How does cortisone work on plantar fasciitis

Convert impact exercise to non-impact exercise — cycling, swimming, and pool running are acceptable alternatives. Use a night splint each night while you sleep. This brace keeps your plantar fascia stretched while you sleep by holding your foot at 90 degrees to your leg. You can purchase a Johnson and Johnson night splint. Tape your feet. There are good instructional videos online Goggle plantar fasciitis taping technique.

Kinesio Tex Gold tape can be purchased. Use ice on the painful area for minutes, at least times per day -especially in the evening. Option A — Fill a styrofoam or paper cup with water and freeze it. Peel back the leading edge of the cup before application.

Massage the affected area for minutes. Option B — Fill a small inch diameter plastic bottle with water and freeze it. Option C — Rest the affected area on an ice pack for minutes. Use an oral anti-inflammatory medication. We recommend over-the-counter ibuprofen. Take three mg tablets, three times per day with food — breakfast, lunch, and dinner. To obtain the proper anti-inflammatory effect, you must maintain this dosing pattern for at least 10 days.

Discontinue the medication if any side effects are noted, including, but not limited to: stomach upset, rash, swelling, or change in stool color. See your doctor when you have failed to respond to the above regimen after three months of application. What can my doctor add? Administer cortisone injections. Injection of cortisone is a potent way to reduce inflammation and expedite the recovery process. Cortisone does not replace the need for supportive shoes, foot orthoses, calf stretching, and other physical measures.

The tape would smell and create a rash, and was not quite the best treatment for the three weeks that I was injecting cortisone. Orthotics were not covered in at my practice in Pittsburgh so we did not really offer them. If that did not work, we considered surgery. We did a lot of endoscopic plantar fascia releases, maybe as many as 20 a week.

I was so good at them by the time residency was over that I could do a release in about eight minutes start to finish without rushing.

It was so simple and it should have worked so well, but only 80 percent of patients got better. Some stayed the same and a few got worse. Why was this happening? I released the fascia off the heel so it should not have pulled on the bone any longer but there was still pain.

After joining UCLA for my initial job, I began to see how doctors at a world- class institution treated plantar fasciitis. I noticed physicians used orthotics much more commonly, both over-the-counter and custom orthotics. Patients had shoe modifications and extensive physical therapy. The physical therapy office was next door to our clinic and I spent some time there for about six weeks. After getting to know the technique, I realized that the instrument was for a Graston or Astym scar tissue break up in the fascia and Achilles.

I found this intriguing and followed my patients who were getting this technique. Again though, I saw mixed results. Over time, I realized the reason why everyone was getting the treatment and that it is not meant for everyone. Cortisone was still the mainstay of treatment for plantar fasciitis and it still was not very good.

After opening my own location with my partner, Gary Briskin, DPM, we really started with a clean slate. We thought about every condition and its treatment, and began to incorporate algorithms that we still use today although we have adjusted and updated these along the way.

We also began to work with our orthotic and prosthetic specialists to consider their best practices, and come up with a team approach to the treatment of heel pain. I hope the current treatment ideas I provide below let you think deeper about heel pain, what you do for it and why. Plantar fasciitis is actually a multitude of conditions that affect the heel.

The affected areas may include the plantar fascia insertion on the heel bone, the calcaneal bursa, the actual heel bone and the nerves on the medial side of the heel and the plantar heel. One can divide plantar heel pain into an initial inflammatory problem we call plantar fasciitis, which is commonly present for the first three to six months, and a chronic non-inflammatory plantar fascia problem we call plantar fasciopathy.

It is important to keep the six-month window in mind. Patients will have similar complaints of initial heel pain with first steps, which improves within a few minutes of walking, but often the chronic state involves residual pain that does not completely resolve.

Central heel pain that increases with walking and activity can be the result of either an issue with the heel bone or the bursa. Finally, nerve pain in the heel region can result in a multitude of pain symptoms and is the most difficult to diagnose. There can be an issue with strain or damage to the tarsal tunnel, an inflammation or muscular strain of the calcaneal branch, or a neuropathic condition that may be causing the pain.

For now, we will leave out back pain as a source of nerve pain in the heel but this should also be a consideration. Often, patients will say they have more pain with sleep or sitting if the heel pain is resulting from pain in their back. Of course, the main issue to consider is the actual plantar fascia pain. If the pain has only been present for a short time, it is mainly inflammatory and a strain of the fascia.

If the patient has had the problem for over six months, it is rarely an inflammatory condition any longer and more commonly a chronic scar formation with microtears of the fascia causing the pain. The initial patient visit consists of an extensive history and a series of questions to consider the length of time the patient has had pain and what he or she has done to treat it.

We will obtain a lateral radiograph of the weightbearing foot in order to check foot alignment, see if there is a spur present and also to ensure there is no cyst or fracture present.

However, a large part of our diagnostic testing centers on the use of ultrasound to image the heel region, the plantar fascia, the calcaneal bursa and the nerve branches leading to the foot in the tarsal tunnel. We do not use ultrasound to diagnose tarsal tunnel syndrome but can use ultrasound to see if there is a space-occupying lesion or any form of venous congestion in the tarsal tunnel. The plantar fascia is very easy to image and we check the consistency of the fascia, whether there is tearing present, scar tissue present and what the insertion on the heel is like.

If you have access to a power Doppler with ultrasound, you may also be able to see the amount of blood in the area. This can help indicate the chronicity of the damage, which will result in less blood flow on power Doppler imaging. Our treatment begins with shoe recommendations, mainly centering on a stiff-soled shoe with good structure and additional recommendations for orthotic or over-the-counter insoles.

We will also try to have patients not go barefoot and will have them wear an arch-supportive shoe at home. We usually begin with physical therapy as a first-line treatment, both at home by the patient and with a physical therapist. We will adjust treatment based on the acute or chronic stage of diagnosis. 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.

So, if we are able to address the mechanical dysfunction, for example with prescription orthotics, then the cortisone injection can effectively address the inflammatory component. Oftentimes there is more of a long-term resolution with this approach. 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. There is a very small 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. Prolotherapy treatment injections are made from a local anesthetic and an irritant, usually dextrose a form of glucose.

The irritant is used to cause inflammation. Some experts believe inflammation spurs the creation of connective tissue collagen , which in turn helps repair tendons and ligaments—ultimately reducing pain. Botox injections.

Some research suggests that injections of Botox, or Botulinum toxin type A BTX-A , may be a safe and effective way to relieve plantar fasciitis pain and inflammation.

Amniotic fluid injections. At least one study has suggested that injections containing material from the amniotic fluid and membranes of newborn humans may be used to treat plantar fasciitis. Patients may also consider other nonsurgical treatments, such as extracorporeal shock wave therapy ESWT. If these medical interventions do not provide relief from plantar fasciitis then surgery may be considered.

Stem Cell Therapy for Sports Injuries. Regenerative Medicine for Sports Injuries. Common Running Injuries: Foot Pain. Plantar Fasciitis: Injections and Prolotherapy share pin it Newsletters.

By Robert Engelen, DO.