Procedure

Ankle Joint Injection

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Ankle Joint Injection, Ankle Injection, Ankle Intra-articular injection, Tibiotalar Joint Injection

  • See Also
  1. Ankle Anatomy
  2. Joint Injection
  3. Injectable Corticosteroid
  4. Regional Anesthesia of the Anterior Ankle
  5. Regional Anesthesia of the Posterior Ankle
  • Indications
  1. Ankle Osteoarthritis
  2. Other persistent and refractory ankle Arthritis
  3. Diagnostic aspiration (e.g. Acute Monoarthritis)
  • Contraindications
  1. Active ankle infection contraindicates Corticosteroid Injection
  • Preparation
  1. Needle
    1. Gauge: 22 to 27 (18 to 21 gauge 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
    3. Triamcinolone (Kenalog) 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
    3. Ropivacaine 0.5% 5 ml
  • 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. Ultrasound guidance (optional)
    1. High frequency linear probe
    2. Position probe over the dorsal foot in long axis to foot (longitudinal plane)
      1. Translate probe to a position medial to the anterior tibialis tendon
      2. Midline indicator lies over the Ankle Joint space
    3. Insert needle out-of-plane from medial to lateral directed toward the joint line
  5. Mark needle insertion site based on landmarks
  6. Sterilize local skin with Betadine or Hibiclens
  7. Insert needle at medial ankle landmark
    1. Direct needle posterolaterally
  8. Patient lies supine for several minutes after procedure
    1. Distribute with passive foot range of motion
  • Complications
  1. Neurovascular injection (lateral ankle)
  2. Talar dome injury
    1. Avoid a steep angle on needle insertion
  • 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
  • References
  1. Greene (2001) Musculoskeletal Care, AAOS, p. 429-30
  2. Tallia (2003) Am Fam Physician 68(7):1356-62 [PubMed]
  3. Wilcox (2026) Am Fam Physician 113(5): 431-9 [PubMed]