Corticosteroid Injection – Foot & Ankle

What is a corticosteroid injection?

Corticosteroids are powerful anti-inflammatory medicines.

At The Podiatry Clinic, we commonly use methylprednisolone acetate (Depo-Medrone) for corticosteroid injections.

A local anaesthetic is also commonly used where appropriate.

The medication is injected directly into or around the structure being treated, allowing treatment to be concentrated at the affected area rather than relying on medication taken by mouth.

Why has a corticosteroid injection been recommended?

A corticosteroid injection may be considered when pain or inflammation is interfering with activity and has not improved sufficiently with other appropriate treatment.

Depending on your diagnosis, injections may be considered for selected:

• painful or inflamed joints
• osteoarthritis where inflammation is contributing to symptoms
• bursae
• tendon sheaths
• plantar fascia-related pain
• areas of localised inflammation; and
• other foot and ankle conditions where corticosteroid injection is clinically appropriate.

Not every painful foot or ankle condition is suitable for a steroid injection.

Your podiatrist will have considered your diagnosis, examination findings, medical history, previous treatment and the structure being treated before recommending an injection.

How does a corticosteroid injection work?

Corticosteroids reduce inflammatory activity within the treated area.

Reducing inflammation may help to:

• reduce pain
• improve movement
• make walking and everyday activities more comfortable
• improve tolerance of rehabilitation; and
• provide a period in which the underlying problem can be managed more effectively.

An injection does not necessarily remove the underlying cause of the condition.

For this reason, where appropriate, treatment may also include rehabilitation, footwear modification, orthotics, activity management or other measures designed to address factors contributing to your symptoms.

Why do we use ultrasound guidance?

At The Podiatry Clinic, ultrasound guidance is normally used for foot and ankle injections.

Ultrasound allows your podiatrist to visualise the relevant structures beneath the skin and guide the needle towards the intended treatment area.

Depending on the condition, ultrasound may also help assess the joint or soft tissues before treatment.

The injection is therefore planned according to your individual anatomy and the structure being treated.

What happens during the procedure?

Before proceeding, your podiatrist will confirm the treatment area, review relevant medical information and discuss the procedure with you.

You will have an opportunity to ask questions before giving your consent.

The skin is cleaned using an appropriate antiseptic solution.

Ultrasound is normally used to identify the treatment area and guide the procedure.

A sterile needle is then carefully introduced and the medication administered into or around the intended structure.

Depending on your treatment, the injection may contain:

• corticosteroid medication, commonly Depo-Medrone; and
• local anaesthetic, where appropriate.

A small dressing may be applied afterwards.

The injection itself normally takes only a short time, although your appointment allows time for assessment, preparation and appropriate aftercare advice.

What does the injection feel like?

You will feel the needle entering the skin and may experience pressure, stinging or temporary discomfort as the medication is administered.

Local anaesthetic is commonly used to make the procedure more comfortable where appropriate.

Most patients tolerate the procedure well.

You should tell your podiatrist if you experience significant discomfort during the injection.

What results can I expect?

Corticosteroid injections are an established treatment for selected inflammatory and painful musculoskeletal conditions.

Many patients experience a useful reduction in pain following treatment, which may improve movement and make rehabilitation or everyday activity easier.

The amount and duration of improvement varies between individuals and depends on:

• the condition being treated
• the structure being injected
• the severity and duration of the problem
• the degree of inflammation present
• your individual response; and
• how the underlying condition is managed afterwards.

Some patients experience substantial improvement, while others experience a smaller or shorter-lasting response.

Occasionally an injection provides little or no benefit.

The aim is therefore to provide a meaningful improvement in symptoms and function, rather than promise a permanent cure.

When will the injection start working?

If local anaesthetic has been used, you may notice temporary improvement relatively quickly.

This effect may wear off after several hours.

The corticosteroid itself normally takes longer to have an effect. Improvement may begin over the following few days, although the timing varies between patients.

It is possible for discomfort to temporarily increase before the steroid begins to take effect.

What is a post-injection flare?

Some patients experience a temporary increase in pain following a corticosteroid injection.

This is known as a post-injection flare.

The area may feel more painful or sensitive for a short period following treatment before settling.

This does not necessarily mean that the injection has been unsuccessful.

Your podiatrist will advise you about appropriate pain relief if required.

What should I do after the injection?

You will normally be able to walk following your appointment.

We generally recommend taking things relatively easy for the remainder of the day and avoiding unnecessary strenuous or high-impact activity immediately following the injection.

Your podiatrist will provide advice appropriate to the structure that has been treated.

If local anaesthetic has been used, the area may temporarily feel less painful. Avoid using this temporary reduction in pain as a reason to significantly increase activity.

You can normally return gradually to your usual activities according to the advice provided by your podiatrist.

Injection treatment works best as part of a treatment plan

Reducing pain and inflammation can provide an opportunity to address the factors contributing to your condition.

Depending on your diagnosis, your treatment plan may also include:

• progressive rehabilitation
• strengthening and mobility exercises
• activity or load modification
• footwear advice
• taping or bracing
• orthotics
• gait or pressure analysis; and
• other treatments where appropriate.

If you have been given a rehabilitation programme, continue this according to the instructions provided by your podiatrist.

What are the potential benefits?

Potential benefits of corticosteroid injection include:

• targeted treatment directly to the affected area
• reduction in pain and inflammation
• improved comfort when walking or exercising
• improved joint or soft-tissue function
• relatively quick procedure
• little downtime for most patients
• potential to improve participation in rehabilitation; and
• a non-surgical treatment option for selected conditions.

What are the possible side effects and risks?

Corticosteroid injections are commonly performed and serious complications are uncommon when patients are appropriately assessed and the procedure is performed using suitable clinical precautions.

However, all injections carry potential risks.

More common temporary effects

These may include:

• discomfort during the injection
• soreness afterwards
• temporary post-injection pain flare
• mild bruising
• temporary swelling; and
• temporary numbness or altered sensation if local anaesthetic is used.

Less common risks

These can include:

• infection
• bleeding or more significant bruising
• skin thinning or a small depression in the tissue around the injection site
• loss or change of skin pigmentation around the injection site
• temporary facial flushing
• temporary changes in blood glucose levels, particularly in people with diabetes
• temporary changes in blood pressure or other systemic steroid effects
• allergic reaction to the medication or local anaesthetic
• nerve irritation or injury
• weakening or injury of nearby soft tissue; and
• tendon weakening or rupture.

Some risks depend considerably on where the injection is being performed.

Your podiatrist will therefore discuss any additional risks that are particularly relevant to your condition or injection site.

Corticosteroid and tendons

Corticosteroid requires particular care around tendons because steroid exposure may weaken tendon tissue.

Where injections are considered around a tendon or tendon sheath, your podiatrist will assess the anatomy carefully and select the injection site accordingly.

Corticosteroid is not injected directly into the Achilles tendon.

Your podiatrist may recommend temporary activity restrictions following treatment where tendon or surrounding soft tissue is involved.

Diabetes and corticosteroid injections

Corticosteroid injections can temporarily increase blood glucose levels.

If you have diabetes, please make sure your podiatrist is aware before treatment.

You may be advised to monitor your blood glucose more closely following the injection according to your usual diabetes management plan.

If your diabetes is poorly controlled or your glucose levels are unusually high, treatment may need to be postponed or discussed further.

Blood-thinning medication

If you take anticoagulant or antiplatelet medication, including medication prescribed to reduce the risk of blood clots, please tell your podiatrist before treatment.

This does not automatically mean that you cannot have an injection, but the medication and potential bleeding risk need to be considered before proceeding.

Do not stop prescribed blood-thinning medication unless specifically advised to do so by the healthcare professional responsible for prescribing or managing it.

Is a corticosteroid injection suitable for everyone?

Corticosteroid injection is not appropriate for every patient or every condition.

Your podiatrist will consider factors including:

• your diagnosis
• the structure being treated
• active infection or recent illness
• allergies
• diabetes
• anticoagulant or antiplatelet medication
• pregnancy or breastfeeding
• previous steroid injections
• recent vaccination where relevant
• previous surgery
• skin problems around the proposed injection site
• your medications and medical history; and
• other factors that may affect the safety or effectiveness of treatment.

Please tell your podiatrist about any significant change in your health or medication before your injection.

Can corticosteroid injections be repeated?

Sometimes a further injection may be considered if symptoms return or if there was a useful response to previous treatment.

However, corticosteroid injections are not intended to be repeated indefinitely.

Repeated injections into the same area can increase the risk of local tissue effects and may not be appropriate for every condition.

Your podiatrist will consider your previous response, the structure being treated, the time since your previous injection and other treatment options before recommending another injection.

What are the alternatives?

Your alternatives depend on your diagnosis.

These may include:

• rehabilitation and progressive loading
• activity modification
• footwear changes
• taping or bracing
• orthotics
• medication
• focused or radial shockwave therapy
• Class IV laser therapy
• other injection treatments where clinically appropriate
• further imaging
• specialist referral
• surgery for selected conditions; or
• choosing not to have the injection and continuing with conservative treatment.

Your podiatrist can explain which alternatives are relevant to your particular condition.

How much does a corticosteroid injection cost?

Corticosteroid Injection – Foot & Ankle: £295

This includes the injection procedure and ultrasound guidance where clinically appropriate.

If you attend specifically for an injection consultation but an injection is not performed, the consultation fee is £150.

Your podiatrist will discuss the recommended treatment with you before proceeding.

When should I contact the clinic?

Some soreness or a temporary flare following injection can be normal.

Please contact the clinic if you develop:

• pain that becomes severe or continues to increase
• significant swelling
• increasing redness or warmth around the injection site
• discharge from the injection site
• persistent numbness or weakness
• a significant unexpected change in function; or
• anything else that concerns you following treatment.

Seek urgent medical advice

Although infection following an injection is uncommon, it requires prompt assessment.

Seek urgent medical advice if you develop severe or increasing pain associated with marked swelling, redness or heat, particularly if you also feel unwell or develop a fever.

Seek emergency medical assistance if you develop symptoms of a serious allergic reaction, such as difficulty breathing or significant swelling of the face, lips, tongue or throat.

Your next step

If you have already booked your injection

Please attend your appointment as arranged.

Make sure we are aware of your current medication, allergies and any significant changes in your medical history.

If you have developed an infection, started antibiotics, become pregnant, had another recent procedure or there has been another important change in your health, please tell us before treatment.

Your podiatrist will review the procedure with you and answer any questions before you provide consent.

If corticosteroid injection has been recommended but you have not yet booked

You can book your Corticosteroid Injection – Foot & Ankle appointment when you are ready to proceed.

£295

Important information

This information sheet supports the discussion you have had with your podiatrist and is intended to help you make an informed decision about treatment. It does not replace individual clinical advice.

Corticosteroid injection is an established treatment that can provide useful relief from pain and inflammation in appropriately selected foot and ankle conditions.

The response and duration of improvement vary between individuals and improvement cannot be guaranteed.

An injection may reduce symptoms but does not necessarily remove the underlying cause of the condition. Where appropriate, rehabilitation and management of contributing factors therefore remain an important part of your treatment plan.

Before treatment, your podiatrist will confirm that the injection remains appropriate, discuss the relevant benefits, risks and alternatives with you, and provide an opportunity for you to ask questions before giving your consent.

The Podiatry Clinic