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Injections for the foot and ankle – a quick guide

Although not the most common, there are a number of joint or soft tissue conditions around the foot and ankle that can be resistant to other forms of treatment. Injections for the foot and ankle are sometime required to achieve the best recovery. Here’s our quick guide.

Like the wrist and hand, the anatomy of the foot and ankle is complex (but endlessly fascinating if you are a physiotherapist!).

Foot & ankle joint injections

Arthritis in the foot and ankle

There are many joints that make up the articulation of the foot and the whilst weight-bearing joints further up the leg (hip and knee) succumb to osteoarthritis commonly, surprisingly the ankle and foot manage to bypass this problem. Arthritis in the foot and ankle can be triggered by ankle injury or fracture and over time start to cause pain and stiffness. Like any weight-bearing joint though, when pain starts it can lead to considerable disability

The main joints that can be affected with osteoarthritis (OA) are

  • ankle joint
  • sub-talar joint
  • mid-tarsal joint
  • big toe joint.

Where there is inflammation caused by OA, cortisone injection is a very effective treatment option. In some cases of OA hyaluronic acid can prove an effective alternative to cortisone.


Foot and ankle soft tissue injections

There are many tendons that wrap around the ankle joint to produce movement of the foot and toes. Injury to tendons or the surrounding tissues can be debilitating.

Tenosynovitis

As tendons pass around the ankle, they are contained by thin sheaths that stop them from ‘bowstringing’ during movement. In order to prevent friction developing, the tendons pass through delicate sheaths  at this point and these can become irritated and inflamed causing a tenosynovitis. The Peroneal tendons, as they pass around the outside of the ankle, are vulnerable to developing Peroneal tenosynovitis most commonly in the active population (e.g. distance and fell runners). Another tendon, Tibialis Posterior is found on the inside of the ankle and as an important stabiliser of the ankle and foot can also be affected with overuse stresses creating tenosynovitis of the Tibialis Posterior. Both of these injuries respond very well to injection and are best done under ultrasound guidance for accurate delivery.

Bursitis

Where the Achilles tendon inserts on the back of the heel bone is another area that is prone to injury. The most likely source of the pain is the Achilles tendon and this is almost always best managed with physiotherapy and exercise management. Deep to the tendon is a small synovial structure called the Retrocalcaneal bursa. In normal conditions, you wouldn’t know it was there but overuse caused by distance hiking or unaccustomed running for example can cause this to become inflamed and very painful. It is characterised by local tenderness, swelling around the back of the heel and pain when walking up a gradient. Retrocalcaneal bursitis responds well to cortisone injection and should be delivered under ultrasound guidance for maximum accuracy.


Plantar fasciitis

Plantar fasciiitis or plantar fasciopathy is an extremely common condition which affects a wide range of people. It is quite common in the active adult population but also in the sedentary population particularly if obesity is present. There are many things that physiotherapy can offer these patients including shockwave therapy which is the ‘gold standard’ treatment for this condition in the first instance. In rare cases, an injection of cortisone is needed but all other avenues should be explored first.



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