Cortisone shots, known medically as corticosteroid injections, are a common and effective treatment for managing pain in the feet and ankles. A cortisone shot delivers a powerful synthetic anti-inflammatory medication directly into a painful, localized area. This direct delivery allows the medication to suppress the body’s inflammatory response much more effectively than oral medications. These injections are frequently used to provide targeted, temporary relief from swelling and discomfort in the lower extremities when conservative measures have failed.
Foot and Ankle Conditions Treated
Corticosteroid injections are frequently directed at specific inflammatory conditions that affect the foot and ankle structure. One common application is treating plantar fasciitis, which involves inflammation of the thick band of tissue running across the bottom of the foot. The injection targets the inflammation at the attachment point on the heel bone, offering significant pain reduction.
Another condition is Morton’s neuroma, which is the thickening of the tissue around a nerve between the toes, often causing a sharp, burning pain. Injecting cortisone around the irritated nerve helps to decrease the surrounding inflammation and swelling that contributes to nerve compression.
Injections are also used for tendinopathy, such as in the Achilles or posterior tibial tendons, to reduce localized inflammation within the tendon sheath. Arthritis affecting the foot and ankle joints, whether due to osteoarthritis or rheumatoid arthritis, also responds well to this treatment. By injecting the medication directly into the affected joint space, the treatment calms the joint lining, reducing stiffness and pain. The goal is to provide relief that allows the patient to begin or continue physical therapy and rehabilitation.
The Injection Procedure
The process of receiving a corticosteroid injection in the foot or ankle is typically quick and performed in an outpatient setting. Before the injection, the clinician cleans the skin over the injection site with an antiseptic solution to minimize the risk of infection. Often, the corticosteroid medication is combined with a local anesthetic, such as lidocaine, which provides immediate, though temporary, numbing and pain relief.
The healthcare provider then inserts a thin needle into the targeted area, which may cause a brief sensation of pressure or stinging. For accuracy, especially in smaller joints or around delicate structures, the clinician may use ultrasound imaging guidance. This imaging ensures the medication is deposited precisely where the inflammation is located for maximum effectiveness. Patients are typically advised to limit strenuous activity for a day or two following the procedure.
Potential Risks and Frequency Limitations
While cortisone shots are generally safe and effective, they carry potential risks, particularly in the weight-bearing structures of the foot. One recognized risk is a temporary post-injection pain flare, often called a cortisone flare, which can cause increased pain and swelling for up to 48 hours. More serious concerns include the weakening or potential rupture of tendons, with the Achilles tendon being a concern if the injection is placed directly into its fibers.
The catabolic nature of corticosteroids can also lead to localized tissue breakdown. This may manifest as atrophy, or thinning, of the protective fat pad on the sole of the foot, especially in the heel area, which can lead to chronic pain and difficulty walking. Repeated injections can also cause changes in the skin, such as depigmentation or atrophy of the subcutaneous fat layer around the injection site.
To mitigate the risk of tissue damage, medical guidelines generally recommend limiting injections to no more than three or four times per year in the same location. This frequency restriction is designed to protect the surrounding tissues, such as cartilage and tendons, from the degenerative effects associated with repeated exposure.
Alternative and Complementary Treatments
Corticosteroid injections are usually considered an intermediate step in a comprehensive pain management plan, often reserved for when conservative treatments have not been successful. These foundational conservative measures typically include non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, to manage generalized inflammation and pain. Rest and ice application are also commonly recommended to reduce acute symptoms.
Physical therapy is a fundamental component of managing foot and ankle conditions, focusing on specific stretching and strengthening exercises to improve function and stability. For many conditions, custom or off-the-shelf orthotics and specialized shoe inserts are used to provide mechanical support, correct biomechanical issues, and redistribute pressure across the foot. These non-invasive options aim to address the underlying cause of the pain. The injection provides a window of reduced pain, making it easier for the patient to fully engage in rehabilitation programs.