Ultrasound-guided corticosteroid injections can be safely done for tibialis tendinopathy
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QUEBEC CITY — Results showed ultrasound-guided corticosteroid injections into the tibial tendon sheath were a safe nonoperative treatment for patients with posterior tibialis tendinopathy, with the best pain relief in obese patients.
“[The posterior tibial tendon] is a strong inverter and plantar flexor of the foot. With degeneration and dysfunction of this tendon, foot malalignment can occur; along with gait dysfunction, and obviously, it leads to some pain as well,” Mark Spencer, MD, said in his presentation at the American Orthopaedic Foot & Ankle Society Annual Meeting. “Steroid injections around the foot and ankle have previously been cautiously approached due to the risk of ruptures, especially in the Achilles tendon.”
Spencer and colleagues at the University of Connecticut retrospectively reviewed data on 33 patients who received 38 ultrasound-guided corticosteroid injections (CSIs) for posterior tibial tendon dysfunction, insufficiency or ankle pain between 2015 and 2020. Injections were administered into the posterior tibial tendon sheath (PTTS). According to the abstract, two patients received three injections; one patient received two injections; and 30 patients received one injection. Outcome measures included overall complication rate, duration of pain relief, amount of pain relief, need for repeat injections and progression to surgery.
Overall, no complications were reported after any injection. Researchers found 47% of patients (n = 18) had “good” or “better” pain relief from their injection, while 21% (n = 7) progressed to surgery. Spencer also noted obese patients (with a BMI 30 kg/m2) had more sustained pain relief compared with non-obese patients.
“In conclusion, we had no adverse events or complications related to ultrasound-guided CSIs into the PTTS,” Spencer said. “We believe CSIs can be safely performed under ultrasound guidance.”
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Spencer M, et al. Clinical outcomes of posterior tibial tendon sheath ultrasound-guided corticosteroid injections. Presented at: American Orthopaedic Foot & Ankle Society Annual Meeting; Sept. 14-17, 2022; Quebec City (hybrid meeting).
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