more cortisone shot questions

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Subject: RE: more cortisone shot questions

trigal38 - 2012-01-23 7:37 AM

I've had the shots before. Always in my feet, probably 3 in my lifetime and they have always been successful.

This time I have been fighting tendonitis (tibialis posterior tendon) in my foot. It has been going on for almost a year now with the worst being after I completed my HIM in June. I have barely run at all since then. I have tried ART, massage, stretching, ice, NASIDS, rest and a treatment called MAT (muscle activation therapy). The MAT worked but only temporarily and I have to drive 3 hours to the city to get to a therapist.

The last time I visited the podiatrist he said we could try a shot but since it is in the tendon I would have to lay off activity (he knows how active I am) due to risk of tendon rupture. He seemed hesitant and I kept thinking I could make it go away. No dice. I'm really ready for this to go away. I'm babying some back pain, it is the middle of winter, if I have to be inactive for a week this would be a good time.

I'm only worried about the phrase "risk of tendon rupture". That sounds scary to me. Anyone have any input for me?

I went through Achilles issues and had the same question about cortizone. The risk of rupture is very real. I'd question any benefit versus the risk of it. In other words: My orthopaedist made it very clear that he wasn't willing to do it and I certainly wasn't either.

I'd look at alternatives; surgery?

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Expert

2189

Dodge County, MN (out in the corn)

Subject: RE: more cortisone shot questions

You just described what I went through last spring. I did finally get the injection and I think it helped. Not really sure. I was super nervous about that tendon rupture thing. It hurt like crazy for a day after and then it got better. I'm really not sure how much it helped. It got me a few races before the rest of my foot broke down. After that I found out (several months later) that I had a nasty heel spur on that foot too. Probably all related as I was compensating for the spur and tweaked my tendon. Now I'm 8 weeks post surgery for the heel spur. I'm making it my personal mission to send my podiatrist's kid to college.

Anyway, good luck to you. If you want any more info, or just to comiserate on bad feet, I'm here.

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Champion

7704

Williamston, Michigan

Subject: RE: more cortisone shot questions

I would advise against the shot. If the Post tib ruptures its a big deal. Go see a foot and ankle trained orthopedist over a podiatrist. If you PM me where you live I may be able to suggest someone for you.

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Bronze member

Subject: RE: more cortisone shot questions

Ok - sounds like no shot. Thanks for being straight with me and sharing your opinions. I'll keep looking for another solution.

Edited by trigal38 2012-01-23 2:09 PM

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Master

2327

Columbia, TN

Subject: RE: more cortisone shot questions

trigal38 - 2012-01-23 6:37 AM

I've had the shots before. Always in my feet, probably 3 in my lifetime and they have always been successful.

This time I have been fighting tendonitis (tibialis posterior tendon) in my foot. It has been going on for almost a year now with the worst being after I completed my HIM in June. I have barely run at all since then. I have tried ART, massage, stretching, ice, NASIDS, rest and a treatment called MAT (muscle activation therapy). The MAT worked but only temporarily and I have to drive 3 hours to the city to get to a therapist.

The last time I visited the podiatrist he said we could try a shot but since it is in the tendon I would have to lay off activity (he knows how active I am) due to risk of tendon rupture. He seemed hesitant and I kept thinking I could make it go away. No dice. I'm really ready for this to go away. I'm babying some back pain, it is the middle of winter, if I have to be inactive for a week this would be a good time.

I'm only worried about the phrase "risk of tendon rupture". That sounds scary to me. Anyone have any input for me?

Why haven't you tried physical therapy? Read this article, it describes the exercises: http://www.sportsinjurybulletin.com/archive/tibialis-tendinitis.html

In addition, why jump straight ahead to a shot in the tendon sheath itself? First try a systemmic dose of corticosteroids. Consider a steroid injection (general, in the hip muscle) followed by a medrol dose pack. Then do the strengthening exercises prescribed for about 2 weeks and see where you go from there.

Also, do you pronate? What type of shoes do you use? I'm normally not a pronation nazi, but pronation is the main contributor to your problem. If you don't have pronation control shoes, consider them.

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Champion

16151

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Subject: RE: more cortisone shot questions

IIWY: I'd contact Socks and take her up on that. Only after I went to a orthopaedic podiatrist who specialized in foot and ankle surgurys did I get a straight answer and offered a solution. He gave me the straight facts, actually imaged the problem and told me the consequences and benefits of all approaches.

Yeah, it was a complete surgical Achilles rebuild and 6-12 months of rehab, but I've since had the right one fixed as well since the left was SO much better after the surgery.

A specialist who has seen these many times is likely your best route.

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Bronze member

Subject: RE: more cortisone shot questions

JeffY - 2012-01-23 3:23 PM

trigal38 - 2012-01-23 6:37 AM

I've had the shots before. Always in my feet, probably 3 in my lifetime and they have always been successful.

This time I have been fighting tendonitis (tibialis posterior tendon) in my foot. It has been going on for almost a year now with the worst being after I completed my HIM in June. I have barely run at all since then. I have tried ART, massage, stretching, ice, NASIDS, rest and a treatment called MAT (muscle activation therapy). The MAT worked but only temporarily and I have to drive 3 hours to the city to get to a therapist.

The last time I visited the podiatrist he said we could try a shot but since it is in the tendon I would have to lay off activity (he knows how active I am) due to risk of tendon rupture. He seemed hesitant and I kept thinking I could make it go away. No dice. I'm really ready for this to go away. I'm babying some back pain, it is the middle of winter, if I have to be inactive for a week this would be a good time.

I'm only worried about the phrase "risk of tendon rupture". That sounds scary to me. Anyone have any input for me?

Why haven't you tried physical therapy? Read this article, it describes the exercises: http://www.sportsinjurybulletin.com/archive/tibialis-tendinitis.html

In addition, why jump straight ahead to a shot in the tendon sheath itself? First try a systemmic dose of corticosteroids. Consider a steroid injection (general, in the hip muscle) followed by a medrol dose pack. Then do the strengthening exercises prescribed for about 2 weeks and see where you go from there.

Also, do you pronate? What type of shoes do you use? I'm normally not a pronation nazi, but pronation is the main contributor to your problem. If you don't have pronation control shoes, consider them.

Lots of info there Jeff, thanks. I only have the recomendations of the podiatrist to go on, I'm not an expert in what to do and just look to him to advise me. So, as far PT - doc never recommended me for any and just said the next step was the shot. That was about 6 months ago. I sought out the MAT therapy on my own which did alleviate the pain almost immediately. It just keeps coming back but I can't get to Indy (3 hour drive) to get treatments regularly. I've had a couple of rounds of oral steriods already. Helps for a while.....

Yes I pronate, already wear orthotics, wear stability running shoes, just bought some Earth shoes for work which I have to say were excellent all day today. I take Naproxen as needed when the pain is too irritating, ice, wear a compression wrap. The MAT therapist gave me a few exercises to do but I'm not sure they are actually doing anything.

I will check out your links, thanks!

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Bronze member

Subject: RE: more cortisone shot questions

pitt83 - 2012-01-23 3:26 PM IIWY: I'd contact Socks and take her up on that. Only after I went to a orthopaedic podiatrist who specialized in foot and ankle surgurys did I get a straight answer and offered a solution. He gave me the straight facts, actually imaged the problem and told me the consequences and benefits of all approaches. Yeah, it was a complete surgical Achilles rebuild and 6-12 months of rehab, but I've since had the right one fixed as well since the left was SO much better after the surgery. A specialist who has seen these many times is likely your best route.

Thanks, I found a few specialists near my parents house - 2 hour drive.

Have I mentioned we live in the middle of no where .

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Champion

16151

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Subject: RE: more cortisone shot questions

trigal38 - 2012-01-23 4:55 PM

pitt83 - 2012-01-23 3:26 PM IIWY: I'd contact Socks and take her up on that. Only after I went to a orthopaedic podiatrist who specialized in foot and ankle surgurys did I get a straight answer and offered a solution. He gave me the straight facts, actually imaged the problem and told me the consequences and benefits of all approaches. Yeah, it was a complete surgical Achilles rebuild and 6-12 months of rehab, but I've since had the right one fixed as well since the left was SO much better after the surgery. A specialist who has seen these many times is likely your best route.

Thanks, I found a few specialists near my parents house - 2 hour drive.

Have I mentioned we live in the middle of no where .

You have better access to large animal veternarians than I do though!

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Subject: RE: more cortisone shot questions

pitt83 - 2012-01-23 4:04 PM

trigal38 - 2012-01-23 4:55 PM

pitt83 - 2012-01-23 3:26 PM IIWY: I'd contact Socks and take her up on that. Only after I went to a orthopaedic podiatrist who specialized in foot and ankle surgurys did I get a straight answer and offered a solution. He gave me the straight facts, actually imaged the problem and told me the consequences and benefits of all approaches. Yeah, it was a complete surgical Achilles rebuild and 6-12 months of rehab, but I've since had the right one fixed as well since the left was SO much better after the surgery. A specialist who has seen these many times is likely your best route.

Thanks, I found a few specialists near my parents house - 2 hour drive.

Have I mentioned we live in the middle of no where .

You have better access to large animal veternarians than I do though!

Ha ha, this is true. And all the large animal smell too!

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1

Subject: RE: more cortisone shot questions

tendonitis like that put the kabash on me running thre thunder road marathon here in charlotte but i was able to run the half AFTER spending a month in a high leg cam walker boot. DO NOT GET THE SHOT. I am a PA working in orthopedics and can give you some strong advie on this. get in the boot, avoid the shot and go see a legitimate, fellowship trained foot and ankle orthopedic surgeon. getting the shot is a slippery slope that no endurance athtlete wants to go down without some sound advice from an MD and solid rest and immobilization in a walker boot for awhile. good luck.

Bronze member

Subject: RE: more cortisone shot questions

Kccyclist - 2012-01-23 6:15 PM tendonitis like that put the kabash on me running thre thunder road marathon here in charlotte but i was able to run the half AFTER spending a month in a high leg cam walker boot. DO NOT GET THE SHOT. I am a PA working in orthopedics and can give you some strong advie on this. get in the boot, avoid the shot and go see a legitimate, fellowship trained foot and ankle orthopedic surgeon. getting the shot is a slippery slope that no endurance athtlete wants to go down without some sound advice from an MD and solid rest and immobilization in a walker boot for awhile. good luck.

Thanks! I already have the boot so that is an easy step to take. Don't worry, I won't get the shot. You all have scared the thought right out of me!

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Veteran

204

Massapequa, NY

Subject: RE: more cortisone shot questions

i recently had 2 coristone injections simultaneously into my shoulder and bicep tendon (same side). It was done at the Hospital for Special Surgery by the same shoulder group that services the NY Giants (why not, insurance paid for it!).

For about 3 months, I felt awesome, but alas, the shots have worn off. Make sure to incorporate some solid physical therapy (as was directed by my orthopedist). I was unable to do the PT, and I feel as though the cortisone (on its own) was wasted treatment (my fault). I guess my point is that it does not appear to be a cure for anything (i cant really speak about anything other than my own personal experience). I am not a doctor, but repeated injections of cortisone are pretty much universally frowned upon. I am shifting my focus to strengthening the tendons via PT, ART therapy, and possibly accupuncture.

Veteran

217

Clemson

Subject: RE: more cortisone shot questions

I had ITBS both sides for about 3 years. I wasn't able to run more that 1 mile without setting it off and being painful for weeks. I was almost committed to surgery and cortisone without much chance of being very active for the rest of my life. Long story short I was lucky enough to find a physical therapist that recognized imbalances in my running gait and tracked it back to upper and lower back tightness that was forcing my walking and running to compensate leading to the leg tightness and the ITB rubbing as it comes across the knee. I worked on the back problems then lots of massage and PT to relearn how to walk and run properly, then slowly strengthening to the point that today I wear neutral shoes, can run 20 minute 5ks and haven't had an ITBS reoccurrabce in over 5 years. I don't know if it would be the same case for you but I hope you can have the perseverance and luck that I did to do it naturally.

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Bronze member

Subject: RE: more cortisone shot questions

coolgenes - 2012-01-24 10:11 AM I had ITBS both sides for about 3 years. I wasn't able to run more that 1 mile without setting it off and being painful for weeks. I was almost committed to surgery and cortisone without much chance of being very active for the rest of my life. Long story short I was lucky enough to find a physical therapist that recognized imbalances in my running gait and tracked it back to upper and lower back tightness that was forcing my walking and running to compensate leading to the leg tightness and the ITB rubbing as it comes across the knee. I worked on the back problems then lots of massage and PT to relearn how to walk and run properly, then slowly strengthening to the point that today I wear neutral shoes, can run 20 minute 5ks and haven't had an ITBS reoccurrabce in over 5 years. I don't know if it would be the same case for you but I hope you can have the perseverance and luck that I did to do it naturally.

I'm currently getting PT for my back right now so let's hope so!!!!!!!!!

I'll ask her about my foot at the next visit. I'm not sure how that works with the insurance, if I need another referral or doctors script or what.

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more cortisone shot questions

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