Cortisone shots in the foot and ankle: what to expect

Your heel or ankle has hurt for weeks, and someone mentions a cortisone shot. A steroid injection can calm a painful flare, but it’s a short-term tool with real limits.

What a cortisone shot is

“Cortisone shot” is the everyday name for a steroid injection. The medicine is a corticosteroid such as triamcinolone or methylprednisolone, usually combined with a local anesthetic such as lidocaine or bupivacaine.^[1] The steroid calms inflammation, but it takes a few days to kick in. The numbing medicine is added for faster relief.^[1]

Very little of the steroid escapes a joint after an injection, so the whole-body side effects of steroid pills, such as weight gain and bone loss, are rare.^[1]

What it’s used for in the foot and ankle

• Arthritis. Steroid shots can ease arthritis pain in joints including the ankle.^[1] See arthritis.
• Bursitis, an irritated, fluid-filled cushion near a joint.^[1]
• Ankle impingement, where soft tissue gets pinched in the ankle joint. In one clinic series, injections worked particularly well for this.^[2]
• Plantar fasciitis, a frequent use,^[6] when heel pain hasn’t settled with stretching, shoes and inserts. See heel pain.
• Morton’s neuroma, a thickened nerve between the toes. In randomized trials, adding a steroid to numbing medicine may have made little to no difference to pain, though ultrasound-guided injections probably did better than unguided ones.^[7] Our Lower Extremity Nerve Institute (external site) covers neuromas in depth.

What the evidence shows for heel pain

A 2019 review of 47 trials found that, in the first six weeks, steroid injections eased heel pain more than foot orthoses or an injection of the person’s own blood. But they weren’t more effective than a placebo injection, and no difference held up once the least reliable trials were left out. From three months to a year, they did worse than dry needling and platelet-rich plasma (PRP).^[6]

In pooled studies, PRP relieved pain better than steroid from three months up to a year, though most studies were at high risk of bias.^[8] Shockwave therapy eased pain more than steroid injections at three and six months.^[9] Compare PRP injections and shockwave therapy.

What happens at the visit

First we make sure of the diagnosis, with an exam and, when needed, X-ray or ultrasound at the practice. The skin is cleaned carefully, because sterile technique keeps the small risk of infection low.^[1] Ultrasound guidance can lower the chance of missing the right spot.^[1]

How soon it works, and how long it lasts

• Right away, the numbing medicine may ease the pain.
• Soon after, some people have a “flare”: pain that gets worse for one to two days before the steroid takes effect.^[1]
• After a few days, the steroid starts working, and relief can last several weeks.^[1]

In one clinic’s review of 365 people who had a foot or ankle steroid injection, 86% reported a significant improvement. When pain came back, it most often returned at around three months.^[2]

Risks to know about

Serious problems are uncommon, but they’re real.^[3,2]

• Skin and fat pad changes. Thinning or lightening of the skin, and thinning of the fat pad on the sole, have been reported, including after neuroma injections.^[3,7]
• Plantar fascia rupture. In one surgeon’s series of 765 people with plantar fasciitis, 51 had a torn plantar fascia, and 44 of those tears were associated with a steroid injection. Many then developed new problems, such as arch and midfoot strain, that were hard to resolve.^[4]
• Tendon rupture. Steroid shots should generally not be used for tendinitis, especially in the Achilles, because they can raise the chance of a rupture.^[1,3]
• Infection. The risk is very small, but a joint infection can be serious and needs prompt care.^[1]
• Higher blood sugar if you have diabetes. In a small review of joint injections in people with diabetes, blood sugar rose in every study, often within one to three days, and sometimes the peak took several days. The authors advise checking your blood sugar regularly for up to a week afterward.^[5]

Common questions

How often can you have one?

There’s no formal limit, but doctors often set a practical limit of three to four shots a year.^[1] Repeated shots can become less effective. Steroid can also harm the cartilage cells in a joint and speed up arthritis, and more injections may raise the risk of infection and tendon tears.^[1] If you need shots often, it’s time to look again at the cause and the other options.

Will a cortisone shot fix the problem?

It calms the pain, but it doesn’t treat the underlying cause.^[1] That’s why we use it alongside treatment aimed at the cause, such as stretching, supportive shoes and inserts, not instead of it.

Does the shot hurt?

You’ll feel the needle and some pressure for a moment.

When to see a podiatrist