#888 Can I run after cortisone injection for a neuroma? - DOC

#888 Can I run after cortisone injection for a neuroma?

Can I run a race after a corticosteroid injection for a neuroma? Well, that is a great question and that is what we’re talking about today on the Doc On The Run Podcast.



I was just doing a second opinion call with a runner. He is a triathlete, and he has had a long course of trouble. We talked about a whole bunch of different things during a call to get him started getting moving in the right direction. Well, he acted on that game plan and turns out he had been misdiagnosed and so when I heard his story, and I listened to him, and we did a long call to really work through his issues, he had been misdiagnosed with a plantar plate sprain.

A plantar plate sprain is usually at the base of the second toe right in here, and you start having pain in the ball of foot and if you have a plantar plate sprain, that is a different thing than some of the other things that can cause pain in the same area. Now, I heard his whole story, and I thought, I think you have a neuroma. I do not think you have a plantar plate sprain. So, what I would do is go get it checked out and told him exactly what to do, exactly what imaging to ask for.

He went, got a study and other doctor looked at it with imaging and decided no, you do not have a plantar plate injury at all. What you have is a neuroma, you have an irritation of the nerve between the metatarsals and that is good, because you do not want to run off course, right? If you are doing a marathon, the fastest way to get to the finish line is to stay on course. If you have an injury, and you are treating a plantar plate sprain, but you actually have a neuroma, ell, it is not going to get better. It is the wrong treatment. So, this is good news.  He was frustrated. He felt like he should have been on course all the time, but whatever, water under the bridge, can’t do anything about it.

Here is what I did. I said, “Look, you got to deal with things the way they are right now.” And then he said, “Well, this is the problem. This is why I am calling you again, is that when I saw her, she said you have a neuroma so let’s go ahead and inject it with cortisone.” And he said I didn’t really think because it was kind of hurried, so I went ahead and did the cortisone injection and he said, “Now, I am having more pain now that I have had the injection and I have a triathlon coming up.” He was feeling really bad about this because he felt like he should have waited until after the race to have the neuroma injection. Now, truthfully, that would have been just fine, because he has had it for quite a while and the corticosteroid injection is unlikely to make that neuroma just go away completely in a few days, and he had a raise that weekend.

He was kind of kicking himself and he wanted to know, though, whether or not this posed a real serious risk for him. So, if you find yourself in this situation, number one, make it clear to the doctor that you have a race coming up, that before you let them do any kind of procedure, even an injection that does not seem like a big deal, make sure they understand that you are doing a race that weekend or next month or whenever it is, so that they really can frame your treatment based on what your most important running goal is, not just the conditions that they treat all the time with the procedures that they normally do for those things.

You are a runner, and you have to think about this differently and you have to expect them to treat you differently based on your goals. Alright, so back to his question. Is it dangerous or is it not dangerous to run on it? Well in his circumstance, not really. Part of it was I have figured out what exactly was injected. So, if you inject something that is water soluble, it goes away very quickly. It worries me less than if it is something that is crystal and it is going to be sitting in the tissues for longer that is going to last a whole lot longer and have more effect. It is more likely to make the neuroma calm down, but it is also more likely to weaken collagen structures in that area and cause trouble.

One of the neighboring structures right by the nerve is the plantar plate ligament and so, given what we talked about and what he figured out after he talked to the doctor’s office again, I didn’t really think it was that risky for him to run on it. In some cases, you would not want to do that. You would never in a million years want to inject your Achilles tendon with cortisone and then go run on it, that would be asking for an Achilles tendon problems. You do not want to do that.

If you had an injection in a joint, I do not think it is really that risky if it is a short acting steroid to go to a race, even a week or less maybe, than having the injection but it depends on what is injected. And so, he a had to call the doctor, find out exactly what was injected and then call me back so we can talk about it, because it does matter. It is not all the same. There are fast acting sort of short, lasting corticosteroids and there are some that last a long time and they behave differently, and your risk is different based on what was injected.

But again, the main thing is that you have got to talk to your doctor and understand what your goals are, and you have to understand that they do not get it unless you tell them so you need to make sure they understand how important that race is to you so that you can then decide whether it is really a good idea or a bad idea to do that injection before the race because obviously, if your foots aching, because you just had an injection, that is not going to make you go faster.

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