Diagnostic and therapeutic injection of the ankle and foot.
Joint and soft tissue injection of the ankle and foot region is a useful diagnostic and therapeutic tool for the family physician. This article reviews the injection procedure for the plantar fascia, ankle joint, tarsal tunnel, interdigital space, and first metatarsophalangeal joint. Indications for plantar fascia injection include degeneration secondary to repetitive use and traumatic injuries that are unresponsive to conservative treatment. Diagnostic aspiration or therapeutic injection of the ankle or first metatarsophalangeal joints can be performed for management of advanced osteoarthritis, rheumatoid arthritis, and other inflammatory arthritides such as gout, or synovitis or an arthrosis such as "turf toe." Persistent pain and disability resulting from tarsal tunnel syndrome, an analog of carpal tunnel syndrome of the wrist respond to local injection therapy. A painful interdigital space, such as that occurring in patients with Morton's neuroma, is commonly relieved with corticosteroid injection. The proper technique, choice and quantity of pharmaceuticals, and appropriate follow-up are essential for effective outcomes.
Tallia
Alfred F
AF
Department of Family Medicine, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, New Jersey 08903, USA. tallia@umdnj.edu
Cardone
Dennis A
DA
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage; D000842:Ankle / Q000473:pathology*; D016512:Ankle Injuries / Q000175:diagnosis / Q000188:drug therapy; D001168:Arthritis / Q000175:diagnosis / Q000188:drug therapy; D036981:Fasciitis, Plantar / Q000175:diagnosis / Q000188:drug therapy; D005534:Foot Diseases / Q000175:diagnosis* / Q000188:drug therapy*; D006801:Humans; D007267:Injections / Q000295:instrumentation / Q000379:methods; D007592:Joint Diseases / Q000175:diagnosis* / Q000188:drug therapy*; D008683:Metatarsophalangeal Joint / Q000033:anatomy & histology / Q000503:physiopathology; D009463:Neuroma / Q000188:drug therapy; D013640:Tarsal Joints / Q000503:physiopathology; D014034:Toes / Q000033:anatomy & histology / Q000503:physiopathology
D000305:Adrenal Cortex Hormones; D000779:Anesthetics, Local