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Old 02-14-2004, 02:45 AM   #1
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Red face Cortisone injection causing fat pad atrophy in ball of foot?

Following an injection of cortisone on the top of my foot in the first intermetatarsal space, I started noticing the fat pad in the ball of my foot, located directly below the injection site, starting to atrophy and become reddened. As the weeks go on, the fat pad atrophy is continuing. I have lost some of the padding in the ball of my foot beneith my 1st and 2nd toes, yet the rest of the ball of my foot is normal and fully padded.

I am really worried about this atrophy, and today I noticed a new spot of atrophy on the ball of my foot beneith the big toe. I can feel the structures of my foot in the area of atrophy between the 1st and 2nd toes. I am not in any pain yet, but sometimes the area feels uncomfortable.

If this is caused by the cortisone injection, my podiatrist never mentioned any side effects whatsoever...he didn't ask me if I wanted an injection, rather he told me he was giving it to me and I didn't know at that time that such side effects existed. So I would NEVER have allowed a shot to be given if I was told that it could cause fat pad atrophy.

For the people here who have had 1 or more cortisone injections in your foot, have you experienced fat pad atrophy?

Do you think my podiatrist is at fault in this situation?

Thanks for your comments.

 
Old 02-14-2004, 07:12 AM   #2
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Re: Cortisone injection causing fat pad atrophy in ball of foot?

Hi Sealover!
I have had one cortisone shot in my left foot and 2 in my right foot. I am going to get my third next week. I have not had any side effects from these injections personally. I have heard that when the injection is given too low in the foot that this may cause soft tissue damage, but my podiatrist has been careful not to go too far down. What does your doc say about this? I can't help but think that this would be a temporary situation. I am going to look up some info on the internet and will post any info I find. I am sorry to hear about your concerns and hope you feel better.

-sonia

 
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Old 02-14-2004, 11:49 PM   #3
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Re: Cortisone injection causing fat pad atrophy in ball of foot?

Hi Lasoniamacaroni,

Thank you so much for searching for info for me! I really appreciate it.

I haven't gone back to the podiatrist who gave me that injection, but I will have to call him and tell him what is happening to my foot. However, I recently went to a University podiatrist who noticed the atrophy, and he said that there is nothing I can have done to replace the fat in the ball of my foot. I'm praying every day that the atrophy stops. It would be great if the fat came back, like yours did. But I noticed another spot of atrophy today and I am starting to have more discomfort because of the lack of padding. I will look into purchasing padding to cushion the ball of my foot. I'm still very worried about the atrophy, because we all need sufficient padding in the balls of our feet.

I happened to find an article by Lisa J. Allen, DPT, on a website that recommends the use of iontophoresis with dexamethasone sodium phosphate (dex) as a substitute for steroid injections. She says that "injecting steroid is known to cause soft tissue atrophy." She also states that "We commonly warn our patients against injection of a steroid because it can cause local tissue damage and atrophy to the tendons, ligaments, or fat pads present. This can lead to tendon or fascial rupture (Achilles, plantar fasciitis) or insufficient fat pad cushioning in places like the ball of the foot (neuroma). Based on animal research, this is not a problem with delivering steroids via iontophoresis."

My new podiatrist said not to get any more injections due to the side effects as mentioned above. I happen to be getting iontophoresis treatments (where the atrophied area is) now from my physical therapist, but I don't know yet what medication she's using. I did notice a reduction in pain the day after my 1st treatment with iontophoresis, and I could finally walk without limping.

You are fortunate that you haven't had any side effects from your injections. And I'm happy to hear your fat pad atrophy went away.

Best wishes to you!

 
Old 07-28-2005, 12:54 PM   #4
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Re: Cortisone injection causing fat pad atrophy in ball of foot?

I am also getting iontophoresis for a morton's neuroma and it is working better that the one cortisone shot I received that worsened my condition significantly. I get a 24 hour pad on my foot that distributes the medicine (dexamethasone) like a cortisone med...and it transmits thru the skin to the foot ....My toe is very numb and tingly but not very painful

 
Old 07-28-2005, 03:54 PM   #5
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Re: Cortisone injection causing fat pad atrophy in ball of foot?

njneuroma,

I'm sorry to learn that a cortisone shot worsened your condition. I'm not surprised, though, because the 2 cortisone shots I received caused permanent fat pad atrophy on the bottom of my foot. My aunt's friend just received a cortisone injection in the ankle area, and now her ankle feels so much worse. I didn't know that Dexamethasone is a steroid med when I received iontophoresis. But cortisone shots are more likely to cause fat pad atrophy than receiving dexamethasone via iontophoresis, and this basically only applies to the bottom of the foot where there is a fat pad.

Hope your morton's neuroma gets better soon!

 
Old 07-29-2005, 07:08 PM   #6
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Re: Cortisone injection causing fat pad atrophy in ball of foot?

Sealover, I also read the article that indicates ionto is better than injections and I left the pod that injected me for a new pod who said the newest and best way to treat a neuroma is the medrol dose pack combined with ionto which attacks the neuroma without the negative potential side effects of the shot. Wish all the pods took their CEU credits and kept up with the latest treatments. Anyway I am not sure yet how many ionto treatments are "OK" before the foot gets too much steroid as I have finished my 10th ionto pad and await advice from my new pod. At a certain point when we stop the ionto I think before any other intervention I might try accupuncture although on the accupuncture site they don't mention whether it has proved beneficial for a neuroma...Hope you neuroma shrinks also and that your foot's fat pad plumps up soon to where it was!

 
Old 08-02-2005, 03:24 AM   #7
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Re: Cortisone injection causing fat pad atrophy in ball of foot?

njneuroma,

It's great that you are looking into different types of treatments for your neuroma. Please leave surgery as your absolute last option. I'm not sure that accupuncture can help shrink a neuroma...I don't think it can...but I think this treatment can help relieve pain temporarily. I've never had accupuncture, so I don't know how much pain this treatment can relieve.

That podiatrist who gave me cortisone injections is from the "old school." I've been to other podiatrists who said that they would NEVER had injected my foot with cortisone.

I don't have a neuroma that I'm aware of, but I was told that the podiatrist who injected me may have hit some nerves with the needles, so I have nerve damage (of the small nerve fibers, I think). I get burning sensations from time to time in the ball of my foot.

Thank you for wishing that my fat pad plumps up. I hate to tell you the bad news, but the damage from the cortisone shots is permanent and nothing can be done to fill in the fat pad.

Anyway, I hope iontophoresis works wonders for your neuroma! Take good care of that foot.

 
Old 06-03-2008, 04:04 PM   #8
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Re: Cortisone injection causing fat pad atrophy in ball of foot?

Hello,

I am in the same situation that you may all be in, just a different part of the body. I had a volleyball injury on my inner left knee and was later diagnosed with bursitus. Anyway, I was given a cortizone injection into my left knee and had about 2 months of physical therapy receiving iontopherisis with what I believe to be a type of liquid cortisone placed on the pads. I completed my physical therapy in October and over the next serveral months, my knee started to atrophy, which caused my knee to sink in and lose pigmentation in that area.

Do you think that I received the physical therapy iontophersis too long of a time period?

My family and I are getting no answers and just was wondering what any of you have heard about your situations.

Thanks!

 
Old 06-04-2008, 08:16 PM   #9
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Re: Cortisone injection causing fat pad atrophy in ball of foot?

Melissa,

A steroid that is injected can definitely cause atrophy of soft tissues (fat) and muscle. I'm not sure how much the iontophoresis contributed to the atrophy in your knee or how far the steroid in the pad can travel through skin and fat. It's possible that the steriod in iontophoresis can cause thinning of skin (even topically applied steroid medications can cause thinning of skin), but I don't know anything about the process of iontophoresis to help you. I tend to think that the injected steriod is your biggest culprit, however, something else may be contributing to the atrophy in your knee such as nerve damage. It's best to have an open-minded doctor give your knee a thorough examination. Bear in mind that doctors who inject patients with steroids in their practice tend to dismiss the fact that steroids (cortisone) can cause atrophy, that's why I mentioned finding an open-minded doctor.

By the way, is the atrophy causing you any pain? Do you know the name of the steroid that was injected? Kenalog was injected into my foot, and that steroid has a bad reputation of causing atrophy of fat and muscle. I tell people to stay away from cortisone injections.

Last edited by sealover; 06-04-2008 at 08:23 PM.

 
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