Review☆Diagnostic and therapeutic injections of the foot and ankle—An overview
Section snippets
Background
Disabling conditions that can profoundly hinder patient’s life-style and activities commonly affect joints, tendons and ligaments of the foot and ankle. Joint and soft tissue injections of the affected structures represent a useful diagnostic and therapeutic tool for physicians dealing with these conditions.
A variety of foot and ankle injuries and pathologies, including degenerative joint disease, plantar fasciitis and different tendinopathies are amenable to diagnostic and therapeutic
What can be injected?
Generally, injections are composed of anesthetics, corticosteroids or both. The use of local anesthetics alone as a symptom relief test is also helpful for diagnostic purposes. The recommendation for the patient to return to their regular activities following a diagnostic or therapeutic injection can also help in the evaluation of symptoms improvement. Corticosteroid and anesthetic mixtures have the added value of providing midterm anti-inflammatory activity in addition to the analgesic effect.
Injection techniques
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Free-hand injections
Easier to be performed at the office environment.
Limited use for small joints or severe foot and ankle deformity.
Unable to confirm correct placement of the needle or the presence of inter joint communication.
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Ultrasound-guided injections
May also be performed at the office.
Allows concurrent evaluation of tendons and joints.
Accuracy of the injection is operator dependent [23].
Different studies demonstrate improved reliability and efficacy of foot and ankle injections with
Tibiotalar joint
Injections of the tibiotalar joint can be used to differentiate intra-articular and extra-articular causes of pain. It is the most common injected joint of the foot and ankle, performed by 97% of the AOFAS members [1].
Technique for anteromedial ankle joint injection (Fig. 1)
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Patient supine, ankle positioned straight, with neutral or minimal plantar flexion and slight external rotation of the hip.
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Palpate and mark down the trajectory of the anterior tibial or dorsalis pedis artery pulse to avoid
Conclusion
Foot and ankle injections are useful diagnostic and therapeutic tools, particularly when the pain etiology is uncertain.
Corticosteroid are commonly used to lengthen the therapeutic benefit, but physicians should be aware of possible side effects including a flare of symptoms, tendon/fascial rupture, skin atrophy and depigmentation.
Image guidance, such as ultrasound, fluoroscopy, and computed tomography can be useful in confirming proper needle placement.
Knowledge of the foot and ankle anatomy
Ethical approval
This article does not contain any studies with human participants or animals performed by any of the authors.
Funding
There is no funding source.
Conflict of interest
The authors declare that they have no conflict of interest related to this manuscript.
References (50)
- et al.
Platelet-rich plasma for foot and ankle pathologies: a systematic review
Foot Ankle Surg
(2014) - et al.
MR arthrography of the ankle: indications and technique
Radiol Clin N Am
(2008) - et al.
Intra-articular corticosteroid injections: a critical literature review with up-to-date findings
Foot (Edinb)
(2011) - et al.
High volume image guided injections for the management of chronic tendinopathy of the main body of the Achilles tendon
Phys Ther Sport
(2013) - et al.
The short-term effects of high volume image guided injections in resistant non-insertional Achilles tendinopathy
J Sci Med Sport
(2010) - et al.
Ultrasound-guided dry needling and high volume stripping for Achilles tendinopathy: outcomes for our cohort
Clin Radiol
(2016) - et al.
Corticosteroid injections in the treatment of foot & ankle disorders: an AOFAS survey
Foot Ankle Int
(2011) - et al.
Localization of specific joint causing hindfoot pain: value of injecting local anesthetics into individual joints during arthrography
Am J Roentgenol
(1995) - et al.
Fluoroscopically guided injections into the foot and ankle: localization of the source of pain as a guide to treatment-prospective study
Radiology
(1997) - et al.
Intraarticular foot and ankle injections to identify source of pain before arthrodesis
Am J Roentgenol
(1996)
Predictors of outcome in patients with oligoarthritis: results of a protocol of intraarticular corticosteroids to all clinically active joints
Arthr Rheum
Accuracy of Posterior Subtalar Joint Injection Without Fluoroscopy
Clin Orthop Relat Res
Variability of joint communications in the foot and ankle demonstrated by contrast-enhanced diagnostic injections
Foot Ankle Int
Efficacy of foot and ankle corticosteroid injections
Foot Ankle Int
Hyaluronic acid and other conservative treatment options for osteoarthritis of the ankle
Cochrane Database Syst Rev
Alcohol injection for Morton's Neuroma: a five-year follow-up
Foot Ankle Int
A comparison of botulinum toxin a and intralesional steroids for the treatment of plantar fasciitis: a randomized, double-blinded study
Foot Ankle Int
Platelet-rich plasma efficacy versus corticosteroid injection treatment for chronic severe plantar fasciitis
Foot Ankle Int
Quantitative assessment of the yield of osteoblastic connective tissue progenitors in bone marrow aspirate from the iliac crest, tibia, and calcaneus
J Bone Jt Surg
Platelet-rich therapies for musculoskeletal soft tissue injuries
Cochrane Database Syst Rev
Impact of local anaesthetics and needle calibres used for painless PRP injections on platelet functionality
Muscles Ligaments Tendons J
Intra-articular corticosteroids
Drugs
Intra-articular and soft tissue injections
Aust Fam Phys
Intra-articular corticosteroids in arthritic disease: a guide to treatment
BioDrugs
Incidence of plantar fascia ruptures following corticosteroid injection
Foot Ankle Spec
Cited by (0)
The research was performed at Medstar Union Memorial Hospital