II. Indications
- Ankle Osteoarthritis
- Other persistent and refractory ankle Arthritis
- Diagnostic aspiration
III. Contraindications
- Ankle infection contraindicates steroid injection
IV. Preparation
- Needle
- Gauge: 25 to 27 (18 to 21 if aspirating)
- Length: 1.5 inches
- Syringe: 10 ml (larger if aspirating joint)
-
Corticosteroid options
- Betamethasone (Celestone) 1 ml of 6 mg/ml
- Methylprednisolone (Solu-Medrol): 1 ml of 40 mg/ml
-
Anesthetic
- Lidocaine 1%: 3 to 5 ml or
- Bupivacaine 0.25% or 0.5%: 3 to 5 ml
V. Technique
- Images
- Patient position
- Supine with relaxed ankle
- Landmarks
- Medial aspect of talus-tibia articulation
- Palpate between anterior and posterior landmarks
- Anterior: Tibialis anterior tendon medial border
- Posterior: Medial malleolus anterior border
- Mark needle insertion site based on landmarks
- Sterilize local skin with Betadine or Hibiclens
- Insert needle at medial ankle landmark
- Direct needle posterolaterally
- Patient lies supine for several minutes after procedure
- Distribute with passive foot range of motion
VI. Follow-up Instructions
- No stress to foot for 2 weeks after injection
- Minimum time to strenuous activity: 48 hours
- Examine again in 3 weeks post-injection
VII. References
- Greene (2001) Musculoskeletal Care, AAOS, p. 429-30
- Tallia (2003) Am Fam Physician 68(7):1356-62 [PubMed]