When patients hear the word "steroids", they usually think of that this drug will allow you to run faster, jump farther, and lift more.   But the truth of the matter is that there is more than one type of steroid, with each having a very different effect on the body. 

The sex hormones testosterone, progesterone and estrogen, for example, are all member of one family of steroids.   Controlling the levels of these hormones is done all the time in medicine, most frequently with the use of the birth control pill. 

Another class of steroids are the anabolic steroids.  This is the class of drugs that allows you to build muscle mass (see picture to the right) and diminish the time needed for the body to overcome physical exertion--the types of steroids some athletes use to enhance their physical performance.  Although some experiments have been done to try to increase muscle mass in patients with diseases that cause muscle wasting, this class of steroid really has little legitimate use in medicine.  The most common type of steroids used in podiatric medicine are corticosteroids.    So-called because they are produced naturally in the "cortex", or outer portion of the body's adrenal glands near the kidneys, this family of steroids have found great effect in medicine.

Corticosteroids are like prednisone, cortisone, dexamethasone and celestone, for example are "immunosuppressive" drugs, meaning they diminish the body's immune response.  In other words, they decrease inflammation.  They come  in a variety of forms--pills, injections, drops, creams--and are used regularly to treat conditions from vasculitis to poison ivy exposure to asthma.  And in podiatric medicine, corticosteroids are frequently use to treat arthritis, psoriasis, plantar fasciitis, and neuromas.  Corticosteroids can make life much more comfortable, save a patient's major organs, and even save lives.

Still, corticosteroids need to be used judiciously.  They can cause a host of adverse effects, including:

• Increased tendency towards infection

• Slower healing

• Bruising

• Skin fragility and thinning

• Weight gain

• High blood sugar (steroid-induced diabetes).  This usually disappears when the steroids are discontinued.

• High blood pressure.  This also usually improves when the steroids are discontinued.

• Osteoporosis (thinning of the bone).  This is more common when the steroids are given over long periods. 

• Cataracts

• Acne

• Hirsuitism (increased hair growth)

• Additionally, some forms of steroids, when injected into the wrong tissues, can cause weakening of tendon or irritation or even crystal-deposition arthritis of a joint. 

For all these reasons, physicians and patients must balance the tremendous benefits steroids can provide against the possible dangers associated with steroids.