#848 Can a Cortisone injection as stop gap for plantar fasciitis in runner - DOC

#848 Can a Cortisone injection as stop gap for plantar fasciitis in runner

Can a corticosteroid injection serve as a stop gap for runners with heel pain? Well, that’s what we’re talking about today on the Doc On The Run Podcast.



On February 23rd, I was sitting in Lake Tahoe in a conference room, listening to a lecture on plantar fasciitis. This was at the International Foot and Ankle foundation meeting, and a doctor of Biomechanics and Podiatric Medicine at Barry University was giving a lecture on  plantar fasciitis.

I was listening intently because the next day I was scheduled to give a lecture called “When heel pain is not plantar fasciitis in runners”. Something he said kind of stopped in my tracks. He said that a cortisone injection can be used as a stop gap treatment to get patient’s relief sooner than waiting for the treatment to completely resolve. It is true that corticosteroid  can reduce the inflammation in and around the plantar fascia and make you have less pain.

But there’s a reason I mentioned what he said in my talk the next day because I virtually never do that anymore. When I had normal practice with normal people, I used to treat plantar fascia this corticosteroid injection pretty much daily. But I almost never do that now for a couple of reasons.

One of them is that we know that corticosteroids stop inflammation and that makes it hurt less. We also know that corticosteroids break up collagen bonds and since the plantar fascia is a huge sheet of collagen, that can make it weaker. So, if you inject the corticosteroids and it makes it weaker, well, that can be a problem and let me explain how.

After months of running and dumbing down your runs and running slower and being frustrated, if you then go in and you get that corticosteroid injection from your doctor, what are you going to do? You’re going to run more. You’re going to train more. And if the fascia is already weaker from all of the inflammation you’ve had for that period leading up to the doctor’s visit and then you actually get a cortisone injection that decreases some of the strength of the fascia further and you suddenly ramp up your training, well, you can get a partial rupture or a little tear in the plantar fascia just because you stressed it and strained it so much when you’re not really fit.

To complicate things when you’ve lost your fitness because you’ve lost you stopped running, well, then you wobble, sway, your forms terrible and all of these structures like the plantar fascia get stressed more. And that can lead to a bigger problem. So, in general, as a rule, I do not inject runners with plantar fasciitis because I’m concerned that they can actually get a partial tear or a rip in the fascia itself.

However, there is a time where I would do that. Let’s say you spend your whole life trying to qualify for Ironman Hawaii, and you finally get in. Once you finally get in, I know you really want to do that race and so, if you have plantar fasciitis that was really problematic, I might inject you before the race explaining to you very carefully that this is going to decrease your pain and help you get through the race in terms of you actually being able to compete and not have a pain in your heel.

I would also explain to you that there’s a good chance that this could increase the risk that it might actually tear when you did the race. And if that is okay with you, and you can live with that risk and it makes sense for you then fine, it’s your call. It’s not mine. When I did Ironman, Hawaii, I actually had pneumonia. My doctor did not like that. But it was my decision, I did the race, I finished, I’m happy I got it over with.

So, you’ve got to think about the risk of these procedures when a doctor offers it to you and many times, we as physicians are so busy, you might not really understand all of it. But hopefully this episode helps you understand a bit more about the risk of cortisone injections in runners.

If you want to learn more about heel pain and you want to see all the strategies I teach to physicians at medical conferences as well as the strategies I use with people who have heel pain that won’t go away and they want to run, you can get it for free at www.docontherun.com/heelpainmasterclass. It’s a free deep dive into all the strategies I use with runners and the same strategies I teach to physicians. So, go check it out, www.docontherun.com/heelpainmasterclass  and I’ll see you in the training.