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Can Cortisone Injections Be Used to Treat Achilles Problems?

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Updated March 24, 2013

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: 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 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 have used cortisone injections in the treatment of Achilles problems.

There are many reports of cortisone injections causing an Achilles tendon rupture, but this must be weighed against the possible benefits of cortisone injections.

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?

Patients undergoing a cortisone injection for the treatment of Achilles tendonitis must carefully understand the possible risk of this procedure. Specifically, they must understand the possibility of Achilles tendon rupture and the possible need for surgery in the treatment of an Achilles tendon rupture.

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 6 months) then injections may be considered.

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.

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