Health Tip: Treating Bunion Pain

If you've got a painful, swollen bump at the base of your big toe known as a bunion, you probably want to know what can be done for relief.

The American Podiatric Medical Association offers these possible options:

• Apply a non-medicated bunion pad.
• Wear comfortable shoes with plenty of room in the toes, and a low heel.
• Apply an ice pack over the bunion when it becomes swollen, red or painful.
• Tape up the foot to help keep the toe in position.
• Take an anti-inflammatory medication to ease swelling and pain. Ask your podiatrist if you're a candidate for a cortisone injection.
• Use orthotic shoe inserts to help keep the feet in better alignment

epidural steroid injection

What is an epidural steroid injection?

An epidural steroid injection is a common procedure to treat spinal nerve irritation that is caused by tissues next to the nerve pressing against it. The beginning of the nerve (nerve root) is most often irritated by an inflamed intervertebral disc, or disc contents, directly touching the spinal nerve.

[Drawing of a disc herniation compressing the spinal nerve root]

An epidural steroid injection involves bathing an inflamed nerve root in steroids (potent anti-inflammation medicine) in order to decrease the irritation of the nerve root that is causing pain.

How is an epidural steroid injection performed?

The epidural steroid injection procedure is quick and simple. While it is common for people to be concerned prior to the procedure, it is actually frequent to hear from patients afterwards: "Is that all?"

The spinal cord rests in the spinal canal. The nerve roots branch out from the spinal cord at each level of a spinal vertebra (the bony building blocks of the spine). The cord is protected by cerebrospinal fluid (CSF), which serves as a shock absorber for the cord. The CSF is held in place by a membrane with several layers, one of which is called the dura, from the Greek for tough (think of "durable"). The Greek word "epi" means "outside of." So, the epidural space is outside of this tough membrane. During an epidural steroid injection, a needle and syringe are used to enter the epidural space and deposit small amounts of long-lasting steroids around the inflamed spinal nerve. A fluoroscope (a viewing instrument using X-rays) is used to visualize the local anatomy during the injection. The epidural steroid injection specifically targets the inflamed area and treats it with a maximal amount of steroids, thereby minimizing exposure of the rest of the body to the steroids.

[Epidural steroid injection with injection needle visible in the epidural space using a fluoroscope)

When are epidural steroid injections used?

Epidural steroid injections are most commonly used in situations of radicular pain, which is a radiating pain that is transmitted away from the spine by an irritated spinal nerve. Irritation of a spinal nerve in the low back (lumbar radiculopathy) causes pain that goes down the leg. Epidural injections are also used to treat nerve compression in the neck (cervical spine), referred to as cervical radiculopathy.