From the Research
Ankle joint steroid/lidocaine injections should be performed using a sterile technique with a combination of a corticosteroid (such as methylprednisolone 40mg or triamcinolone 40mg) and lidocaine 1% (2-3ml), as this approach has been shown to be effective in reducing inflammation and pain in patients with ankle osteoarthritis and other conditions 1.
Key Considerations
- The anterior approach is most commonly used, with the patient's foot in slight plantarflexion to open the joint space.
- The injection site is typically 2-3cm distal to the medial malleolus, between the tibialis anterior and extensor hallucis longus tendons.
- After cleaning with antiseptic solution, insert a 22-25 gauge needle perpendicular to the skin until reaching the joint space, aspirate to ensure no blood return, then slowly inject the medication mixture.
Indications and Contraindications
- These injections are indicated for inflammatory arthritis, osteoarthritis, and synovitis, providing relief by reducing inflammation through inhibition of inflammatory mediators and interrupting pain signals.
- Contraindications include active infection, significant coagulopathy, and previous allergic reactions to the medications.
Potential Complications
- Adverse events, such as postinjection flare, skin reaction, and plantar plate ruptures, can occur, but are relatively rare 2.
- Limit injections to 3-4 per year in the same joint to prevent cartilage damage, tendon weakening, and other complications.
Recent Evidence
- A 2021 study found that platelet-rich plasma injections did not significantly improve ankle symptoms and function in patients with ankle osteoarthritis compared to placebo injections 3.
- Another study published in 2017 found that intra-articular triamcinolone injections resulted in significantly greater cartilage volume loss compared to saline injections in patients with knee osteoarthritis, highlighting the potential risks of corticosteroid injections 4.