Plantar fasciitis injection  [Cortisone Injection for Plantar Fasciitis vs. other injections]

Do plantar fasciitis cortisone injections hurt?

Cortisone shots vary in the amount of pain and/or discomfort they cause. Many factors can affect the injection pain, such as the needle’s size and gauge and the location of the injection.

Unfortunately, certain cortisone shots will cause pain no matter the precautions. Plantar fasciitis injections & cortisone injections into the foot sole and hand palm are usually considered a little more painful than other body sites. In general, the shots are painful when the cortisone is delivered to a small area. We are optimistic and believe we can make the shot as painless as possible!

The amount of pain is also determined by the length and width of the needle. Besides, larger needles are more painful than smaller ones. At our clinic, we utilize a 30 gauge needle, which is considered extremely thin. This can really minimize the pain of your plantar fasciitis injection.

Some patients ask their podiatrists for smaller needles to decrease the pain. Yet, the choice is determined by the location of the injection. For example, when the cortisone shot is injected into the knee, it needs to be inserted deep enough to penetrate the connective tissue of the knee. Luckily in the plantar fascia and heel, we can use a skinny needle as long as we avoid penetrating along the bottom of the heel.

In addition, the thickness or viscosity of the cortisone may need a gauge needle compared to the smaller needles used for subcutaneous injections.

If you are worried about the injection site pain, your podiatrist may recommend some techniques to relieve the pain, such as:

• A smaller needle, if possible: In some cases, the smaller needle can provide the same effects as the larger one. However, in other cases, it is not possible to go with the smallest available needle due to the thickness of the skin or the viscosity of the injection substance.
• Ask for a numbing agent: Cold sprays and topical anesthesia can relieve the injection site pain by reducing the injection sensation and numbing the skin area.
• Take your time: It can be harrowing if you want to get your cortisone shot over fast. A slower injection with a slower needle generally creates much less pain. Take your time and let your doctor talk you through the procedure to feel less frightened.
• Relax: Try to relax and take deep breaths. The procedure takes only a few minutes.

How often can you get a plantar fasciitis steroid injection?

Generally speaking, since there are many risks associated with cortisone shots, it is recommended to receive only one cortisone injection every 12 weeks and no more than 3 to 4 shots each year in a joint, and no more than 6 per year for any other body part.

 However, every person is different. Therefore, your doctor may recommend a different number of cortisone shots depending on many factors, including your level of pain tolerance and overall health.

What if the plantar fasciitis injection doesn’t work?

If the first cortisone shot does not work for your condition, your doctor may recommend a second shot 6 to 8 weeks after the first one. However, if the second shot does provide pain relief, it is not recommended to try another one. Cortisone has many side effects on the ability to heal cartilages, tendons, and ligaments.
Here are some essential facts you should be aware of about cortisone.

• It can reduce inflammations. However, it does not treat the underlying cause.
• The cortisone shot results are temporary and only last for 6 to 8 weeks.
• Cortisone inhibits the ability to heal.
• Other options can relieve and treat your condition.

Cortisone Shot for Plantar Fasciitis:

Cortisone injections are highly recommended for severe and chronic cases of plantar fasciitis in the scientific literature. A steroid is considered to be a potent anti-inflammatory. Therefore, it can decrease the level of pain significantly for about 3 to 4 months.

Studies show how effective cortisone shots are in relieving plantar fasciitis pain. A 36-month clinical study found that corticosteroid injections are way more effective than platelet-rich plasma therapy (PRP), prolotherapy, and extracorporeal shock wave therapy (ESWT). On the other hand, the 36-month follow-up showed that cortisone injections are no longer effective in managing the condition.

This means plantar fasciitis steroid injections are beneficial in the short term but alone will not solve this problem completely.

If conservative treatments failed to relieve your plantar fasciitis pain after 6 to 9 months, cortisone shots might be the best option to relieve your pain, especially if you do not have time or cannot afford surgery.

Keep in mind that cortisone injections will not treat your condition. They are just a pain management method. In other words, they will relieve your pain and reduce inflammation, but they will not repair the damaged arch.

If you want to repair the damaged arch, you can wear orthotic inserts for a while to re-cushion your heel and realign your arch. Also, physical therapy can help to stretch and strengthen your arch and make it more flexible.

If all the previous options failed, surgery could be the solution. The most common surgical procedure for plantar fasciitis is fasciotomy, which depends on releasing the plantar fascia to lower the tension in the foot muscles.

How Long Does a Cortisone Shot Take to Work? (How Long for Cortisone Shot to Work?)

It is important to know how long a cortisone shot takes to work in case you have an upcoming event such as a sports game. Also, it is important to choose the best time to have your cortisone injection because it can make a difference in its success or failure.

In general, a cortisone injection takes about 4 to 5 days to work. However, it is recommended to take the shot a week earlier if you have an event to ensure that your pain is relieved completely.

Notice that the cortisone shot makes the pain worse in the first few days. Therefore, you have to rest after getting the shot for a few days to prevent the pain from getting worse.

What Does a Cortisone Shot Do?

In general, cortisone is a steroid medication that helps inhibit inflammations in the body and decrease swelling. It works by preventing the release of the inflammation-causing molecules, preventing the body from having an immune response.

The purposes for taking a cortisone shot differ depending on the condition. For example, it can be taken as an orthopedic treatment. In this case, it is injected directly into the inflammation site.
It is used to relieve pain. However, it is not a pain medication. Cortisone is an anti-inflammatory that prevents collagen production by inhibiting the collagen-producing cells in the inflammation site, such as tendons and joints, which inhibits the inflammation and gradually reduces the pain.

Also, it is important to remember that cortisone does not cure your condition or the underlying problem causing it.

Cortisone works once it is injected. However, the pain relief effects vary from a patient to another. In other words, some patients feel immediate relief while other patients feel better over a few days or weeks.

If the condition is severe or chronic and ongoing when you get the shot, the effects may take longer and be less strong than expected.

Allergic Reaction to Cortisone Shot:

Before getting the cortisone shot, you must inform your doctor if you have ever had an allergic reaction after an injection. It is infrequent to react to the cortisone shot because it is a synthetic version of cortisol, a steroid produced naturally in your body. Also, allergic reactions can develop from the local anesthesia added to the injection, but it is uncommon.

However, if you experienced any of the following symptoms, you have to call your doctor and/or go to the nearest emergency room.

• Skin Rash.
• Itching or Hives.
• Swelling of the Face, Lips, or Tongue.

Cortisone Shot and COVID Vaccine:

According to the timing of the vaccination, there are two main concerns.

• Cortisone Injections Before Getting the COVID Vaccine:

If you are about to get the COVID vaccine, you will be informed about when you will receive it. According to the available research, you should wait about 4 weeks after getting a cortisone shot before getting your COVID vaccine. Your doctor will determine the exact amount of time between the two shots depending on the type of steroid and the dose you receive.

• Cortisone Injections After Getting the COVID Vaccine:

After receiving the vaccine, the immune system must function properly to produce antibodies and other immunity cellular components to reduce the risk of getting infected with the Coronavirus.
According to the manufacturers, the following is recommended:

• Pfizer-BioNTech COVID-19 mRNA Vaccine:

• Cortisone injections will not interfere with the expected immunogenicity after 28 days of the first COVID vaccine or 7 days after the second dose. It is recommended to continue corticosteroid injections after this period.

• Moderna COVID-19 mRNA Vaccine:

• It is recommended to continue corticosteroid injections at around day 14 or 42 after the second dose. The vaccination will work, but you may have a lesser response than others. Therefore, it is recommended to wait about 2 weeks after receiving the second mRNA vaccination dose before receiving your cortisone shot. Also, it is not clear yet if any booster shots or routine antibody monitoring are recommended.

Cortisone Shot Cost (How Much Does a Cortisone Shot Cost?) (How Much Do Cortisone Shots Cost?):

Generally, a basic, single cortisone shot price ranges from $25 up to $100. Some clinics offer discounts, especially on the first shot and if the problem will be treated in series of injections as part of your pain management treatment.

In addition, the costs may vary according to the size of the injection. For example, a cortisone shot in the knee costs $300 to $900, an elbow shot costs $200 to $250, and a shoulder shot usually costs about $170.
The price of the shots does not include the doctor’s visits.

Cortisone shots are injected at certain points in the body, depending on the issue. The cost may vary according to the problem.

For example:

• Cystic Acne – The cost is $25 to $100 per injection
  Cortisone shots are the best and most effective way to make active acne lesions disappear. It is the best option if you have an important event and want to look perfect fast. The cortisone is injected directly into the pimples. After a while, they will appear smaller, and the inflammation will disappear.
• Trigger Point/Tendon Injections – The Average Cost is $868
  If you experience pain in a certain body part originating from another body part with trigger points. Trigger points are sensitive areas of the body. Once irritated or stimulated, they cause effects in other areas, especially tender areas in muscles that cause musculoskeletal pain when overstimulated.
  When cortisone is injected into the trigger points, it makes them more relaxed or inactive, relieving the pain in the other body part.
• Epidural Steroid Injection – The National average cost is $2,068

If you suffer from spinal pain due to a herniated disc, spinal stenosis, or degenerative disc disease, an epidural steroid injection is one of the best non-surgical pain management treatments. It is usually prescribed so that the patient can participate in physical therapy.

How Does a Cortisone Shot Work?

Cortisone works by inhibiting or preventing the release of the molecules, causing inflammations and subsequently swelling, which leads to decreasing swelling and inflammation in the body. These molecules trigger the immune system to respond, which leads to inflammations and swellings. When the release of the inflammatory molecules stops, the immune system will not react from the beginning.

Can You Get Two Cortisone Shots at the Same Time?

Yes, it is possible to have two cortisone shots at the same time. However, they must be injected into different parts of the body.

Your doctor will adjust the doses of the two shots to limit the risks and make the best out of the two doses. In other doses, lower doses are injected into each body part.

However, there are more risks associated with getting more than one cortisone shot at the same time, including:

• Nerve damage.
• Cartilage damage.
• Temporary increase in blood sugar levels.
• Tendon weakness.
• Tendon rupture.
• A temporary flare of pain and inflammations, especially in joints.
• Osteoporosis, especially with multiple injections at the same place.
• Temporary redness, hotness, or flushing of the face.

Your doctor will inform you about your specific risks.

What Are the Side Effects of Cortisone Shots?

The side effects of cortisone shots can be divided into:

• Short-Term Side Effects: They are rare but include:
• Shrinkage and fading away of the skin color at the site of injection.
•  
• Bleeding when a blood vessel is broken in the muscle or skin.
• Soreness at the site of injection.
• Post-injection flare, which means aggravating the inflammation at the injection site as a reaction to the cortisone.
• Tendon weakness.
• Tendon ruptures.
• Cortisone can elevate blood sugar levels in diabetic patients.
• Cortisone makes it harder to recover from infections.
• It is not recommended to get a cortisone shot if you have blood clotting problems.
• Long-Term Side Effects: They depend on the frequency and dose of the cortisone treatment. Higher doses and frequent shots can cause the following side effects:
• Skin thinning.
•  
• Weight gain.
• Increasing blood pressure.
• Puffiness of the face.
• Bone problems such as osteoporosis.
• Cataract formation.
• Avascular necrosis: it is an infrequent but serious condition that may happen to the bones of large joints.

How Long After Cortisone Shot Can I Drink Alcohol?

There is no problem with drinking alcohol after getting a cortisone shot. Therefore, you can drink alcohol before and/or after the injection.

Cortisone Shot Needle:

A 1.5 inch, 21-gauge needle is usually used to inject cortisone in large joints such as the shoulder and knee joint, while 0.5 inch, 23- or 25-gauge needles are usually used for smaller joints.

Doctors argue whether it is better to give the patient a separate local anesthetic injection before the cortisone shot or give both the local anesthesia and cortisone in a single shot. Some doctors prefer to give the patient 1 shot of the corticosteroid preparation mixed with a local anesthetic since 1 needle is usually less painful than 2.

On the other hand, the cortisone material is thick, and a larger gauge is usually required. Therefore, 2 needles are usually more tolerated than one.
In the 2-needle technique, your doctor will anesthetize the area first using a small, 25-gauge needle, wait for about 5 minutes until the anesthesia works, and then a larger-bore needle (21-22 gauge) is used for the cortisone shot.

It is recommended to ask your doctor if a smaller needle is possible before the procedure.

How Long After a Cortisone Shot Can I Run?

Generally, patients should not run or do heavy exercise for 2 weeks after receiving a long-acting cortisone shot. After 10 days to 2 weeks, they can start performing gentle range-of-motion exercises as tolerated to stay active.

What Are Cortisone Shots Used For?

Cortisone shots are usually used to relieve orthopedic problems. In other words, it can reduce swelling and inflammations in bone and muscle problems such as arthritis, tendonitis, or bursitis.

However, cortisone is not a painkiller. It has anti-inflammatory properties. Therefore, it can reduce inflammations and swellings, which subsequently reduces the pain.

The most common indications for cortisone injections include the following inflammatory conditions:

• Synovitis.
• Osteoarthritis.
• Bursitis.
• Tendinitis.
• Muscle trigger points.
• Entrapments syndromes such as carpal tunnel syndrome.
• Fasciitis.

What to Expect after Cortisone Shot in Foot?

A cortisone shot in the foot reduces inflammation and swelling of all the soft tissues (muscles, tendons, and ligaments) within the foot joint.

Reduction of inflammation leads to decreasing pain. Since cortisone is a potent anti-inflammatory, your foot pain will be relieved immediately after the injection or within 48 hours. It depends on many factors, including age, the severity of pain, and the underlying cause.

Cortisone shots in the foot are safe, and the side effects are rare.

Alternatives to Cortisone Shots:

Platelet Rich Plasma (PRP) is the best alternative to cortisone shots. PRP depends on injecting a concentrated blood platelets solution in the damaged area. This solution contains proteins and growth factors that promote healing.

It is better than cortisone because:

• Complications are extremely infrequent since it depends on injecting the patient’s blood.
• It relieves pain while promoting healing of the damaged tissue because it contains bioactive proteins.
• Patients are less likely to need surgical intervention in the long run. However, PRP is usually more expensive than cortisone shots and takes longer to relieve pain and inflammation. Another alternative for cortisone shots is prolotherapy. Prolotherapy depends on injecting regenerative solutions such as dextrose, antioxidants, and/or amino acids with short-acting anesthetics such as lidocaine or procaine into the damaged area to stimulate the healing process and enhance the collagen production within the damaged area.

  It is better than cortisone shots because:

• It is suitable for acute injuries to healthy tissues that take a longer time to heal.
• It is safer, more natural, and effective than surgeries and cortisone shots.
• It uses the healing ability of the body to relieve both acute and chronic pain, make the damaged tissues stronger, and restore the function of the joints. Prolotherapy is highly recommended in the following conditions:
• Minor ACL/MCL/LCL tears/sprains.
• Minor Meniscus injuries
• Frozen shoulder
• Adhesive capsulitis
• Tendonitis
• Sprains

It is recommended to try 1-2 prolotherapy sessions before PRP or cortisone shots. Also, patients with a history of chronic diseases or inflammations should consider prolotherapy before PRP injections to calm the joint.

Pros and Cons of Cortisone Shot for Plantar Fasciitis:

In Plantar Fasciitis cases, the cortisone is injected into the most painful area of your plantar fascia.

The Pros:

• Short-term pain relief of a few months.
• Keeping the inflammation down for even longer than that.

The Cons:

Repeated cortisone injections into the plantar fascia may lead to:

• Fat Atrophy.
• Skin Thinning.
• Fascia Rupture.

Cortisone Shot in Ankle:

A cortisone shot reduces stiffness, swelling, and pain in your ankle. It is highly recommended for patients with chronic pain who tried prolonged rest, physical therapy, or painkillers but did not manage their pain.

It is generally safe and has a low risk of side effects. However, repeated cortisone shots, especially with larger doses, can lead to serious side effects such as:

• Making arthritis worse.
• Damaging the joint and/or cartilage over time.
• Weakening the bones and tendons.

If you want to avoid these side effects, you should stick to the optimal dose of steroid injections 4 times per year.

The ankle cortisone shot usually takes a few days before work. The time varies from a person to another. For example, some patients report that they experience immediate relief, while others report that their symptoms started getting better after a few days.

Besides, the length of pain relief caused by cortisone can also vary depending on many factors, such as the affected joint and the patient’s overall health.
Generally, cortisone pain relief can last for 6 to 12 weeks. If the cortisone shot is used with other rehabilitation treatments such as physical therapy, the length of effectiveness can be longer or even curative.

Ankle injections are usually painful. You may experience some pressure and discomfort during the procedure, but it is usually not too painful. However, the pain can be avoided with the help of your doctor.

In a nutshell, cortisone shots are one of the most common ankle injections. They are injected into the ankle joint to relieve ankle pain and inflammation.

Cortisone Shot in Heel:

A cortisone shot in the heel is one of the best options to relieve the pain and inflammation of plantar fasciitis, especially in chronic and severe pain cases. As a powerful anti-inflammatory, it can relieve your pain for about 3 months.

A 36-month clinical study showed that cortisone injections are more effective than extracorporeal shock wave therapy (ESWT), prolotherapy, and platelet-rich plasma therapy. However, the cortisone injection lost its effectiveness completely after 36 months.

If your heel pain is not responding to any treatments after 6 to 9 months, it is time to try cortisone shots to manage your pain.

Remember that cortisone shots are just a method to manage your pain and will not cure your condition.
In other words, the cortisone will lower the level of pain and inflammation, but it will not repair your damaged arch.

If you want to cure your heel and repair your damaged plantar fascia, you should wear orthotic inserts to re-cushion your heel and realign your arch. Besides, it would be best to do stretch exercises to strengthen your plantar fascia and foot muscles and improve your arch’s flexibility. Also, rest and put ice on your feet as needed.

Walk-in Clinic Cortisone Shot:

The visit usually starts with a complete medical history and a full physical examination at a cortisone shot clinic. Tests such as x-rays may be taken if needed.

If the cortisone shot is recommended, your doctor will explain everything; the procedure, the benefits, and the risks. If you have any questions before or after the procedure, they will answer them too.

Once you are 100% ready for the injection, your doctor will thoroughly clean the site area and surroundings.

A local anesthetic may be applied before the injection to numb the area. When the needle is inserted into the injection area and the cortisone is released, the patient may feel pressure.

The injection usually includes an anesthetic, which immediately relieves pain, and the cortisone will start working in a few days.

Cortisone Shot for Plantar Fasciitis Didn’t Work.

If the cortisone shot does not work for your plantar fasciitis, many other options may relieve your pain and even cure your condition.

• Ultrasound Therapy:

Ultrasound therapy usually works by stimulating cells and tissues via vibration. The procedure is simple, painless, and less expensive than other procedures and treatments.

• Extracorporeal Shockwave Therapy (ESWT) for Plantar Fasciitis:

ESWT is more expensive than other procedures. It is also more painful than ultrasound therapy. However, many studies say that it is more effective in treating stubborn cases of plantar fasciitis than other methods.

• Platelet-Rich Plasma (PRP) Injections:

After centrifuging your platelet cells, they are injected into the damaged plantar fascia. It is more expensive than cortisone shots, yet it is popular among athletes.

• Radiation Therapy:

Radiation therapy can be effective in treating some stubborn plantar fasciitis cases. It is cheap, simple, and non-invasive. Also, it has minimal side effects and low risks. It is like getting an x-ray.

• Intracorporeal pneumatic shock therapy (IPST):

IPST applied shock waves to heel spurs. It is similar to ESWT but less painful, less expensive, and requires local anesthesia.

• Plantar fasciitis surgery options:

Surgery is the last resort because it is expensive and has many complications. It is recommended only when other treatments fail.
Most plantar fasciitis surgeries have high success rates. However, they require a lot of time off your feet, high expenses, and of course, pain.