Cortisone Injections for Foot Pain: What to Know Before Your Shot

You've been dealing with foot pain for weeks or months. You've tried rest, ice, new shoes and maybe some stretches. Now your doctor suggests a cortisone injection. You've heard it eases pain. You've also heard it "just masks the pain" or "wears off after a few months." So what's the real story?

Cortisone injections can help the right problem at the right time. They're also easy to misunderstand. Here's what the research shows, and how we decide.

What Cortisone Actually Does

Cortisone is a corticosteroid, a strong medicine that calms inflammation. An injection puts it right where the inflammation is. A pill, by contrast, sends medicine through your whole body.

The injection usually has a numbing medicine mixed in, called a local anesthetic. That part works right away and wears off within hours. The cortisone itself takes a few days to start working.

How long relief lasts varies with the problem and the person. For heel pain, a Cochrane review found the benefit was small and lasted up to about a month, then faded (David and colleagues, 2017).

When Cortisone Injections Help

Cortisone is used for foot and ankle problems that involve inflammation. Common examples are plantar fasciitis, Morton's neuroma, bursitis, an inflamed joint lining (capsulitis) and some arthritis flares. The research is mixed, but it helps set expectations.

• Heel pain. A steroid injection may ease heel pain slightly for up to about a month, compared with a placebo or no treatment (David and colleagues, 2017). Another review found cortisone beat some other treatments in the short term, but not a placebo injection (Whittaker and colleagues, 2019).
• Morton's neuroma. In a randomized trial, steroid injections improved foot pain and function for at least three months, compared with numbing medicine alone (Thomson and colleagues, 2013). Read more about Morton's neuroma symptoms and treatment.
• Big toe arthritis. An injection helped most in the early stages. In advanced arthritis it gave little relief (Solan and colleagues, 2001). Read more about a stiff big toe (hallux rigidus).

An injection can ease pain for a while. Many people use that window to keep up with stretching, better shoes or other care aimed at the cause of the pain.

When They're Not the Best Choice

Cortisone has limits. It calms inflammation, but it doesn't repair tissue. In a large review of tendon problems, cortisone injections eased pain in the short term. For some tendons, though, that benefit reversed over the following months (Coombes and colleagues, 2010).

It also has risks. Cortisone has been linked with rupture of the plantar fascia, the thick band along the bottom of the foot. In one clinic's records, most of the plantar fascia ruptures it saw had followed cortisone injections (Acevedo and Beskin, 1998). After a rupture, the original heel pain often eased, but many people developed new foot problems (Acevedo and Beskin, 1998). Tendon rupture after an injection near a tendon has also been reported, though it is rare (Brinks and colleagues, 2010).

Other reported side effects include thinning or lightening of the skin at the injection site. The fat pad under the foot can also thin (Brinks and colleagues, 2010). In the heel pain trials, serious problems were rare (David and colleagues, 2017). Still, the Cochrane authors note they may be under-reported.

Cortisone is also less useful when pain comes from the shape of the foot. A bunion pressing on a shoe won't shrink because of an injection. Neither will a hammertoe rubbing on the top of a shoe.

If you have diabetes, a steroid injection can raise your blood sugar. A review of joint injections found blood sugar went up after the injection, sometimes a lot, often within the first few days (Choudhry and colleagues, 2016). Check your sugar more often afterward, and call your doctor if it runs high.

How Many Cortisone Shots Can You Get?

There isn't a set yearly number that's right for everyone. At our office, each injection is decided on its own, based on clinical need. Before any repeat injection, Dr. Patish re-examines your foot. He looks at how well the last injection worked and whether another one still makes sense.

He also goes over other options with you. These may include stretching, footwear changes, custom orthotics, a night splint, shockwave therapy or platelet-rich plasma (PRP). For heel pain that lasts, some trials found PRP or dry needling did better than cortisone over the longer term (Whittaker and colleagues, 2019). The evidence is still limited.

If pain keeps coming back after an injection, that's a sign to look again at the diagnosis and the plan. Repeating the same injection isn't the only answer.

What the Injection Feels Like

It depends on where the injection goes. Most people feel pressure and a quick sting. Injections into the heel or the ball of the foot can be more uncomfortable, but the discomfort passes quickly. The numbing medicine in the injection starts working right away.

If needles make you nervous, tell us. We'll walk you through each step before we start.

What to Expect After

The injection site may be sore for a short time. Ice and acetaminophen usually help. Some people have a flare, where the area hurts more for a short while before it gets better (Brinks and colleagues, 2010).

Call us if you notice redness that spreads, warmth, swelling that gets worse, pus or a fever. Infection after an injection is rare, but it needs care right away.

An injection is one part of a plan, not the whole plan. Stretching, footwear changes and other treatment still matter, especially if the problem has been building for a while.

The Bottom Line

Cortisone can be a useful option for the right problem. It won't fix everything, and it isn't something to fear. If foot pain from inflammation hasn't improved with home care, a cortisone injection may help. It can ease the pain for a while as part of a wider plan.

We'll talk through the pros, the cons and the other options before we decide together. Request an appointment or call (760) 728-4800.