Ankle Injections

What are ankle injections?

An ankle injection is a common treatment approach for chronic ankle pain. This non-invasive approach involves administering medication such as lidocaine and cortisone to the ankle joint. Cortisone is a steroid that reduces inflammation and lidocaine is an anesthetic that relieves pain. Ankle injections are usually suggested for patients who were previously treated with physical therapy, extended rest, or NSAIDs but did not experience significant relief.

Who is a good candidate for ankle injections?

Doctors typically discuss the option of receiving an ankle injection treatment with individuals who did not experience relief from their symptoms after resting the ankles, receiving physical therapy, or taking non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen.

When are ankle injections typically recommended?

Ankle injections are usually recommended if over-the-counter pain relievers (e.g., aspirin, ibuprofen) have been ineffective at treating the ankle pain and an individual is beginning to suffer from significant mobility problems, swelling, tenderness, deformity, or cracking and popping sounds during movement. Ankle injections may also be recommended before more invasive approaches, such as surgery, are considered.

In addition to being used as a therapeutic treatment to reduce or alleviate pain, ankle injections are also used as a diagnostic tool to determine if a patient may respond well to more invasive forms of treatment, such as a nerve block. The nerve block procedure involves injecting the strong medication that temporarily prevents nerves from transmitting pain signals to the brain or destroys the nerves that are responsible for the pain. A series of successful ankle injections indicate that a nerve block would probably be effective.


Chronic ankle pain is often the result of tissue damage and inflammation that may develop due to various conditions or blunt trauma to the ankle. Conditions that may cause tissue damage, inflammation, and chronic pain in the ankles include:

How ankle injections work

An ankle injection is a non-invasive procedure that takes a few minutes to complete. The injection site is initially cleaned and then topical anesthesia is applied to the affected area. A needle is carefully inserted into the ankle and its correct placement is confirmed. Next, a corticosteroid (e.g., cortisone) and anesthesia are administered through the needle. The steroid reduces the inflammation, while the anesthesia relieves the pain. Some patients report feeling mild pain and pressure while the medication is being injected.

What to expect post-treatment

It is usually recommended that patients stay off of the affected foot for several days in order to protect the ankle. Accordingly, people who walk or stand frequently at their jobs typically have to take a few days off or find ways to avoid putting unnecessary pressure on the ankle until the pain subsides.

The use of a cold compress for 20 minutes several times throughout the day and non-steroidal anti-inflammatory medicine such as ibuprofen is often suggested for temporary pain and swelling after the injection. Dramatic pain relief usually begins one to two days after the injection for most patients, but if pain persists for more than a few days, it should be reported to a doctor.

Risks of ankle injections

Risks that are associated with ankle injections include infection, the potential puncturing of an artery or vein, a possible tendon rupture or a weakened tendon, cartilage deterioration, thinning of the bone (osteoporosis), or the death of surrounding bone (osteonecrosis). The Achilles tendon, in particular, must be avoided during the insertion of the needle.

Having a history of allergic responses to injections, autoimmune diseases that disrupt the body’s ability to fight injections, skin or blood infections, or diabetes that is poorly controlled makes individuals more susceptible to experiencing complications after the procedure.

Doctors typically avoid administering more than three to four injections during one year in order to prevent these types of complications from occurring. Patients who are taking herbal supplements or medication that thins the blood are instructed to discontinue taking them several days before the injection to minimize bleeding and bruising at the injection site.

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