Steroid Injection for Ankle Arthritis

Ankle osteoarthritis (OA)  is the gradual breakdown of the cartilage that cushions the bones in the ankle joint. This can lead to pain, stiffness, swelling and reduced mobility of the ankle. 

Causes

• Previous trauma. The most common cause is previous trauma to the ankle – such as fractures, dislocations or severe ankle sprains (Golightly et al, 2017). Around 40% of athletes who suffer severe ankle sprains or fractures will develop ankle osteoarthritis within 10-15 years post-injury (van Dijk et al,2019). Swan et al (2021) found that 15-25% of individuals who had experienced significant ankle trauma before the age of 30 developed osteoarthritis within 10 years. Proper management and rehabilitation can reduce the risk of developing ankle osteoarthritis (van Dijk et al,2019).
• Obesity. The ankle is a weight-bearing joint; therefore, more body weight will increase the stress and pressure through the joint (Golightly et al, 2017). Obesity has been linked to chronic, low-grade inflammation in the body which can contribute to joint degeneration (Sokolove et al, 2013).
• Age. As with all types of osteoarthritis, natural wear and tear can cause degeneration of the cartilage in the ankle (Golightly et al, 2017).
• Physically demanding occupations. Jobs which include repetitive squatting, heavy lifting or prolonged standing had a 2-3 times higher risk of developing ankle osteoarthritis compared to those in less physically demanding jobs (Thomas et al, 2019).

Symptoms of ankle joint osteoarthritis

• Pain deep in the ankle joint, usually around the front of the ankle but can extend into the foot and lower leg. Pain is usually worse with prolonged walking or standing.  The pain may become a constant ache.

• Stiffness around the ankle joint, particularly after a period of being sedentary, such as first thing in the morning or after sitting for a while.

• Swelling might be present, especially after an aggravating activity or at the end of the day. This is due to inflammation. As osteoarthritis progresses, the joint might get bigger or change shape due to bony deformity.

Anatomy

The ankle joint is a complex joint which connects the foot to the leg.

It is made up of the following:

• Tibia is the larger bone in the lower leg that supports most of the body weight.
• Fibula is the smaller bone in the lower leg that provides stability.
• Talus is the bone that sits on the heel.

The tibia and fibula sit on the talus and allow upward and downward movement of the ankle (dorsiflexion and plantarflexion).

Surrounding the tibia, fibula and talus is a protective articular cartilage which provides a smooth surface for movement. When this protective articular cartilage becomes damaged,  this leads to pain and stiffness in the joint.

How to diagnose

An XRAY would be required to confirm the diagnosis of osteoarthritis in the ankle joint. You may also need other tests to rule out other conditions. An ultrasound scan will also give us information about the health of the joint including any swelling present and osteophyte (bone spurs) formation around the bones which are suggestive of osteoarthritis. 

Treatment

• Taking regular breaks and pacing yourself. Avoiding activities which aggravate the pain.
• An independent exercise program from your physiotherapist to strengthen and improve mobility in the ankle.
• Over-the-counter pain relief can help reduce the pain. Speak to your pharmacist before taking any medication.
• If you are overweight, losing excess body weight can reduce the pressure through the ankle joint and therefore help pain. When walking the ankle takes 5 times your body weight, so losing 1kg will reduce the pressure in the ankle joint by 5kg (Brockett et al, 2016).

Ankle Osteoarthritis and Injection therapy

If the pain does not settle with physiotherapy treatment, then an injection might be appropriate.

Ultrasound-guided steroid injection

A steroid injection is where a strong anti-inflammatory medication, corticosteroid, is injected into the ankle joint. This is performed under ultrasound guidance, which has been shown to improve accuracy and enhance outcomes (Daniels et al, 2018).  Steroid injections have been found to provide immediate relief, however often symptoms do return (Vannabouathong, C et al, 2018). Multiple steroid injections are not recommended as this can lead to greater cartilage loss and further narrowing of the ankle joint (Ayub et al, 2021).

Ultrasound-guided Hyaluronic Acid Injection

Hyaluronic acid (HA) is a gel-like substance which mimics the same natural substance within our joints. It is injected into the ankle joint under ultrasound guidance and acts as a lubricant and shock absorber in the joint. This has been found to improve function and reduce pain in those with ankle osteoarthritis (Younger et al, 2019).

Surgery

In severe cases of ankle osteoarthritis which don’t respond to conservative treatment, surgery might be required.

If you are experiencing ankle pain and want to find out what is causing your symptoms, please get in touch and one of the team will assess, diagnose and advise on the best treatment option for you. Please contact us on 020 3475 5767 or email reception@oxfordcircusphysio.co.uk