Ankle Injections

What is an ankle injection?

Our ankles are comprised fairly simple joints that affect the way we move through our day. The ankle consists of the large talus bone that receives the lower legbones. A variety of tendons and ligaments stabilize the leg and the foot during movement. Nerves are wound throughout the joint as well.

When these structures hurt, ankle injections are an option to reduce pain. These injections use corticosteroids and an anesthetic to relieve ankle pain in the joint and the soft tissue surrounding it.

Ankle injections are usually recommended in the following scenarios:

• When over-the-counter pain relievers have been ineffective at treating ankle pain
• If pain causes significant mobility problems, swelling, tenderness, deformity, or cracking and popping sounds during movement
• In addition to and complementing physical therapy if treating an underlying condition
• Before more invasive surgical options are pursued

In addition to use as a therapeutic treatment for pain, ankle injections are also a diagnostic tool. Ankle injections can help identify which nerves are causing pain and how to later treat it. For example, a series of successful ankle injections indicates that a nerve block to permanently disable the nerves would probably be effective.

Ankle injection benefits

Ankle injections are typically recommended only after other conservative measures have failed. The benefits of ankle injections for those who suffer from ankle pain and inflammation can be profound.

Chronic ankle pain is often the result of tissue damage and inflammation from either chronic conditions or blunt trauma to the ankle. When rest, physical therapy, and non-steroidal anti-inflammatory drugs (NSAIDs) are ineffective, ankle injections can reduce pain and improve mobility for most patients.

Conditions that cause tissue damage, inflammation, and chronic pain in the ankles include:

• Rheumatoid arthritis
• Osteoarthritis
• Tarsal tunnel syndrome
• Bursitis
• Tendonitis
• Gout
• Synovitis

Both arthritis and tarsal tunnel syndrome share the symptoms of pain, burning, tingling, and pricking sensations. These symptoms become worse during weight-bearing activities. Arthritis is common in not only those who have had multiple ankle injuries but also in older patients. Tarsal tunnel syndrome refers to the compression of the tibial nerve in the ankle region.

Bursitis, tendonitis, gout, and synovitis are inflammatory conditions that can cause ankle pain.

How does an ankle injection procedure work?

An ankle injection is a minimally-invasive procedure that takes just a few minutes to complete. To perform the procedure, your pain specialist will clean the injection site and apply topical anesthesia. They’ll carefully insert a needle into the ankle in the appropriate placement.

Next, a corticosteroid and anesthesia are administered through the needle. The steroid reduces inflammation, while the anesthesia relieves pain. Some patients report feeling mild pain and pressure while the medication is being injected, but it is otherwise not too painful.

Ankle injections can be repeated three to four injections a year. More than that is not recommended.

Patients taking herbal supplements or medication that thins the blood should discontinue taking them several days before the injection, once approved by your doctor. This minimizes bleeding and bruising at the injection site.

Dramatic pain relief usually begins one to two days after the injection for most patients, but if pain persists for more than a few days, call your doctor.

Ankle injection risks

Ankle injections are a low-risk, minimally-invasive procedure, but there are risks to be aware of. These include:

• Infection
• Potential puncturing of an artery or vein
• Tendon rupture or a weakened tendon
• Cartilage deterioration
• Thinning of the bone (osteoporosis)
• Death of surrounding bone (osteonecrosis)

To prevent serious injury, the Achilles tendon must be avoided during the insertion of the needle. Further, working with a pain specialist with extensive experience in performing this procedure can help reduce your risk.

There are some patients for whom ankle injections are not recommended, including those with:

• Allergic responses to injections or medications used
• Autoimmune diseases
• Skin or blood infections
• Poorly-controlled diabetes

These patients may be more susceptible to complications from ankle injections. If you experience any signs of infection (e.g., fever, swelling, or pain that persists), call your doctor.

Ankle injection recovery

After receiving ankle injections, patients should stay off the affected foot for several days to protect their ankle. Patients whose jobs require lots of walking or standing typically take a few days off or find other ways to avoid putting unnecessary pressure on the ankle until the pain subsides.

After the injection, apply a cold compress to the ankle for 20 minutes several times throughout the day. This helps ease swelling at the injection site. NSAIDs can also relieve temporary pain from the injection.