Injection therapy is becoming increasingly used by Total Foot Health. Broadly speaking there are three types of injections in common use, although by far the most useful of these is steroid (cortisone) injection.
It should be remembered that whatever substance is being injected into the foot it is worthwhile remembering that to work well it is best to have 48 hours of reduced activity with a gradual increase following this. WE DO NOT recommend that patients drive following their injection, this is especially so if a local anaesthetic is involved. Generally a small plaster will be placed over the injection site and this should be left in place overnight. It is likely that the foot will feel bruised for a day or two following the treatment.
Steroid injections are used when we want to introduce a powerful, anti-inflammatory agent into a specific area. Common reasons for this are:
- painful joints, such as hallux rigidus or metatarsalgia secondary to hallux valgus
- painful bursitis, often associated with other deformity
- painful nerve conditions, in particular Morton’s neuroma
- painful trigger points such as nerve pain following an ankle sprain
- painful post-operative scars
Steroids work in two ways, firstly there is a powerful anti-inflammatory effect that is used to break the cycle of pain and inflammation. This vicious cycle is quite common in the foot as it is, in fact, very difficult to rest an injured area completely. Steroids also work by reducing the bulk of soft tissue in an area. Like any treatment there are risks involved with steroid injections, to include:
- infection of the injection site is a rarely seen complication, this would however require prompt treatment with antibiotics.
- steroid flare, where the area becomes very sore for a day or two. This will settle with extra rest and ice to the area and, fortunately, does not seem to affect the outcome of the injection.
- worsening of symptoms due to tissue trauma from the injection itself.
In our experience the first injection is usually the best one and it is rare to offer more than two injections in a course of treatment. We do, however, find that some patients gain considerably from their injection but over time the effect wears off and they require a further injection, perhaps a year later. This is a perfectly safe approach to take to the use of steroids but repeated injections, at short intervals, are to be avoided in the foot.
Ultrasound guided steroid injections are used more commonly in my practice now as this allows both further investigation of the area to be treated as well as pinpoint accuracy in placement of the drug.
This technique is used for introducing an artificial lubricant and buffer into painful, early stage arthritic joints as seen in Stage I hallux rigidus. This is not a technique we use a lot as we find we get excellent results with steroid injections for the same problem.