II. Indications

  1. Ankle Osteoarthritis
  2. Other persistent and refractory ankle Arthritis
  3. Diagnostic aspiration

III. Contraindications

  1. Ankle infection contraindicates steroid injection

IV. Preparation

  1. Needle
    1. Gauge: 25 to 27 (18 to 21 if aspirating)
    2. Length: 1.5 inches
  2. Syringe: 10 ml (larger if aspirating joint)
  3. Corticosteroid options
    1. Betamethasone (Celestone) 1 ml of 6 mg/ml
    2. Methylprednisolone (Solu-Medrol): 1 ml of 40 mg/ml
  4. Anesthetic
    1. Lidocaine 1%: 3 to 5 ml or
    2. Bupivacaine 0.25% or 0.5%: 3 to 5 ml

V. Technique

  1. Images
    1. OrthoAnkleInjectAnterior.jpg
  2. Patient position
    1. Supine with relaxed ankle
  3. Landmarks
    1. Medial aspect of talus-tibia articulation
    2. Palpate between anterior and posterior landmarks
      1. Anterior: Tibialis anterior tendon medial border
      2. Posterior: Medial malleolus anterior border
  4. Mark needle insertion site based on landmarks
  5. Sterilize local skin with Betadine or Hibiclens
  6. Insert needle at medial ankle landmark
    1. Direct needle posterolaterally
  7. Patient lies supine for several minutes after procedure
    1. Distribute with passive foot range of motion

VI. Follow-up Instructions

  1. No stress to foot for 2 weeks after injection
    1. Minimum time to strenuous activity: 48 hours
  2. Examine again in 3 weeks post-injection

VII. References

  1. Greene (2001) Musculoskeletal Care, AAOS, p. 429-30
  2. Tallia (2003) Am Fam Physician 68(7):1356-62 [PubMed]

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Related Studies

Ontology: Injection of joint of ankle (C0188613)

Concepts Therapeutic or Preventive Procedure (T061)
SnomedCT 69073003, 34333007
CPT 20605
English injection of ankle joint, injection of ankle joint (treatment), injection in an ankle joint, Injection of ankle (procedure), Injection of ankle joint, Injection of ankle, Injection of joint of ankle (procedure), Injection of joint of ankle, Injection of ankle, NOS, Injection of joint of ankle, NOS
Spanish inyección en el tobillo, inyección en el tobillo (concepto no activo), inyección en la articulación del tobillo (procedimiento), inyección en la articulación del tobillo