Ankle Joint Injection

Aka: Ankle Joint Injection, Ankle Injection, Ankle Intra-articular injection

1. See Also
   1. Joint Injection
   2. Injectable Corticosteroid
2. Indications
   1. AnkleOsteoarthritis
   2. Other persistent and refractory ankle arthritis
   3. Diagnostic aspiration
3. Contraindications
   1. Ankle infection contraindicates steroid injection
4. Preparation
   1. Needle
      1. Gauge: 25 to 27 (18 to 21 if aspirating)
      2. Length: 1.5 inches
   2. Syringe: 10 ml (larger if aspirating joint)
   3. Corticosteroid options
      1. Betamethasone (Celestone) 1 ml of 6 mg/ml
      2. Methylprednisolone (Solu-Medrol): 1 ml of 40 mg/ml
   4. Anesthetic
      1. Lidocaine 1%: 3 to 5 ml or
      2. Bupivacaine 0.25% or 0.5%: 3 to 5 ml
5. Technique
   1. Images
      1. 
   2. Patient position
      1. Supine with relaxed ankle
   3. Landmarks
      1. Medial aspect of talus-tibia articulation
      2. Palpate between anterior and posterior landmarks
         1. Anterior: Tibialis anterior tendon medial border
         2. Posterior: Medial malleolus anterior border
   4. Mark needle insertion site based on landmarks
   5. Sterilize local skin with Betadine or Hibiclens
   6. Insert needle at medial ankle landmark
      1. Direct needle posterolaterally
   7. Patient lies supine for several minutes after procedure
      1. Distribute with passive foot range of motion
6. Follow-up Instructions
   1. No stress to foot for 2 weeks after injection
      1. Minimum time to strenuous activity: 48 hours
   2. Examine again in 3 weeks post-injection
7. References
   1. Greene (2001) Musculoskeletal Care, AAOS, p. 429-30
   2. Tallia (2003) Am Fam Physician 68(7):1356-62