Causes and findings:
• Inversion injury
• Pain at lateral side of ankle
• Painful: passive inversion of ankle
Equipment:
Syringe - 1ml
Needle - 25G 0.5 inches (16mm) orange
Kenalog 40 - 10 mg
Lidocaine - 0.75 ml 2%
Total volume - 1 ml
Anatomy:
The anterior talofibular ligament runs medially from the anterior inferior edge of the lateral malleolus to attach to the talus. It is a thin structure, approximately
the width of the little finger. The bifurcate calcaneocuboid ligament runs from the calcaneus to the cuboid and is often also involved in ankle sprains. Both ligaments run parallel to the sole of the foot.
Technique:
• Patient lies supported on table
• Identify and mark anterior inferior edge of lateral malleolus
• Insert needle to touch bone
• Pepper half solution around origin of ligament
• Turn needle and pepper remainder into insertion on talus
Aftercare:
Patient keeps ankle moving within pain-free range. For the first few days, ice, elevation and taping in eversion are helpful, together with a pressure pad behind the malelleous to control swelling. Exercises to strengthen the peronei and proprioception usually need to be given.
Comments:
This injection is an option when the pain is very acute or where conservative treatment has failed in the chronic stage.
Alternative approaches:
This lesion responds very well in the acute stage to a regime of ice, elevation, gentle massage, active and passive mobilization and taping.
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