Plantar fasciitis steroid injection technique

Poor blood flow in the veins of the legs, known as chronic venous insufficiency, is a common health problem, particularly with ageing. It can cause leg pain, swelling (oedema), itchiness (pruritus) and tenseness as well as hardening of the skin (dermatosclerosis) and fatigue. Wearing compression stockings or socks helps but people may find them uncomfortable and do not always wear them. A seed extract of horse chestnut (Aesculus hippocastanum L.) is a herbal remedy used for venous insufficiency. Seventeen randomised controlled trials were included in the review. In all trials the extract was standardised to escin, which is the main active constituent of horse chestnut seed extract.

The pain associated with plantar fasciitis is typically insidious in onset and is usually located over the medial attachment of the plantar fascia onto the heel bone. Occasionally, the pain will be acute in onset, occurring after missing a step or after jumping from a height. The pain is often worse upon arising from bed in the morning or after periods of rest during the day. Thus, it causes what is known as “first step pain”. The degree of discomfort generally lessens with activity during the course of the day or after “warming-up”, but can become worse if prolonged or vigorous activity is undertaken. The pain is also often noted to be more severe in bare feet or in shoes with minimal or no padding at the sole.

Regular updates are a key feature of tutorials. As new science and information becomes available, I upgrade them, and the most recent version is always automatically available to customers. Unlike regular books, and even e-books (which can be obsolete by the time they are published, and can go years between editions) this document is updated at least once every three months and often much more. I also log updates, making it easy for readers to see what’s changed. This tutorial has gotten 75 major and minor updates since I started logging carefully in late 2009 (plus countless minor tweaks and touch-ups).

There is a very small risk of infection related to the injection. Therefore the injection site is prepped with alcohol to help minimize this risk. There is also the risk that some the underlying structures are weak prior to the injection and will become further weakened with cortisone. As mentioned, a cortisone injection directly into the plantar fascia is commonly done. But this increases the risk of partial tearing of the fascia. Therefore at our clinic, we like to inject at the interface between the fascia and the fat pad to help minimize this risk.

Thank you for your article as I too have been suffering for well over 18 months. I had to stop running about 12 months ago because I just couldn’t walk for several days afterward and it wasn’t worth the pain. I also have 3-young children that don’t afford me the opportunity to sit on the couch or keep my feet elevated for days on end, not that anyone can do that! After 6 months of slowing down, not running and icing my feet with no relief I decide to start aggressively treating the symptoms. In that time I’ve seen a podiatrist, had xrays to confirm heel spurs in both feet, custom orthotics, deep tissue massages, PT sessions with dry needling, KT-taping, massage, ultrasounds and mild ESWT treatments (twice a week for 2-months). I’ve also iced, stretched, started Pilates, used heat therapy on hips, thighs & calves to loosen the muscles to help my feet, golf balls, foam rollers, new shoes, night splints etc. I even recently tried a round of Acupuncture on my legs and feet to relieve the swelling and pain. I have to say everything worked for a few days but nothing has really stuck for an extended period of time- for me anyway. My right foot has made drastic improvements but my left is still very inflamed and seems to be progressing very slowly. All in all, both feet are better than when I started this journey but definitely not where I’d like to be…minimal pain.
After much hesitation, I finally broke down and received my first Cortisone injections last week in both feet. My right foot which has been reduced to minor pain through the series of events listed above & seems to be responding well and the pain is at a minimum but not completely gone. My left foot…well, its still not great. The Podiatrist indicated the shots may take a few days to actually start relieving the pain but I’m scheduled for a follow up next week. Needless to say…very frustrated! I’ve pretty much done it all, tried everything (not at once but introduced new procedures/techniques every 2-3 weeks if the last one did not work).
After reading the entries above, I think I will try the heal inserts to see if the cushioning makes any difference but would love to hear of any other tips or techniques that may be helping others- different shoes, other treatments, etc.
Thanks for letting me vent…hopefully my feet will find some relief in the coming weeks.

Interesting that you don’t mention what I find to be the #1 cause of plantar fascitis. It is trigger points in the soleus muscle which cannot be stretched in the same manner that is used to stretch the other calf muscle (the gastrocnemius). You can work the foot and heeel all day long and not resolve the problem until you get rid of the triggr points in the soleus and learn how to stretch it properly.
I am a massage therapist and you don’t even mention seeing this group of professionals who can be very helpful in working with someone. Massage the calf; do NOT massage the foot. Once you have gotten rid of the trigger points and gotten the calf muscles in good shape you can then massage the foot…..but chances are you wont’ need to. It will have become a non-issue.

Plantar fasciitis steroid injection technique

plantar fasciitis steroid injection technique

There is a very small risk of infection related to the injection. Therefore the injection site is prepped with alcohol to help minimize this risk. There is also the risk that some the underlying structures are weak prior to the injection and will become further weakened with cortisone. As mentioned, a cortisone injection directly into the plantar fascia is commonly done. But this increases the risk of partial tearing of the fascia. Therefore at our clinic, we like to inject at the interface between the fascia and the fat pad to help minimize this risk.

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