Ross Hauser, MD, Danielle Matias, PA-C, Demi Foster, APRN

Cortisone may provide temporary relief of ankle pain by reducing inflammation. The injections however do not treat arthritis.

A March 2025 study in the journal Rheumatology advances in practice (1) notes intra-articular corticosteroid injections are commonly used to treat ankle osteoarthritis but there is not enough evidence to suggest they work, as noted next. . .”Over recent years, there has been a growing awareness of potential detrimental effects of intra-articular corticosteroid injections including chondrotoxic effects and accelerated osteoarthritis progression, subchondral insufficiency fractures, osteonecrosis and increased risk of prosthetic joint infection, although the evidence is not robust. (Research indicates) that although recurrent intra-articular corticosteroid injections may provide some improvements in pain, function and quality of life up to 24 months after administration, they did not outperform placebo or other injectables at 12 and 24 months. (However this research was limited to knee and hip osteoarthritis) but questions remain unanswered about the effectiveness of steroid injections in foot and ankle osteoarthritis.

Future research is needed to address fundamental questions around the use of intra-articular steroids in the foot and ankle. Key uncertainties include: whether these treatments are clinically- and cost-effective, which products should be injected, whether imaging guidance improves outcomes, whether injected corticosteroids delay time to surgical treatment or whether they increase the likelihood of adverse events, such as post-injection infection.

A June 2020 study in the journal Pain Therapy (2) notes that the research on corticosteroid injections for ankle osteoarthritis is limited. Combined research suggests that corticosteroid injections could help patients with less severe osteoarthritis but the long-term effects are not clear.

Trying to fill that knowledge gap was a December 2023 study in the journal Foot & ankle orthopaedics (5) which examined the possible chondrotoxic (toxic to cartilage) effects of intraarticular corticosteroid injections. The researchers of this paper write: “Although laboratory studies indicate certain corticosteroids and local anesthetics used in intraarticular corticosteroid injections are associated with chondrotoxic effects, and selected agents such as ropivacaine and triamcinolone may have less of these features, clinical evidence is lacking.”

To assess how intraarticular corticosteroid injections are used, the researchers surveyed surgeons in the American Orthopaedic Foot & Ankle Society (AOFAS). In total, 387 surveys were completed.

• Lidocaine (51.2%) and triamcinolone (39.3%) were the most common anesthetic and corticosteroids used.
• Less than half of survey respondents felt corticosteroids or local anesthetics bear a risk of chondrotoxicity.
• Survey respondents agreed that corticosteroids are chondrotoxic and were more likely to use triamcinolone.
• Respondents agreeing local anesthetics risk chondrotoxicity were less likely to use lidocaine.
• Respondents choosing a local anesthetic based on literature were more likely to use ropivacaine.

What the researchers found and concluded was: “Corticosteroid and local anesthetic use in intraarticular corticosteroid injections varied greatly. The rationale for intraarticular corticosteroid injection formulation was also variable, as the clinical implications are largely unknown. Those who recognized potential chondrotoxicity and who chose based on literature were more likely to choose ropivacaine and triamcinolone, as reflected in the basic science literature.”

Alternatives to cortisone shots: Updated reviews. Ross Hauser MD

Our published research

Avascular Necrosis Case Report of Direct Bone Marrow Injections and Prolotherapy Treatment

References

1 Jones K, Bruce J, Lewis TL, Nolan CN, Munteanu SE, Menz HB, Backhouse MR. Intra-articular corticosteroid injections for the treatment of people with foot and ankle osteoarthritis: a systematic review. Rheumatology Advances in Practice. 2025 Mar 11:rkaf030. [Google Scholar]

2 Parker EB, Hering KA, Chiodo CP, Smith JT, Bluman EM, Martin EA. Intraarticular Injections in the Foot and Ankle: Medication Selection Patterns and Perceived Risk Of Chondrotoxicity. Foot Ankle Orthop. 2023 Dec 21;8(4):24730114231216990. [Google Scholar]