secs & change, 10 times. WONDERFUL stretch – it cleared up my heel pain in 2 weeks.
the casual mention of arnica cream and to “find a good acupuncturist” — can you expand on this?
I am finding toe towel scrunches are a big help.
Towel toe scrunching is great because it gets all those little muscles to work and creates more flexibility. (maybe I’ll make a video).
Seth, acupuncturists can help relieve pain caused by tight strained muscles by needling pressure points throughout the leg. Arnica is a homeopathic anti-inflammatory which will reduce the inflammation along the sole of the foot without all the negative side-effects.
I swear by “Traumeel” (contains arnica). And acupuncture changed my life. No joke.
any recommendations on local acupuncturists Michael or Megan?
Good question, Seth. But as the internet is global, perhaps some criteria in choosing an acupuncturist. Most states have some sort of laws pertaining to the practice of acupuncture (Oklahoma and Wyoming are the only ones that don’t), so the first step is to make sure that practitioners are abiding by the law of the land. Also, acupuncture is best when NOT learned over the course of a weekend via a series of webinars. Most great practitioners have not only gone to school for several years to learn the art, but are also constantly seeking to improve on their educations, so don’t be afraid to ask questions of the individual to whom you are entrusting yourself. Also, seek out referrals from friends in your area. Bad acupuncture is a pretty miserable experience and most people will be very honest if they saw someone and did not think it was beneficial. The flip side is that good acupuncture is a wonderful experience and most people would be very happy to refer you to someone they trust.
Some day as you age you may find that adhesions and scar tissue make it impossible to just stretch to correct conditions like faciitis. Then you need to seek out a good Active Release Technique practitioner who will break up the adhesions & scar tissue and allow you to get back the suppleness necessary to resume normal activity. It will hurt, but it will be worth it.
WHAT ABOUT THOSE ELECTRIC STIMULATION PADS THAT THEY USE IN PHYSICAL THERAPY? ARE THERE ANY SIDE AFFECTS FROM THOSE?
I know a chiropractor who never goes near electro-stimulation pads because he feels that the current must harm the cells of the body. I’m sure you can find arguments and studies going either way. I think so long as you are only using the pads occasionally and not hooking yourself up for hours on end, you’ll survive.