Can Cortisone Shots Treat an Achilles Tendon Injury?

Studies suggest consequences may far outweigh benefits

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Cortisone is a powerful anti-inflammatory drug used in the treatment of many orthopedic conditions. When delivered by injection to the site of an injury, it can provide reduce inflammation and pain in joints of the ankle, elbow, hip, knee, shoulder, spine, or wrist. Even the smaller joints of the hands and feet can sometimes benefit.

So, it would seem reasonable to assume that a cortisone shot would be the ideal solution to treat injuries of the Achilles tendon, such as tendinitis (tendon inflammation) or bursitis (inflammation of the fluid-filled sac that cushions the heel and Achilles tendon).

But the evidence, in fact, has shown that this is not the case and that the consequences of a cortisone shot may far outweigh the benefits.

Cortisone's Effect on the Body

Cortisone shots are meant for short-term relief of pain that is persistent and severe. Depending on its use, relief can last anywhere from six weeks to six months.

The problem with long-term use is that the effects of the drug tend to wane over time as the body becomes accustomed to it. And, if a person continues to use cortisone as the sole means of relief (as opposed to undergoing physical therapy), the shots can progressively—and sometimes rapidly—cause ligaments, tendons, and cartilage to soften.

This is the main concern we have with regards to the Achilles tendon. Since this tendon needs to flex and retract whenever we walk, any softening can cause the structure to rupture, sometimes completely. It is not only serious injury but one that often requires surgery and lengthy rehabilitation.

Debating Cortisone in the Achilles Heel

While most health authorities will advise against the use of cortisone shots to treat an Achilles injury, a recent survey of orthopedic surgeons found that as many as a third will them for this purpose. As opposed to an outright ban, many of these surgeons believe that the judicious use of cortisone, injected around rather into the tendon, has its place in treatment.

Others disagree, believing that there is no clear indication of how much cortisone is "too much" or how treatment should vary based on the degree of injury. To these doctors, the use of cortisone is highly subjective and prone to error.

This belief has largely been supported by the research into the use of cortisone among athletes, a group inherently at higher risk of Achilles tendon injury. What researchers have found was that the drug often functioned more as a panacea rather than a cure.

How Cortisone Affects the Achilles Tendon

With a normal injury, inflammation is part of the healing process wherein blood vessels will expand to allow immune cells and stem cells to flood the area of damage. By doing so, new collagen will be laid down, damaged tissue will be remodeled, and the injury will be repaired

Whenever cortisone is injected, this process is stopped. By blocking inflammatory response, the process of cellular repair is also stopped. As a result, weakened tissues remain vulnerable for longer periods of time, exposing the person to repeated and often worsening injury. With an Achille tendon rupture, the damage can often be permanent.

Making the Appropriate Choice

Generally speaking, cortisone injections should be avoided to treat an Achilles injury.

There are exceptions, of course. They may be advised if all other treatment options have failed and the individual's quality of life has been significantly impaired.

In the end, cortisone shots should only be considered if a person fails to respond to the full range of standard therapies after trying for no less than six months. This includes the use of anti-inflammatory drugs, activity modification, footwear changes, heel lifts, stretching, and physical therapy.

Even then, the decision to treat should be made with caution, weighing the benefits of treatment alongside the possible side effects.

If you know someone who has had surgery to repair an Achilles rupture, you will understand why this is so important. The rehabilitation from this surgery is extensive, and you would have to be in a cast or walking boot for weeks or months, after which physical therapy would be needed to fully restore your range of motion. All told, it could take six months to return to full activity and over a year before you are fully recovered.

Sources:

Brinks, A.; Koes, B.; Volkers, C. et al. "Adverse effects of extra-articular corticosteroid injections: a systematic review." BMC Musculoskeletal Disorders. 2010; 11:206.

Kuwada, G. "Retrospective study of the incidence of plantar fascial rupture following cortisone injection." Foot and Ankle Online Journal. 2016: 9(1):9.

Madanagopal, S.; Kovaleski, J.; and Pearsall, A. "Survey of short-term oral corticosteroid administration by orthopedic physicians in college and high school athletes." Journal of Sports Science Medicine. 2009; 8(1):37-44.

Nepple, J. and Matava, M. "Soft Tissue Injections in the Athlete." Sports Health. 2009; 1(5):396-404.

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