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Injection under Ultrasound Guidance

The use of ultrasound guided injection techniques has revolutionised our ability to treat our patient’s foot problems. There is a wide variety of conditions that is suitable to this approach including:

  • Painful joints, such as hallux rigidus or metatarsalgia secondary to hallux valgus
  • Plantar fasciitis
  • Painful nerve conditions, such as Morton’s neuroma
  • Painful bursitis, often associated with other deformity
  • Painful trigger points such as nerve pain following an ankle sprain
  • Painful tendinitis
  • Painful post-operative scars

The most common injection is that of steroid (cortisone) which is a very powerful anti-inflammatory medicine. We would use this to break the cycle of pain and inflammation that we often see in the foot as it is very difficult to rest an injured area completely. Steroids can also work by reducing the bulk of soft tissue in a damaged structure and we often undertake high volume injections to supplement this. Fortunately complications are rare particularly when the post procedure advice is followed diligently, but do include:

  • Infection of the injection site; which is fortunately very rare but would require prompt antibiotic treatment.
  • Steroid flare; where the area becomes very sore for up to a week. This is more common in joint injections, particularly if they are not guided, and may occur in up to 10% of injections. This will settle with extra rest and ice to the area, the good news is that it does not affect the outcome of the injection.
  • Worsening of symptoms due to tissue trauma from the injection itself, is less of a problem with guided injections

Patients often ask if it is it safe to have several steroid injections. The answer is that when used appropriately steroids are very safe. The fundamental rule is that repeated injections at short intervals are to be avoided in the foot. It is perfectly safe however to undergo injections at intervals of six months or more to treat a particular problem, as long as that problem is responding appropriately to the intervention.

There are basic rules to follow after a foot injection in order to get the very best result.

We advise our patients to plan 48 hours of rest following the injection. This will have two effects, firstly the area will be a little bruised and will need time to settle, secondly if you walk on the foot too much you are likely to move the steroid away from the target site.

We advise that our patients do not drive immediately following injections as, usually, a local anaesthetic is involved which will void any driving insurance whilst the foot is numb.

Once the area has settled following the injection you can start to resume activities although it is best to do these on a gradual basis. This is particularly so if the work involves a lot of standing or heavy lifting or perhaps you play a lot of sport.

A small plaster will be placed over the injection site and should be left in place overnight. It is likely that the foot will feel bruised for a day or two and taking the above measures will minimise its effects.

If you do have any concerns before or after your injection by all means contact us for specific advice.