The foot and ankle is a complex region with a multitude of possible pathologies that can cause pain and dysfunction. Fortunately, many foot and ankle conditions respond well to injection therapy and physiotherapy. Below is a list of commonly injected foot and ankle conditions. Please click on the links to know more;
Frequently asked questions on foot and ankle pain
When would an ultrasound injection help my foot and ankle pain?
Many patients suffering from foot and ankle pain can be effectively treated with relative rest or activity modification and physiotherapy. If your pain is not improving and these more conservative treatments have not been effective then an ultrasound guided injection can be considered.
If your symptoms reflect one or more of the below factors then an injection maybe the next most effective treatment option:
- Significant levels of pain which is getting worse despite rest
- Significant pain that has lasted over 6 weeks
- Pain that stops you from completing activities of daily living such as walking or going up and down the stairs
- Pain that stops you working, exercising or participating in activities that you enjoy
To make an appointment or to talk to one of our clinical experts contact Complete 020 7482 3875 or email injections@complete-physio.co.uk.
Before we carry out an injection, we always ensure we know exactly where your pain is coming from. An effective injection requires an accurate diagnosis. To diagnose foot and ankle pathology quickly and accurately requires both a clinical assessment and diagnostic imaging. If you have already had a diagnosis from your GP or consultant then please ensure you bring your consultation letters and correspondence.
At Complete as part of your appointment (no extra cost) we always carry out a diagnostic ultrasound scan. Ultrasound is an excellent imaging technique for assessing the foot and ankle and is capable of using ‘real time’ imaging to assess the surrounding muscles, ligaments, tendons and joints.
Complete clinicians are all experienced physiotherapists as well as musculoskeletal sonographers and are well placed to provide an accurate diagnosis. If an injection is required our team is able to undertake an injection and give you appropriate rehabilitation advice all in the same appointment.
What injection options are available for foot and ankle pain?
Choosing the right injection option is important and is dependent on your diagnosis. There are three injection options available for treating foot and ankle pain, all of which work differently to achieve the common goal of relieving pain and increasing function.
The three injection options for treating foot and ankle pain are:
Platelet rich plasma injections
Our clinical experts will discuss your treatment options with you, allowing you to make a fully informed decision. If you would like to discuss these options before making a booking feel free to call 020 7482 3875 or email info@complete-physio.co.uk and one of our expert clinicians will get in touch.
Why should injections be ultrasound guided?
Ultrasound guided injections are the gold standard. At Complete all our experts use ultrasound to guide their injections. An ultrasound guided injection is a highly accurate, effective and safe treatment technique. The procedure uses a diagnostic ultrasound machine to visualise and monitor a needle as it delivers the medication directly to the source of the pain.
The ‘real time’ feedback ensures that delicate structures nearby are avoided such as blood vessels, tendons and nerves). This ensures any pain related to the procedure is kept to a minimum.
Ultrasound guided injections are less painful than non-guided (also known as blind or landmark guided) injections. This is because local delicate structures can be seen and avoided and thinner and shorter needles can be used to deliver the medication. Furthermore, the most direct route can be quickly and easily chosen and targeted.
Are foot and ankle injections painful?
Many people come to an injection appointment with a preconceived expectation that it will be a painful experience and therefore feel anxious and afraid. The reality is often a pleasant surprise. Pain is a subjective experience and injections are tolerated differently between individuals. Although some discomfort is unavoidable when undertaking an injection, they are, on the whole, well received with many patients reporting it to be no worse than a flu jab or blood test.
There is a 1 in 4 chance of experiencing a short lived flare up of symptoms following an injection. This is a normal reaction and if you experience a post injection flare there is no need to worry. This is normal and will soon pass.
Injections can be made more comfortable by using a short acting local anaesthetic at the time of the procedure. To ensure the best experience possible all injections at Complete are guided and accompanied by a local anaesthetic.
How long do the effects of an injection last?
The effectiveness of an injection is dependent on many factors including; obtaining an accurate diagnosis, how long you have your symptoms, the severity of your condition and if you have other coexisting medical conditions.
A steroid (also known as a corticosteroid) is a powerful anti-inflammatory medication which has the potential to quickly and effectively relieve pain. Steroid stays active in your system for about 3-4 before being removed via your kidneys; however, the effects do last much longer. In most situations a minimum of 3 months of pain relief is expected following a single injection. This period is enough for you to engage in a course of physiotherapy to address your underlying condition. In most cases, we recommend that to gain maximum effects of the injection, physiotherapy should commence about two weeks after an injection. Not all injections require physiotherapy, your clinician will provide clear advice on what you need to do after your injection depending on your specific diagnosis.
How many injections am I allowed to have? Is there a limit?
The vast majority of patients only require one injection.
However, there are times when one injection is not enough to resolve your pain. For example, degenerative conditions such as osteoarthritis often require a long-term management plan and will often require a repeat injection.
Guidelines set by the Arthritis Research Council (ARC) suggest no more than three injections in one area in a one-year period.
Platelet rich plasma (PRP) injections for osteoarthritis or tendon pain may require a course of 2 or 3 injections to resolve.
After your assessment at Complete your clinician will be able to discuss with you what to expect and will help you design a post injection management plan.
Do injections just mask pain?
Injections do not just mask pain. Each injection option is designed to play a specific role in reducing your pain.
Steroid injections
A steroid is a potent anti-inflammatory which is designed to reduce the inflammation associated with an injury, Steroid is capable of fast effective pain relief and the return of lost function.
Hyaluronic acid injections
Hyaluronic acid is a synthetic replica of your joint’s natural lubricant. Its job role is to provide lubrication and shock absorption, protecting the cartilage layer inside a joint.
Platelet rich plasma injections (PRP) – PRP
injections provide a damaged tendon or joint with a boost of regenerative chemicals stimulating the healing process.
How quickly do injections work?
The speed of an injection to take effect varies considerably between individuals and what injection is carried out.
Steroid injections are very fast acting with the effects being felt between the first few days up to two weeks. Hyaluronic acid injections take longer to work, often taking between two to 5 weeks to take effect. PRP injections often require two or three injections to work and can take two to 6 weeks to 3 months. As a general rule the longer they take to work the longer the duration of the pain relief.
How much does an ultrasound guided injection cost?
Ultrasound guided injection prices vary depending on exactly what procedure is carried out. At Complete we provide a one-stop clinic for foot and ankle complaints. One appointment includes a clinical assessment, a diagnostic ultrasound scan, an ultrasound guided injection and a full clinical report/letter of our findings and procedures.
Single guided injection charges start at £250 for a steroid injection, £350 for a hyaluronic acid injection and £450 for a PRP injection.
If you would like to talk to one of our team or to book an appointment, contact us on 020 7482 3875 or email injections@complete-physio.co.uk.
What foot and ankle conditions can be injected?
Injections for Osteoarthritis of the ankle
Osteoarthritis of the ankle joint is a degenerative condition driven by ‘wear and tear’ of the articular cartilage. The articular cartilage lines the joint surfaces and provides protection to the joint and a friction free surface for movement to occur.
The ankle joint is an important weight bearing joint and is placed under considerable pressure throughout life and so is susceptible to developing osteoarthritis. Osteoarthritis commonly affects people from the 6th decade onwards and is associated with pain, stiffness and loss of function.
Signs and symptoms of osteoarthritis of the ankle includes:
- A deep dull ache felt within the ankle
- A sensation of stiffness in the ankle
- Pain and stiffness which is worse first thing in the morning or after exercise
- The ankle my look thicker or swollen
Osteoarthritis of the ankle requires a long-term management plan including physiotherapy, stretching and strengthening. In many cases these conservative measures are enough to keep symptoms under control however, when conservative treatment fails then a steroid injection can be used to reduce pain and return function, allowing you to continue with your rehab program.
Hyaluronic acid and PRP injections should also be considered to provide more long-term pain relief for osteoarthritis. Your clinician will discuss these options with you at the time of your appointment.
injections for 1st metatarsophalangeal joint (big toe) osteoarthritis
The large joint at the base of the big toe is placed under considerable stress and strain, especially when walking, hiking, running and playing sports. It is therefore a common site for osteoarthritis to occur.
Osteoarthritis is a progressive, degenerative condition which affects the articular cartilage within a joint. The articular cartilage provides the joint with a friction free surface to move on, protecting the joint from damage. Over time and with prolonged periods of stress the cartilage can become thin and eventually worn resulting in 1st metaphalangeal joint (MTP) osteoarthritis.
The signs and symptoms of 1st metatarsophalangeal (MTP) joint osteoarthritis includes:
- A deep dull ache felt at the base of the big toe
- Stiffness and pain felt within the big toe especially when walking or exercising
- Stiffness is often worse first thing in the morning
- Intermittent flare ups of swelling and pain
- Thickening of the big toe joint
It is vitally important to maintain flexibility and strength within the big toe using both an exercise program and physiotherapy. This is often enough to control symptoms however, if suffering from a flare up of symptoms which don’t settle with physiotherapy, then an injection can be used to return function. A podiatrist may also help to alleviate symptoms by providing bespoke orthotics.
Hyaluronic acid and PRP injections are a potential option and can provide a long-term pain relief than a steroid injection. At the time of your appointment these options will be discussed with you once a full assessment has been carried out.
injections for Chronic ankle sprains
The foot and ankle is a complex area consisting of many joints all of which are stabilised by ligaments. The ligaments surrounding the outer (or lateral) aspect of the ankle joint are commonly injured while twisting or rolling the ankle. The lateral ankle ligaments can become strained or even torn after a fall, causing the ankle to become unstable.
Ankle ligament injuries require a period of physiotherapy and rehabilitation to return function and stability. Over half of the patients suffering an ankle ligament injury go on to report long term pain and instability. This is what is known as a chronic ankle sprain. If this is the case, an injection can be performed to control symptoms and allow you to continue with a functional rehabilitation program supervised by a physiotherapist.
Sign and symptoms of a chronic ankle sprain include:
- Pain felt mainly around the outer aspect of the ankle joint (but can also be on the inside of the joint)
- A history of trauma (either one significant event or multiple accidents)
- A sensation of instability or poor balance in the ankle
- Lack of confidence on the ankle particularly playing sport or going up and downstairs.
- Swelling, thickening or ‘puffiness’ around the outer aspect of the ankle
- Clicking can sometimes be felt in the ankle when walking, going up and down stairs or squatting
injections for Morton’s neuroma
A Morton’s Neuroma is a painful condition affecting a small nerve which runs between the long bones of the forefoot (between the toes). A Morton’s neuroma can occur in both men and women alike, often from the 4th decade onwards. It is often not associated with a traumatic event such as a fall and becomes gradually more symptomatic over time. Morton’s neuroma can develop due to poor lower limb biomechanics or wearing high heels or tight-fitting shoes.
Signs and symptoms of a Morton’s neuroma include:
- Sharp pain between the toes, often made worse with walking and exercising
- A sensation of pins and needles felt in the toes
- A feeling of standing on a pebble or walking with a ‘small stone in their shoe’
- Pain made worse when walking or running on uneven surfaces
- A ‘clicking’ sensation when they squeeze the ball of the foot – this is known as a ‘Mulder’s click’
Treating a Morton’s neuroma can be challenging and requires well fitted shoes and a strength and stability rehabilitation programme under a physiotherapist to improve the arch strength of the foot. Customised orthotics or a ‘metatarsal pad’ under the ball of the foot can also help your pain. If symptoms remain stubborn then an ultrasound guided steroid injection should be considered.
injections for Plantar fasciitis
The plantar fascia is a thick band of tissue that sits underneath the heel. It runs from under the heel to the big toe and acts as an elastic band, storing and releasing energy during walking and running. The plantar fascia is placed under increasing pressure when walking, running and playing sport and can become irritated and inflamed. An inflamed plantar fascia is known as plantar fasciitis. If the plantar fascia is subjected to repeated episodes of fasciitis its integrity can become compromised resulting in a weakened worn fascia. This is called plantar fasciopathy.
Plantar fasciitis/fasciopathy commonly occurs when it is subjected to a sudden increase in activity such as when starting a new sport or exercise program. It can occur in both men and women alike and at any age. It is often associated with stiffness and weakness in the calf, poor running form and ill-fitting unsupportive trainers.
Signs and symptoms of plantar fasciitis/fasciopathy include:
- A sharp or achy pain felt under the heel
- Exquisite pain on stepping out of bed first thing in the morning
- Pain in the heal which is made worse with walking, running or playing sport
- Pain that lingers into the next day after exercise.
- Heel pain that is made worse when walking barefoot
Plantar fascia pain can be very stubborn and is often resistant to physiotherapy, shockwave and rehabilitation exercises and can take many months to resolve. If conservative measures are not effective then an injection should be considered to reduce pain, increase function and allow rehabilitation to continue.
Injections for Sinus Tarsi syndrome
The sinus tarsi is a bony tunnel found on the outer aspect of the mid foot which provides balance and stability to the foot. The sinus tarsi is filled with fat cells and is richly supplied with both nerve and proprioceptive (providing both a sense of awareness and balance) cells. Sinus Tarsi syndrome occurs when the delicate nerve and proprioceptive cells become compressed within the tunnel.
There are many risk factors involved in developing sinus tarsi syndrome. These include:
- Repeated ankle injuries (twist or rolling the ankle)
- One major traumatic event resulting in an ankle ligament tear
- Over pronation of the foot (also known as a flat foot) can put additional pressure on the sinus tarsi, compressing the delicate structures within
- Being hypermobile can also compress the sinus tarsi, driving sinus tarsi syndrome
Signs and symptoms of sinus tarsi syndrome include;
- Pain over the outer aspect of the foot made worse with prolonged standing, walking or exercising
- Pain when touching the outer aspect of the foot
- A deep, burning pain (which can at times be sharp) felt over the outer aspect of the foot
Sinus tarsi syndrome requires a strength and stability rehabilitation program alongside good supportive footwear however, if this does not resolve the situation then an injection should be considered.
injections for Mid foot osteoarthritis
The mid foot is formed from the articulation of 5 irregular shaped bones. It creates the arch of the foot which provides a flexible, stable shock absorbing platform to move on. The mid foot is required to be flexible, stable and strong during weight bearing and is therefore a common site for osteoarthritis to occur. MidFoot osteoarthritis often develops slowly without a traumatic event and can become incredibly painful affecting all aspects of daily life.
Signs and symptoms of mid foot osteoarthritis include:
- A deep, dull ache within the middle of the foot.
- Occasional sharp pain and swelling
- The development of a limp whilst walking
- A sensation of stiffness in the foot, especially first thing in the morning
- Osteoarthritis often changes the shape of a joint, making it look bigger when compared to the opposite side
Osteoarthritis is a progressive degenerative condition which requires a long-term management program including, supportive footwear/orthotics, physiotherapy, strength, flexibility and balance rehabilitation exercises. When these conservative measures become ineffective then an injection can be incredibly helpful, allowing pain to be controlled and rehabilitation to restart.
injections for Calf tear (tennis leg)
A calf tear (also known as a ‘tennis leg’) is a common injury seen in exercise and sport enthusiasts. It refers to a tear in the connective tissue between the two muscles of the calf (the soleus and the gastrocnemius). A tennis leg occurs when the calf is subjected to a sudden high force stretch, as when attempting to sprint or chase a ball during a game of tennis.
A tennis leg can also occur when misjudging a step and jarring the calf into a quick unexpected stretch. Tennis leg can happen to anyone at any time but is most common in the sporting population and in middle-aged men.
Signs and symptoms of a tennis leg include:
- A sudden onset of calf pain (and in some case a pop or tear can be heard) during exercise, especially straight after attempting a sprint/fast movement
- A swollen, and in some cases a bruised, calf
- Limping due to calf pain when walking
- Pain when the calf is touched
If you have experienced a ‘pop’ or a ‘snap’ at the time of injury, we would strongly advise you to book in for a diagnostic ultrasound scan to ensure you have not injured your Achilles tendon as this requires specialist input immediately.
In the vast majority of cases a period of rest, physiotherapy and calf rehabilitation exercises are enough to treat a tennis leg however, in some cases, a large swelling can become trapped between the two calf muscles affecting the muscles ability to heal. If this is the case then an aspiration (removal of the fluid) is required. A fast and accurate diagnosis is required for an aspiration to be effective. If you feel you have a tennis leg then contact Complete 020 7482 3875 or email injections@complete-physio.co.uk.
Injections for Gout
Gout can be an incredibly painful condition which occurs rapidly and causes significant pain and disability. Gout mainly affects joints with the big toe being the most commonly affected joint. Gout has been associated with a diet rich in red meats and alcohol. Obesity and kidney failure are also causative factors. Gout becomes more prevalent as age increases. Men are much more likely to suffer from gout than women however, anyone at any age can suffer from an episode of gout.
Signs and symptoms of gout include;
- A sudden and significant onset of pain within the big toe joint
- Inability to touch the big toe, put socks or shoes on
- Pain when attempting to move the joint
- The development of a limp
- A sudden red, hot swelling of the joint
Long term gout sufferers are required to control their diet and often need to take Allopurinol (a prescription only medication used to control uric acid levels). Anti-inflammatory medication can be effective when suffering from a flare up of gout however, if these treatments are not effective and symptoms remain significant then an ultrasound guided steroid injection is recommended.
Injections for Bursitis of the heel
There are two small fluid-filled, friction reducing sacks (known as bursa) found at the heel, both of which are designed to support and protect the Achilles tendon. These are the retrocalcaneal bursa (between the Achilles tendon and the heel bone) and the subcutaneous bursa (between the Achilles and the skin).
Heel Bursitis occurs when one or both of the bursa becomes irritated, inflamed and painful. These bursas are placed under considerable pressure when walking, hiking and exercising and whilst they are capable of meeting these demands, when a sudden unexpected increase in activity the bursae can become pathological. Heel bursitis is also common in patients suffering from rheumatological conditions.
Signs and symptoms of heel bursitis include:
- Sudden onset of sharp pain around the back of the heel
- Pain made worse with direct pressure through the heel such as wearing shoes or driving
- Pain made worse with walking and exercising
- Pain with stretching the calf muscles
- A swelling over the back of the heel. The heel can also appear red
- A sensation of squeakiness in the heel when walking
A diagnostic ultrasound scan is the most sensitive imaging technique to diagnose bursitis. This will be carried out at your appointment at no extra cost.
In the main heel bursitis requires a period of activity modification, appropriate footwear, physiotherapy and a rehabilitation program. When these conservative treatments are ineffective an ultrasound guided steroid injection can be an effective option.
Injections for mid portion Achilles tendinopathy
The Achilles tendon is the most powerful tendon in the body and the most common site for ankle pathology to reside. This powerful tendon is placed under considerable pressure during walking, running and playing sports. If the tendon is not well prepared to deal with these loads it can become irritated and inflamed.
An inflamed Achilles tendon is known as Achilles tendinitis. If the Achilles tendon continues to be placed under inappropriate loads and not given the time to recover and strengthen then the tendon structure can become compromised and weakened. A compromised and weakened Achilles tendon is known as Achilles tendinopathy. By far the most common site on the Achilles to become pathological is two inches above the calcaneus (heel bone) in an area known as the ‘mid-portion’.
A Mid-portion Achilles tendinopathy develops when the Achilles tendon is suddenly subjected to loads that it cannot cope with and is common in both sporty people as well as people living a more sedentary lifestyle. It can occur in both men and women of any age and can cause prolonged periods of significant pain and loss of normal mobility.
Signs and symptoms of a mid-portion Achilles tendinopathy include:
- A sharp achy pain felt just above the heel directly over the Achilles tendon
- The Achilles can appear swollen and thickened when palpated
- Pain made worse when moving after a prolonged period of sitting or upon stepping out of bed first thing in the morning
- Morning pain and stiffness
- Pain at the start of exercise. This typically wears off as you continue to exercise
- Increased pain after exercise that flows into the next day
The first port of call when treating a mid-portion Achilles tendinopathy should be conservative treatments including physiotherapy, a strength and conditioning rehabilitation program and shockwave therapy. If these measures fail and pain remains consistent then an injection should be considered. The Achilles tendon is a crucial, powerful tendon and so an injection should not be taken lightly and your clinician will discuss the pros and cons with you prior to undertaking an injection. Following the injection your clinician will provide clear instructions on the next steps of your recovery. This is likely to include a rehabilitation programme.
Injections for Baxter’s nerve-entrapment
The Baxter’s nerve is a small sensory nerve that runs past the inner aspect of the heel. This nerve can become pinched (or entrapped) between two muscles as it passes the inner aspect of the heel on its pathway under the foot. When Baxter’s nerve becomes entrapped it causes significant heel pain, affecting weight bearing activities including walking and exercising. A Baxter’s nerve-entrapment is often misdiagnosed as the much more common plantar fasciitis which can present in a very similar way.
Signs and symptoms of a Baxter’s nerve entrapment include:
- A sharp stabbing like pain felt underneath and over the inner aspect of the heel
- Pain made worse with weight bearing activities such as standing, walking and exercise
- Pain stepping out of bed first thing in the morning (this may be accompanied by a short period of limping)
- Pins and needles in the inner aspect of the heel made worse if hit or knocked
- Pain with touching the inner aspect of the heel
Obtaining a correct diagnosis of Baxter’s nerve entrapment can be challenging and requires both clinical testing and diagnostic imaging. Treatment options should include supportive footwear, orthotic innersoles and an ankle and foot rehabilitation program. This condition can be resistant to conservative management and so an injection should be considered.