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Achilles tendonitis: are corticosteroid injections useful or harmful?
I Shrier1, G O Matheson, H W Kohl
1Herzl Family Practice Centre, Department of Family Medicine, McGill University, Montreal, Quebec, Canada.
Summary
Local corticosteroid injections show no proven benefit for Achilles tendonitis and may weaken the tendon, increasing rupture risk. More research is needed to weigh the risks and benefits of this controversial treatment.
Area of Science:
- Orthopedics
- Sports Medicine
- Rheumatology
Background:
- The efficacy and safety of local corticosteroid injections for Achilles tendonitis remain debated.
- Some advocate for their use to accelerate healing, while others caution against potential side effects.
Purpose of the Study:
- To critically appraise the existing literature on corticosteroid injections for Achilles tendonitis.
- To examine the evidence regarding the effectiveness and safety of this treatment modality.
Main Methods:
- A comprehensive literature search of MEDLINE (since 1966) was conducted for English and French articles.
- Included clinical and animal studies with experimental and quasi-experimental designs.
- Evaluated study designs for relative strengths and examined factors related to corticosteroid effectiveness and safety.
Main Results:
- Rigorous studies (RCT, cohort) found no benefit of corticosteroids over placebo for Achilles tendonitis.
- Animal studies indicated intratendinous injections temporarily weaken tendons, while paratenon injections do not affect strength.
- Local corticosteroid injections have a ~1% incidence of side effects, with potential for permanent skin changes; Achilles tendon rupture risk is unevaluated.
Conclusions:
- Insufficient data exist to determine the comparative risks and benefits of corticosteroid injections for Achilles tendonitis.
- Animal data suggest intratendinous injections may increase Achilles tendon rupture risk for several weeks post-injection.
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