So my first blog posts on the kind of treatments that are available comes in the form of the steroid injection. The idea here is that the injection will help reduce any swelling and hopefully will be able to decrease any pain to a more tolerable level. Note that I am not a doctor or a specialist and that everything on here is just my experience with the disease and some information from on-line resources and that you should trust what your doctor tells you. I am not responsible for what you chose to do so please don't make your choice based on what you see here and blame me.
How and why do steroid injections help a plantar fibroma / ledderhose disease?:
Steroids such as cortisone are released into the body from the adrenal gland after periods of stress. Their effect is normally short lived and can be weak due to delivery through the blood stream. The actual role of steroids in the body are not as specific as their use here but they do aid the reduction of inflammation (1). Their role in the healing process that they are trying to get with plantar fibroma's, is at least in my understanding to try and reduce inflammation that is being caused by the presence of the lump. It has also been shown that steroids added to cultured cells from Dupuytrens patients have increased levels of apoptosis, for those without a science background this is the process of programmed cell death and means that the addition of the steroids is targeting the abnormal cells and causing them to chose to die (2).
Results?:
I have tried to access research articles that cover this but have had no luck so I am restricted a bit in what I can say. For what happened with me see the end bit of this post. The only other account that I have is from someone on the Plantar Fibroma Support forum (3). She had a very difference experience to me. She found that the steroid injection made the lump worse and was not at all helpful. I guess that the usefulness of these injections comes down to the stage, size and type of lump and the only way to know it works is to try.
Side Effects:
Well as you heard from the above case of a plantar fibroma being injected with a steroid it can make it more aggressive and do nothing useful at all. I think a fairly common problem is the one that I had (see below). I was fine when I had the injection but when the local wore off I was in agony and it felt like the bottom of my foot was covered in bruises and it was really unpleasant for 24 hours or so but gradually got better. As far as I am aware there are no serious side effects. Side effects are particularly worrisome in Ledderhose as the injection can cause loss of fat cells which will mean a lack of padding in the feet and potentially increase pain (4).
My Experience:
I had a steroid injection into my Plantar Fibroma in July(ish) 2010 and it was the second form of treatment attempted by the specialists after initially sending me for physio which was a know go from the start. I am not sure how this procedure it performed elsewhere in the world but in my case it was performed with the use of ultrasound to ensure that the steroid was delivered to the correct site and it was done under a local to ensure that I was not in too much pain.
The process started with them having to find the lump under the ultrasound and this only took a minute and I was quoted as having one on the larger side. Next I was given the local to the surrounding area, this was quite painful and although it hurt it was not as bad as some of the reports I have read on-line and I guess this is because they were having the injection without the local but that is just a guess. I was then fine for the next few hours but then the pain became unbearable and I was hardly able to walk at all, this lasted about 24 hours and then gradually dissipated. I then felt an improvement in the lump as there was both a decrease in size and pain which lasted a couple of months before things returned.
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| This picture is actually from much later when I was having radiotherapy but it shows nicely the area in which the steroid injection was applied - picture added 05/06/2012. |
References:
(1) Macmillan - http://www.macmillan.org.uk/
(2) Meek et al, 2002,The effect of steroids on Dupuytren's disease: role of programmed cell death, J Hand Surg Br. 2002 Jun;27(3):270-3.accessed 21//01/2012
(3) Plantar Fibroma Support Forum - Post by peekaboo64 http://plantarfibroma.freeforums.org/injections-t9.html
(4) Dupuytren Online, Steroid Injections - http://www.dupuytren-online.info/dupuytren_steroids.html accessed 21/01/2012
Blog is posted in association with Plantar Fibroma Forum
Do you think the steroid shot was worth it? I currently just have a piece of foam with the area cut out where my Fibroma is in my work boots. I work on my feet, up and down steps and by the end of my work shift tHe Fibroma is irritated and larger, How many days do you estimate I will miss work? I thank anyone for any information they can provide me with. And, yes I must wear steel toe boots to work.
ReplyDeletePersonally having a steroid injection did delay the onset of me having to use a stick and go for more serious treatment options, there has been talk that getting it repeatedly might be best. The following link has some useful information on steroid injections:
ReplyDeletehttp://www.podiatrytoday.com/point-counterpoint-conservative-care-best-approach-plantar-fibromatosis
At the time I was mostly on my feet and I found it impossible to stand for long periods of time on the day of the injection and the next 2 days but everyone is different. I was able to walk ok but being on your feet all day in steel toe capped boots would be hard. So about 3 days off work including the day of the injection, they will likely put local on your foot so that takes the worst of the sting out of it until that stops your foot being numb.
I am not a doctor but even the specialists can't decide whether they think this is good or not, personally at the time I felt it was worth a shot and it did work (to some extent) for me and I have heard this happen for others as well but.... What I have also heard is that when the effects of this wear off ( if it works this will likely be after 6 months to a year or so) it often comes back worse but this was likely the path of the disease anyway...
It is hard say without knowing people personally and being a medical professional, as I said for me it helped and that is all I have to go on.
Best of luck and if you want more information please feel free to reply or e-mail using the address in the sidebar (p.s. would be great to know location (country))
Keep us updated
Gary
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