Cortisone shots are a common and effective medical intervention used to treat various painful conditions in the foot and ankle. These treatments involve injecting a powerful anti-inflammatory medication, known as a corticosteroid, directly into a localized area. The primary goal is to significantly reduce inflammation, which alleviates pain and swelling in the affected joint, tendon, or soft tissue. While they offer temporary relief, these shots are part of a broader treatment plan aimed at managing chronic pain and restoring mobility. The procedure is typically quick and performed in an outpatient setting for patients whose pain has not responded to conservative treatments.
Common Foot and Ankle Conditions Treated
Corticosteroid injections are frequently used to manage inflammatory conditions affecting the foot and ankle. The most common target is the plantar fascia to address the chronic heel pain of plantar fasciitis. When conservative therapies like stretching, special footwear, or over-the-counter drugs fail, a cortisone shot can provide relief lasting several weeks to months.
Another common application is treating Morton’s neuroma, a painful condition involving thickened tissue around a nerve, usually between the third and fourth toes. The injection helps shrink the inflamed tissue surrounding the irritated nerve, decreasing pressure and associated pain. Localized arthritis, such as that affecting the midfoot or big toe joints, is also frequently managed with these shots. The anti-inflammatory action can calm the joint lining (synovium) and provide relief from stiffness and pain.
Tarsal tunnel syndrome, which involves compression of the posterior tibial nerve near the ankle, can also be targeted. Reducing inflammation in the surrounding structures alleviates pressure on the entrapped nerve, offering temporary symptomatic relief. These injections are not a cure but a tool to manage pain and inflammation, allowing the patient to participate more effectively in physical therapy.
How the Injection Works and What to Expect During the Procedure
The medication used is a synthetic corticosteroid that mimics the anti-inflammatory action of natural hormones. This powerful substance suppresses the localized immune response responsible for the swelling, heat, and pain of inflammation. The injection typically contains a mixture of the corticosteroid for long-term relief and a local anesthetic, such as lidocaine, which provides immediate pain relief.
During the procedure, the healthcare provider cleans the skin with an antiseptic solution. They then insert a thin needle directly into the affected area, often using ultrasound guidance to ensure precise placement of the medication. Patients may feel a brief sensation of pressure or stinging, but the local anesthetic immediately begins to numb the area.
Following the injection, some patients experience a temporary increase in pain, known as a “cortisone flare,” which occurs in about 5% of cases. This flare is due to a short-term reaction to the corticosteroid crystals and usually resolves within 48 hours. Patients are advised to rest the injected foot for one to two days and avoid strenuous activity for at least 48 hours.
Safety Considerations, Side Effects, and Frequency Limits
Cortisone injections are generally safe, but there are important safety considerations and potential side effects, particularly given the high-stress nature of the foot. A primary risk is the weakening or rupture of nearby tendons, especially when injecting near the Achilles tendon or plantar fascia. Repeated injections into the heel pad can also lead to fat pad atrophy, causing the protective cushion to thin and potentially increasing pain.
Due to the risk of tissue damage, healthcare providers strictly limit the number of injections a person can receive in the same area. The standard guideline suggests no more than three to four shots per year in a single site, spaced at least six weeks to three months apart. Other possible side effects include skin discoloration or thinning at the injection site.
Patients with diabetes must be aware that the corticosteroid can cause a temporary elevation in blood sugar levels, requiring close monitoring for a few days. Cortisone shots are avoided if there is an active infection or if the patient is taking blood-thinning medication, which increases the risk of bleeding. The treatment is not a long-term solution and is maximized when combined with physical therapy and appropriate footwear.