Ankle Joint Injection

Chronic capsulitis

Causes and findings:
• Post-trauma
• Pain at front of, or within, ankle
• Painful and limited: more passive plantarflexion less passive dorsiflexion

Equipment:
Syringe - 2ml
Needle - 23G 1.25 inches (30mm) blue
Kenalog 40 - 30 mg
Lidocaine - 1.25 ml 2%
Total volume - 2 ml

Anatomy:
The easiest and safest entry point to the ankle joint is at the junction of the
tibia and fibula just above the talus. A small triangular space can be palpated
there.

Technique:
• Patient lies with knee bent to 90° and foot slightly plantarflexed
• Identify and mark small triangular space by passively flexing and extending the ankle while palpating
• Insert needle into joint angling slightly medially and proximally to pass into joint space
• Deposit solution as bolus

Aftercare:
Excessive weight-bearing activities are avoided for at least 1 week. The patient should be warned that heavy overuse of the foot will cause a recurrence of symptoms and therefore long-distance running should be avoided. Weight control is also advised and footwear should be checked to ensure correct support.

Comments:
The ankle joint rarely causes problems except after severe trauma or fracture, and then often many years later. The infiltration is usually very successful in giving long-lasting pain relief and can be repeated if necessary at intervals of at least 3 months with an annual X-ray to monitor degenerative changes.