Cortisone injection causing fat pad atrophy in ball of foot? - Foot Problems Message Board

sealover · 02-14-2004, 03:45 AM

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.

Lasoniamacaroni · 02-14-2004, 08:12 AM

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

sealover · 02-15-2004, 12:49 AM

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!

njneuroma · 07-28-2005, 01:54 PM

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

sealover · 07-28-2005, 04:54 PM

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!