Archive for November, 2011

Cortisone shots and plantar fasciitis

Thinking about getting a cortisone shot for that plantar fascia pain? You might want to think again.

I was searching around in the PubMed archives (yes, I do this for fun) and came across the following abstract. I’ve been preaching against cortisone shots for a long time, but this study really made me shake my head. From the abstract:

From 1992 to 1995, 765 patients with a clinical diagnosis of plantar fasciitis were evaluated by one of the authors. Fifty-one patients were diagnosed with plantar fascia rupture, and 44 of these ruptures were associated with corticosteroid injection.

Wow. So of the people who actually had a rupture, over 85% were associated with some kind of corticosteroid injection. (There are a lot of different types of corticosteroids, so not all of these may have been cortisone. But since all of the options are chemically similar, they might as well have been.) This means that there’s a very good chance that if those patients hadn’t been injected, the overall rate of plantar fascia tearing might have dropped from 6.7% to slightly over 1%. In other words, going from an uncomfortable but treatable condition to a full-blown rupture (i.e., now you need surgery) was more than six times as likely to happen with a shot than without one.

If that right there isn’t enough to convince you, read on:

In most cases the original heel pain was relieved by rupture. However, these patients subsequently developed new problems including longitudinal arch strain, lateral and dorsal midfoot strain, lateral plantar nerve dysfunction, stress fracture, hammertoe deformity, swelling, and/or antalgia.

Okay, so you get pain relief from your plantar fasciitis…but then you develop a whole host of other problems. And if you don’t know what all the medical conditions above are, let me just say that a lot of them are a lot worse than plantar fasciitis.

At an average 27-month follow-up, 50% had good/excellent scores and 50% had fair/poor scores. Recovery time was varied. Ten feet were asymptomatic by 6 months post rupture, four feet by 12 months post rupture, and 26 feet remained symptomatic 1 year post rupture. Our findings demonstrate that plantar fascia rupture after corticosteroid injection may result in long-term sequelae that are difficult to resolve.

So your recovery chances are 50/50. And these academic researchers, who don’t have any particular ax to grind when it comes to one therapy or another (the study in question can be found here if you’re interested), end by saying that corticosteroid shots are basically a bad idea because they can cause worse conditions than the one they were intended to heal.

Yet, as we all know, doctors still like to prescribe them. It just doesn’t add up.

Before you try something that has been scientifically shown NOT to help, doesn’t it make sense to try something that’s been scientifically shown TO help? Especially if that something is cheaper? The techniques in my book have that scientific support (not to mention a whole host of real-world testimonials), but before you decide to order it I encourage you to take a free, one-minute test to see if they are right for your condition. No one therapy is right for everyone, and you want to make sure that something is a good fit for your particular condition before you spend any money.

Author: Alex Nordach