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Cortisone Injections

Cortisone is a synthetic form of cortisol, a steroid hormone produced by the adrenal glands. We use cortisone injections to reduce pain and inflammation. They are performed when conservative treatments of musculoskeletal conditions have not been successful. These injections are only performed when the podiatrist has reviewed diagnostic ultrasound imaging performed by a radiologist. The podiatrist can refer for imaging to a radiologist if necessary.

Our cortisone injections are performed under guided ultrasound so we can view and locate the structures of interest as well as accurately deposit the cortisone in the targeted location.

We use a range of corticosteroids such as:

  • Betamethasone (Celestone Chrondose)
  • Methylprednisolone (Depo-Medrol)
  • Triamcinolone (Kenacort)

The corticosteroid selected is based on the anatomical location, size of the structure and the patient’s history of cortisone injections. A local anaesthetic is mixed with the selected corticosteroid prior to injection to reduce discomfort and pain.

Conditions we Treat with Cortisone Injections

  • Achilles’ tendinopathy
  • Bursitis
  • Capsulitis
  • Ganglion cysts
  • Morton’s Neuroma
  • Osteoarthritis
  • Plantar Fasciitis
  • Rheumatoid Arthritis
  • Sesamoiditis
  • Sinus Tarsi Syndrome
  • Synovitis
  • Tarsal tunnel syndrome

Common Adverse Effects

  • An increase in blood glucose levels for up to 48 hours
  • Bruising
  • Sleep disturbance and flushing
  • Injection site periarticular calcifications (usually asymptomatic)
  • Temporary worsening of musculoskeletal symptoms within 48 hours before they improve
  • Skin hypopigmentation
  • Tissue atrophy

COVID-19 Vaccine

Currently there is no evidence to suggest that a steroid injection to a joint or soft tissue before or after the administration of a COVID-19 vaccine reduces the efficacy of the vaccine. However, following the administration of a single injection of cortisone there is a hypothalamic-pituitary-adrenal suppression of adrenocorticotropic hormone (ACTH) and cortisol for up to 4 weeks which is the same timeline of the reported peak efficacy of vaccines.

Our podiatrists have considered the timing of a cortisone injection such that it will be administered no less than two weeks prior to a COVID-19 vaccine dose and no less than one week following a COVID-19 vaccine dose.

How Long does the Injection Work?

Once administered, a cortisone injection begins to work in 3-4 hours, although there are times when it may take five days to a few weeks for the full effect to be felt. Timing of relief varies depending on the severity of the inflammation or how long it has been present. Symptom relief can be maintained for a minimum of four weeks. Depending on the condition, a person may need more than one injection.

How Many Injections Can be Given?

We perform a maximum of four injections per site in one year.

Persons with the Following Conditions Cannot Receive an Injection

  • Structures that are torn cannot be injected i.e plantar fasciae tear, ruptured Achilles’ tendon
  • Infection of the skin at the injection site
  • Systemic infection
  • Infection of the joint or soft tissue of interest
  • Injection into a joint that is to be replaced in less than 3 months
  • COVID-19 vaccine dose must be administered a minimum of 2 weeks prior to a cortisone injection or a minimum of one week following a COVID-19 vaccine dose
  • Cushing Syndrome
  • Renal impairment
  • Hypertension
  • Myasthenia gravis
  • Peptic ulcer disease
  • Glaucoma

After Care

  • We recommend having a responsible adult drive you home after the injection
  • Blood sugar levels may increase temporarily. If you are a diabetic, we recommend monitoring blood sugar levels for 7 days post injection.
  • Reduce weightbearing and rest for 24 to 48 hours post-injection. Avoid strenuous activity during this time frame.
  • Elevate and ice area to reduce swelling and discomfort.

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