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Cortisone shot for Insertional Achilles Tendinitis? (Read 2541 times)

    I was wondering if anyone here has ever had a Cortisone shot for Insertional Achilles Tendinitis. I've been doing some research and it seems it's not recommended as it may weaken the Achilles tendon. I saw an Orthopedic Surgeon yesterday and it seems that I have Insertional Achilles Tendinitis in both heels, but the right heel seems to be worse as the bone spur seems to have fractured and split in 2. While surgery is a last resort, the doctor suggested I can try a Cortisone shot. I've been reading horror stories about people having surgery and to be honest, if it gets to the point that that is the only way I can run, then I would give up running, especially since I don't have any real issues when I don't run except for some slight soreness in the mornings.
    Derek


    A Dance with Monkeys

      I have an opinion on this, but want to make sure I understand your view before I posit it. This being a message board and all, I would hate to do something alarmist and nasty, such as post an opinion that does not support your preconceived ideas. Any guidance is appreciated. Evil grin (I was being snarky in general, not at you.) BTW, Derek, long time no see! Glad you are around Big grin
        I have an opinion on this, but want to make sure I understand your view before I posit it.
        I would certainly like to know your view on it. My Orthopedic Surgeon doesn't seem to have a problem with the Cortisone shot. I mentioned it to my dad who is a GP and he didn't seem to have an issue, but it would be good to hear from a runner. Unless I get some new info, I'm planning to go ahead and get at least one shot, hoping that one wouldn't cause a problem and it would let me see if I can resume running consistently. I'm going with the (possibly wrong) assumption that one shot of cortisone wouldn't be a problem. Some of my fears are: - It weakens my Achilles tendon and causes it to break - Even if I can run, I would do more damage that may require more drastic solutions later on like surgery. Right now, I can walk and go about my life, but I can't run. I don't want to do something that endangers my day-to-day life and as much as I want to resume running, I can accept that my running days may be over and I need to find some other activity to do. I'm trying to figure if there is anything I can do to resume running without causing future issues.
        Derek


        A Dance with Monkeys

          I would take oral steroids or get a shot in the hip before I would get a shot directly into the tendon. I think your concerns are founded and the general education I received was fairly clear that soft tissue injections do very little to help and may harm. (As opposed to joint space injections, which often do help.) Systemic steroids from pills or shots in the hip are helpful and are lower risk. I do not know the latest in the literature on this, but I think it may be worth asking your ortho for some.


          A Saucy Wench

            Somewhat threadjacking question....a few years ago I was in PT for achilles stuff and they did a treatment where they applied steroid through a gel and used electric current to drive it in to the tendon. Crap I am totally losing my terminology. It was the same type of electrical PT that I had had before, but they put steroid on the pad. I know at the time they said it was something that was just being tried, not standard yet. I've never heard of it since. Anyway, I only mention it because it seemed to work so well for me and theoretically had the advantage of localized steroid but without the risks of injection scarring. It cleared up my tendonitis in one application. Has anyone else ever had this done?

            I have become Death, the destroyer of electronic gadgets

             

            "When I got too tired to run anymore I just pretended I wasnt tired and kept running anyway" - dd, age 7

              its called iontophoresis
                Somewhat threadjacking question....a few years ago I was in PT for achilles stuff and they did a treatment where they applied steroid through a gel and used electric current to drive it in to the tendon. Crap I am totally losing my terminology. It was the same type of electrical PT that I had had before, but they put steroid on the pad. I know at the time they said it was something that was just being tried, not standard yet. I've never heard of it since. Anyway, I only mention it because it seemed to work so well for me and theoretically had the advantage of localized steroid but without the risks of injection scarring. It cleared up my tendonitis in one application. Has anyone else ever had this done?
                I had it done 3 hours ago! That was the second time. I also had an ultrasound treatment. The therapist said that the swelling has gone down since Friday, so maybe the treatments + ice + stretching + rest are helping. I hope I can run again soon. I used the arc trainer at the Y while ago, but it's just not the same.


                A Dance with Monkeys

                  Yes, iontophoresis is likely much safer.
                    By no means am I pro cortisone because I do feel it can have catabolic effects and potential risks. I also think it is overused. BUT, one has to look at risk vs. reward. For me who dealt with upper hamstring tendonitis and bursitis for 8 months and tried ultrasound, iontophoresis, phonophoresis, icing, 4 weeks of Naproxen, rest, strengthening, flexibility etc. After 8 months the sports doc said, you have tried everything it is time for cortisone. I reluctantly agreed and the pain relief was immediate. I think it knocked out the bursitis and I slowly came back. The results were immediate for me. Just my opinion and I am not recommending you do or not do it.

                    Those who try, fail! Those who do what it takes to succeed, succeed!!

                      I had the shot in my knee 2 weeks before a race. the pain was cut in half did it make my knee all better no the swelling went down it takes about 48 to72 hrs to really start to work. this was my last choice I went to PT did the RICE but I was not missing my race. in the end I had surg. now I am starting to come back. From what I have read tests show that multi shots given does ruin soft tis. and ligs. I can not spell. In the end I could run my race BUT it did not heal me. good luck!
                        Thanks everyone for the advice. I decided to go ahead and get the Cortisone, but please be assured that I took everyone's advice into consideration. I also asked my Ortho about the tendon weakening it and he mentioned that the tendon ruptures are actually associated more with shots into the tendon 2-3″ above where my shot would be. I decided to go ahead with the shot under the following conditions: * I would only get ONE shot in my right heel. I may get one in my left heel in the future, but I’ll only do one shot in any given area. I’m hoping that one shouldn’t cause an issue with tendon weakness. * I’ll see how the shot works out and if I find that it doesn’t help or the pain returns, then I’ll explore other options or simply give up on running. I made the appointment and went this morning to get it. After all the build up of people telling me how it would hurt, including my Ortho who said it would sting, it was actually a very easy procedure. I felt a prick from the first needle that he used with an anesthetic, but after that initial prick, I felt very little. To be honest, I don’t know all the fuss was about with regards to the pain. My heel is a little sore right now (an hour later) and I imagine it will be this way throughout the day, but I’m really glad there was no pain and that it didn’t hurt like everyone else said it would. And believe me, if there was pain involved, I would know…..I’m a huge wuss when it comes to needles and pain!! So, now I will rest the heel for a couple days and my Ortho said I can run again on Saturday. My fingers are crossed and we’ll see how this works out…..
                        Derek


                        A Dance with Monkeys

                          Good luck and recover well!
                            Derek, good luck!! Yesterday, my PT said I could try another short run, which I did on the indoor track at the Y this afternoon. I ran for one mile and it felt fine. It was tempting to go farther, but I didn't. I stretched afterwards, and just put ice on my ankle. I hope I'm over the worst of it now.
                              Thanks everyone for the advice. I decided to go ahead and get the Cortisone, but please be assured that I took everyone's advice into consideration. I also asked my Ortho about the tendon weakening it and he mentioned that the tendon ruptures are actually associated more with shots into the tendon 2-3″ above where my shot would be. I decided to go ahead with the shot under the following conditions: * I would only get ONE shot in my right heel. I may get one in my left heel in the future, but I’ll only do one shot in any given area. I’m hoping that one shouldn’t cause an issue with tendon weakness. * I’ll see how the shot works out and if I find that it doesn’t help or the pain returns, then I’ll explore other options or simply give up on running. I made the appointment and went this morning to get it. After all the build up of people telling me how it would hurt, including my Ortho who said it would sting, it was actually a very easy procedure. I felt a prick from the first needle that he used with an anesthetic, but after that initial prick, I felt very little. To be honest, I don’t know all the fuss was about with regards to the pain. My heel is a little sore right now (an hour later) and I imagine it will be this way throughout the day, but I’m really glad there was no pain and that it didn’t hurt like everyone else said it would. And believe me, if there was pain involved, I would know…..I’m a huge wuss when it comes to needles and pain!! So, now I will rest the heel for a couple days and my Ortho said I can run again on Saturday. My fingers are crossed and we’ll see how this works out…..
                              Good luck Derek. Yes, my shots in both hammys were pretty much painless. Nothing to it. Doc told me not to run for 2 weeks because of potential risk with tendon weakness. I could cross train. I eased back into running with no issues and kept intensity low, and still do other than races.

                              Those who try, fail! Those who do what it takes to succeed, succeed!!

                                I would take oral steroids or get a shot in the hip before I would get a shot directly into the tendon. I think your concerns are founded and the general education I received was fairly clear that soft tissue injections do very little to help and may harm. (As opposed to joint space injections, which often do help.) Systemic steroids from pills or shots in the hip are helpful and are lower risk. I do not know the latest in the literature on this, but I think it may be worth asking your ortho for some.

                                 

                                Trent, digging up old post but ...

                                 

                                Exctly what does the cortisone shot do and/or why would oral steriods be better?   Should have asked earlier but had one directly into my tendon this morning.  Since not recovering as I would have liked Dr. said " well we could wait or do the shot"  i asked him of down side and he said "none .. either it works or it doesn't"  so I thought it was a no lose situation.

                                 

                                BTW ... My shot hurt like a mother for a few seconds.  Should have known when Dr. asked that I not kick him.  but he said would be normal needle prick, which started off as that and thought to myself why would anyone kick someone from a needle prick, but then dug it into the tendon and $%^#!!!!!  Dr "Oh there is a nerve right there might have hit that?"  You think.  Oh well the major sting only lasted a few seconds, hopefully it helps.

                                "It's supposed to be hard. If it wasn't hard, everyone would do it. The hard... is what makes it Great!
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