Foot or Ankle Joint Cortisone Injection Advice Sheet

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Many of the joints in the foot and ankle are difficult to isolate and inject by feel alone. This is why you have been brought in to have it done under X-ray (Fluoroscopy) guidance. 

What is the purpose of the injection? 

  • Scientifically it aids us in confirming your diagnosis.
  • It can provide symptom relief for you (albeit temporary).
  • It can give you an idea what ‘sorting out’ that joint might achieve

What should I expect?

  • It is a daycase procedure and takes about 15-20 minutes to setup and perform
  • It is done in the operating theatre for equipment purposes, utilising a mobile xray machine
    • You will change in to a gown and travel to and back from the ward on a hospital bed
    • You will need an accompanying adult to take you home and be with you for the 1st 12 hrs.
    • You will stay on the ward for 20-30mins after the injection to make sure you are not having any allergy or immediate drug reaction
  • Local anaesthetic (Chirocaine) injected into the joint and will numb the joint for 6-12hrs relieving any pain caused by this area
    • Once this wears off the area can be a little more sore for 1-2hrs
  • The cortisone (depo-medrone) is also injected into the joint but it can take some 2 days to 2 weeks to take effect and does so gradually
    • The cortisone effect is by no means a guarantee and will not last forever.   
    • Experience has shown anything from 0-2 years pain relief!

What is in the injection?

  • The joint will be infiltrated with medical chemicals including  a drop of Omnipaque followed by depo-medrone and Chirocaine mixed together.  Between 2 & 6mls of fluid in all.
    • Lidocaine 1% - A quick acting local anaesthetic that is injected just under the skin to numb the area and allow gentle movements of the needle deeper towards the joint to be more comfortable.  This is similar to having your tooth numbed at the dentist
    • Omnipaque 240mcg– a  mild iodine chemical dye that shows up on xray to confirm the injection is exactly in the joint where intended (usualy less than 0.5ml)
      • If you are allergic to Iodine – alert the hospital team*
    • Chirocaine 0.5%– A local anaesthetic that can last approximately 6-12hrs, numbing the joint in question
    • Depo-medrone 40mg – A locally acting cortisone (steroid) that calms down the body’s reaction to joint inflammation from arthritis or otherwise.

What are the risks of the injection?

  • Feeling Faint immediately after the injection
    • People react to injections in various ways but owing to this more common risk you will return to the ward after the injection lying on a trolley and be observed by the nurses for approximately 20mins before leaving the hospital.
  • Bleeding from the needle prick – very rare
    • If it doesn’t stop with gentle pressure then seek medical attention
  • Infection being introduced by the needle despite our best care – Very rare
    • Would present as redness and pain in the area that slowly deteriorates.  You could start to feel unwell.
    • If it occurs please seek medical attention
  • Nerve damage from the needle prick
    • Experienced as pins and needles or altered sensation in the foot
    • It will usually settle after a few weeks. Please highlight this at your next clinic appointment
  • Drug reaction from chemicals used – Very rare
    • If you get any general symptoms feeling unwell, rash, fever or shortness of breath that deteriorate within hours of the injection seek medical attention urgently.
    • **A full list of all potential adverse reactions is available from my secretary upon request or using the links below.
  • Steroid flare - Uncommon
    • A temporary increase in the symptoms that can last 24-48hrs
  • Recurrent symptoms
    • An almost certainty at some point as mentioned above
  • Local bone, cartilage, tendon or ligament weakening with repeated injections

Full details of the side effect profile of each drug are available:

What can I or should I do afterwards?

  • Initial 12 Hours
    • Begin a mental or written record of your experience.
    • Test the effect of the local anaesthetic by walking and performing routine activities at home.
    • You should not drive until the Local Anaesthetic has worn off.
    • Watch for any side effects – Allergy, Rash, Bleeding or  swelling.  Alert a nurse or doctor if concerned
  • After 12 Hours
    • You can drive if normal sensation / feeling in the foot has has returned and you feel safe
    • Return to all usual activities as before the Injection once you feel safe

Can I have another one?

  • If the first injection doesn’t work it is unlikely to work a second time
  • If the first injection provides partial or short term relief a second will be considered but no more if the same response is repeated.
  • If  considered successful it can be repeated
    • The number of times per year is controversial as there is a worry over local bone, ligament or tendon weakness.
    • There is some weak evidence that it can slow joint degeneration
    • I therefore advocate no more than 2 per year dependent on age and other individual factors if effective.

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Next Steps...

If you would like to arrange a consultation to discuss your foot or ankle problems with Mr Williams, then please contact us.