If you’ve been dealing with persistent foot pain that hasn’t responded to stretching, icing, and over-the-counter remedies, your podiatrist may recommend a cortisone injection. It’s one of the most common procedures we perform at Balance Foot & Ankle, and for good reason — when used appropriately, cortisone shots can provide dramatic, rapid pain relief. But they’re also surrounded by myths and misunderstandings. Here’s what you actually need to know before deciding.

What Is a Cortisone Shot?

A cortisone shot is an injection of a corticosteroid medication — a powerful anti-inflammatory — directly into the inflamed tissue. Unlike oral anti-inflammatories (ibuprofen, naproxen) that circulate through your entire body, a cortisone injection delivers a concentrated dose precisely where the inflammation is occurring. This means faster, stronger relief with fewer systemic side effects.

The injection typically contains a corticosteroid (such as dexamethasone, betamethasone, or triamcinolone) mixed with a local anesthetic (lidocaine or bupivacaine). The anesthetic provides immediate pain relief within minutes, while the corticosteroid takes 2–7 days to reach its full anti-inflammatory effect. The relief typically lasts weeks to months, depending on the condition being treated and the specific corticosteroid used.

Foot Conditions That Benefit from Cortisone

Plantar fasciitis: Cortisone injections provide significant short-term relief for plantar fasciitis, especially in acute, severe cases where patients can barely walk. A 2024 meta-analysis showed cortisone injections are superior to placebo at 1 month but equivalent by 3–6 months. We use them strategically to break the pain cycle while other treatments (stretching, orthotics) take effect.

Morton’s neuroma: Injections around a Morton’s neuroma reduce nerve inflammation and swelling, providing relief for 60–70% of patients. Series of 2–3 injections spaced 4–6 weeks apart, combined with metatarsal pads and wider shoes, can avoid the need for surgery in many cases.

Arthritis (big toe, midfoot, ankle): Joint injections for osteoarthritis or inflammatory arthritis reduce swelling, improve range of motion, and decrease pain for weeks to months. Particularly effective for hallux rigidus (big toe arthritis) and midfoot arthritis where joint space narrowing concentrates friction and inflammation.

Bursitis: Injections into inflamed bursae (retrocalcaneal, intermetatarsal) can resolve symptoms rapidly. Bursitis often responds to a single injection when combined with activity modification and appropriate footwear changes.

Capsulitis: Inflammation of the toe joint capsule — particularly second toe capsulitis — can benefit from a targeted cortisone injection to reduce inflammation while taping and orthotic therapy address the underlying biomechanical cause.

Tarsal tunnel syndrome: Injections along the tibial nerve pathway can reduce inflammation and swelling that’s compressing the nerve, providing diagnostic and therapeutic benefit.

What to Expect During the Injection

The entire procedure takes about 5 minutes. Your podiatrist will clean the injection site, then use a thin needle (typically 25–27 gauge) to deliver the medication. Many patients expect cortisone shots to be extremely painful, but most describe it as a brief sting or pressure lasting 5–10 seconds — comparable to a blood draw. We may use ethyl chloride spray or a topical numbing agent to minimize discomfort.

For deeper structures or when precision is critical, we use ultrasound guidance to visualize the needle in real time and ensure the medication reaches the exact target. Ultrasound-guided injections have been shown to be more accurate and effective than landmark-based injections for conditions like Morton’s neuroma and plantar fasciitis.

After the injection, you may experience numbness from the local anesthetic for 2–4 hours. A temporary “cortisone flare” (increased pain for 24–48 hours) occurs in about 5–10% of patients as the corticosteroid crystals initially irritate the tissue. Ice and over-the-counter pain relievers manage this easily. Most patients feel significant improvement within 3–7 days.

How Effective Are Cortisone Shots?

Effectiveness varies by condition. For plantar fasciitis, studies show 70–80% of patients experience significant pain relief within the first 2 weeks, with effects lasting 4–12 weeks on average. For Morton’s neuroma, approximately 60–70% of patients report meaningful improvement. For arthritis, relief duration depends on the severity of joint damage — early arthritis may see months of relief, while advanced arthritis provides shorter benefit.

The critical point is that cortisone injections are most effective when used as part of a comprehensive treatment plan. A 2025 randomized controlled trial in Foot & Ankle International found that patients who received cortisone injections PLUS stretching, orthotics, and footwear changes had significantly better 12-month outcomes than those who received injections alone. The injection breaks the pain cycle, creating a window of reduced pain during which other treatments can take effect.

Risks & Side Effects

A single cortisone injection is very safe. However, understanding the potential risks helps you make an informed decision.

• Cortisone flare: Temporary pain increase for 24–48 hours (5–10% of patients) — managed with ice and NSAIDs
• Fat pad atrophy: Repeated heel injections can thin the heel fat pad, reducing natural cushioning. This is the main reason we limit heel injections.
• Plantar fascia rupture: A known risk with repeated injections into the plantar fascia attachment. Rupture occurs in approximately 2–6% of patients receiving multiple injections. A single injection carries very low rupture risk.
• Skin depigmentation: The injection site may develop a lighter-colored area, particularly in darker skin tones. This is usually temporary but can persist.
• Tendon weakening: Injections near tendons (especially the Achilles) can weaken the tendon structure. We avoid injecting directly into or near tendons.
• Blood sugar elevation: Diabetic patients may experience a temporary blood sugar spike for 1–3 days after injection. We advise close glucose monitoring during this period.
• Infection: Extremely rare with sterile technique (less than 1 in 10,000 injections)

How Many Shots Can You Get?

There’s no universal rule, but most podiatrists follow evidence-based guidelines: no more than 3 cortisone injections in the same location per year, with a minimum of 6–8 weeks between injections. For the plantar fascia specifically, many providers limit it to 1–2 injections total due to the rupture risk. For joints (arthritis), injections can be repeated every 3–4 months if beneficial, though long-term repeated use may accelerate cartilage degradation.

If you need more than 2–3 injections for the same condition, it’s a sign that the underlying cause isn’t being adequately addressed. At that point, we reassess the treatment plan and consider alternative approaches — physical therapy, orthotics, shockwave therapy, or potentially surgery.

Alternatives to Cortisone Injections

Platelet-rich plasma (PRP): PRP injections use your own concentrated platelets to promote tissue healing rather than suppressing inflammation. Emerging evidence suggests PRP may provide longer-lasting relief for plantar fasciitis compared to cortisone, though it takes longer to work (4–6 weeks vs. 3–7 days). PRP is typically not covered by insurance.

Extracorporeal shockwave therapy (ESWT): A non-invasive treatment that delivers acoustic waves to stimulate healing in chronic conditions. Evidence supports its use for chronic plantar fasciitis and insertional Achilles tendinopathy. We offer this in our offices as an alternative to repeated injections.

Alcohol sclerosing injections: For Morton’s neuroma, a series of dilute alcohol injections (4% ethanol) can shrink the neuroma tissue. Studies show 60–80% success rates over a series of 4–7 injections spaced 1–2 weeks apart, without the tissue-thinning risks of corticosteroids.

Hyaluronic acid injections: For joint arthritis, hyaluronic acid (viscosupplementation) provides joint lubrication and may have anti-inflammatory properties. It offers a lower-risk alternative to repeated cortisone injections for patients with ongoing joint pain.

Frequently Asked Questions

Does a cortisone shot in the foot hurt?

Most patients rate the discomfort as 3–4 out of 10 — a brief sting lasting 5–10 seconds. The bottom of the heel can be more sensitive than other locations. We use topical numbing spray and fine-gauge needles to minimize pain. The local anesthetic in the injection provides immediate numbness after the initial sting. Most patients say it was much less painful than they expected.

How long does a cortisone shot last in the foot?

Duration varies by condition and individual. For plantar fasciitis, relief typically lasts 4–12 weeks. For Morton’s neuroma, 4–8 weeks. For arthritis, 8–16 weeks. Some patients experience longer relief, especially when the injection is combined with other treatments (stretching, orthotics, footwear changes) that address the root cause.

Can I walk after a cortisone shot in my foot?

Yes — you can walk immediately after a cortisone injection. The foot may feel numb for 2–4 hours from the local anesthetic, so take care on stairs and uneven surfaces. We recommend taking it easy for 24–48 hours (avoid running, prolonged standing, or intense exercise), but normal walking is fine. If you experience a cortisone flare (temporary pain increase), rest and ice for 24–48 hours.

Are cortisone shots safe for diabetics?

Cortisone injections can temporarily raise blood sugar levels for 1–3 days. For well-controlled diabetics, this is usually manageable with close glucose monitoring and temporary insulin adjustments. We always discuss this with diabetic patients before injecting and may recommend coordination with their endocrinologist or primary care provider for patients on insulin pumps or with poorly controlled diabetes.

The Bottom Line

Cortisone injections are a safe, effective tool for managing foot pain — when used appropriately. They provide rapid relief that creates a treatment window for addressing the underlying cause with stretching, orthotics, and footwear changes. A single injection carries minimal risk. The key is using cortisone as part of a comprehensive plan, not as a standalone “fix.” Our podiatrists at Balance Foot & Ankle use ultrasound guidance for precision, discuss all risks and alternatives, and always pair injections with a long-term strategy to resolve the underlying condition.