Steroid Injections

Information

Locally injected steroids can be useful in the treatment of inflamed joints and inflammation of soft tissue. They do this by potently suppressing the inflammation and shrinking the swollen tissue particularly in the short term. They are called local because they act only in the injected area. Injecting a joint is called 'intra-articular' injection while injection close to a joint is called 'peri-articular'. There are two types of steroid (soluble and insoluble), The podiatrist will select the most suitable for your particular condition.

Common conditions treated include:-

• inflammation of soft tissue
• Ligament (including plantar fasciitis)
• Nerve irritation (including neuro/tarsal tunnel syndrome)
• Tendon (tenosynovitis)
• Soft tissue lumps and bumps (including ganglions/bursitis)
• Scar pain/sensitivity
• Joint pain
• Localised joint inflammation (synovitis)
• Arthritis (including osteo/rheumatoid/gout/pseudogout)

The podiatrist may include a local anaesthetic to make the injection more comfortable, but nevertheless it may still be painful at the time and may give rise to pain after the local anaesthetic has worn off, up to 48 hours after the injection.

Frequency of injections

The recommended advice is a course of 3 injections at no less than four weekly intervals and at an interval of at least 6 months between course of injections.

Post injection advice

It is advisable to rest the joint or affected part for two to three days after injection. Try not to undertake any of the previous movements or activities that you know irritates the problem. After this, a slow return to normal activity is recommended.

Side effects

Side effects are very unlikely but regular and frequent injections may result in the increased likelihood of undesirable effects occurring.

Possible effects of steroid injections

1. Pain

   Despite the use of local anaesthetic it is possible to experience pain and inflammation, or a steroid flare, at the injection site. It may be necessary to take oral painkillers such as ibuprofen and or/ paracetamol during this period, and also use ice packs on the affected area. Symptoms should begin to settle after 48 hours or so.

2. Facial Flushing

   Sometimes patients can experience flushing, or redness, of the face and neck and usually in the absence of any other symptoms. Should this happen the flushing can be reduced with a simple anti-histamine tablet, and will usually disappear within 48 hours or so.

3. Infection

   As an aspect technique is used, this is a rare complication. The development of pain increasing in severity 48 hours after injection may indicate an infection and medical or podiatric advice should be sought.

4. Tendon/Plantar fascia/ Joint Ligament Rupture

   Repeated injections into the same area may result in rupture of tissue, which could lead to instability, foot deformity or even chronic disability.

5. Localised thinning of the fat layer of the skin (lipodystrophy)

   This can occur when the steroid is injected into the fat layer of the skin and can result in dimpling and reduced shock absorption, particularly if injected into the hell or bell of the foot.

6. Loss of skin pigment

   Discoloured of the skin may occur at the site of injection.

7. Local joint numbness

   A rare side effect is a painless destruction of the joint, particularly following repeated injections into the joint. This may or may not be accompanied with a deviated and deformity of the toe, joint or foot.

8. Diabetes

   Occasionally localised steroid injections can result in fluctuations of blood sugar levels for approximately 48 hours.

9. Hypersensitivity, or allergic reaction to the steroid or local anaesthetic
10. Bruising or haematoma

Occasionally, there may be some local bleeding into the tissues, though this would be more likely in someone taking aspirin or other anticoagulant drug. Patients taking warfarin may have their anti-coagulation reduced for a short period prior to injection to reduced this risk.

Any severe reactions should be reported back to the podiatrist straight away. Minor reactions need to be reported back at the next visit so that a decision can be made as to whether a course of injections should be continued or not.