Can Cortisone Injections Be Used to Treat Achilles Problems?

Risk of Achilles Tendon Rupture Limits Use of Cortisone

Achilles tendon, illustration
SEBASTIAN KAULITZKI/Science Photo Library/Getty Images

Question: Can Cortisone Injections Be Used to Treat Achilles Problems?

Cortisone is a powerful anti-inflammatory medication used in the treatment of many orthopedic conditions. However, many doctors refuse to inject cortisone around the Achilles tendon. Why are cortisone injections around the Achilles tendon such a concern?

Answer: Concerns Over Cortisone Injections and Achilles Tendon Rupture

Cortisone, a drug that helps reduce inflammation, pain, and swelling for many different conditions, isn't recommended for Achilles tendonitis.

It's not that cortisone can't be used, but the risk of complications when using cortisone use around the Achilles tendon are high. Specifically, cortisone injections can lead to a rupture of the Achilles tendon.

Some Doctors Continue to Use Cortisone Injections for Achilles Problems

Some doctors believe that cortisone injections should never be given in the area around the Achilles tendon. Other doctors may argue that cortisone injections should be used carefully around the Achilles tendon. One recent survey of orthopedic surgeons found that about one-third of them have used cortisone injections in the treatment of Achilles problems.

Studies Find Tendon Rupture as Complication of Cortisone Injections

There are many reports of cortisone injections causing an Achilles tendon rupture, but this must be weighed against the possible benefits of cortisone injections. Reviews of studies have been done to look at whether these reports were significant.

A review of 25 studies of corticosteroid injections for athletic injuries found that tendon and fascial ruptures were the chief complications reported.

What is known: Cortisone injections should not be given directly into the Achilles tendon. This has been shown to weaken the tendon strength and is probably the cause of Achilles tendon ruptures.

However, in some patients, the inflammation of Achilles tendonitis is not directly inside the tendon. These are the patients who may benefit from cortisone injections.

Should You Have a Cortisone Injection for Achilles Tendonitis?

If you are thinking of getting a cortisone injection for the treatment of Achilles tendonitis, you must carefully understand the possible risk of this procedure. Specifically, you must understand the possibility of Achilles tendon rupture and the possible need for surgery in the treatment of an Achilles tendon rupture.

If you know someone who has had an Achilles rupture and surgery, you will understand why this is something you want to avoid if at all possible. The rehabilitation from surgery is very lengthy, and you would be in a cast or walking boot for several weeks, then face physical therapy to restore your ankle range of motion. It takes six months to return to full activity, and it may be over a year before you are fully recovered.

Second, cortisone injections should only be considered after a lengthy course of attempted treatment with standard Achilles treatments including anti-inflammatory medications, activity modifications, footwear changes, heel lifts, stretching and physical therapy.

If patients have tried these treatments over a long stretch of time (at least six months) then injections may be considered.

It takes patience to fully comply with this treatment, but avoiding increased risk of Achilles tendon rupture is a very wise goal.

Sources:

Gill, SS, et al. "Fluoroscopically Guided Low-Volume Peritendinous Corticosteroid Injection for Achilles Tendinopathy. A Safety Study" J. Bone Joint Surg. Am., Apr 2004; 86: 802 - 806.

Shrier I, et al. "Achilles tendinitis: are corticosteroid injections useful or harmful?" Clin J Sport Med.1996; 6:245 -50.

Nichols AW. "Complications associated with the use of corticosteroids in the treatment of athletic injuries" Clin J Sport Med. 2005 Sep;15(5):370-5.

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