An ankle sprain or twist leads to torn ligaments and pain and swelling in the ankle. Generally, most ankle sprains settle with physiotherapy. However, an ankle sprain sometimes fails to resolve with rehab and needs more invasive treatments. One of these treatments is a steroid injection in the ankle. So, when do you need a cortisone shot for a sprained ankle, and what does it involve?
What is an ankle sprain?
An ankle sprain is a twist or roll of the ankle, often while running or playing a sport. Generally, the ankle inverts or rolls inward. This movement tears the ligaments inside and outside the ankle, leading to bleeding, swelling and pain.
Treatment of ankle sprain
Generally, we start with simple treatments first, incorporating physiotherapy and rehab.
We suggest a three-phase process to get you back to sport:
- Phase 1 includes rest from sports, compression, and regular icing to limit swelling. A short course of ibuprofen can help. Also, a small cast boot may provide extra support.
- Phase 2 includes range-of-motion exercises, stretching, and calf strengthening. Balance exercises are also essential to prevent a recurrence.
- Phase 3 involves complex exercises, a gradual return to running, and a change of direction activity. Your therapist will introduce agility drills to test the ankle.
When a cortisone shot for a sprained ankle is needed
About 10% of lateral ligament sprains do not improve with simple treatments. In these cases, seeing your doctor is necessary to determine whether you have more than just an ankle sprain.
Generally, we recommend imaging such as an MRI or ultrasound to exclude other ankle pathologies, such as fractures, cartilage and tendon damage.
A cortisone shot will help in cases where pain and swelling are due to persistent inflammation in the ankle joint (also called soft tissue impingement or post-traumatic ankle joint synovitis).
How is a cortisone shot for a sprained ankle performed?
=We usually perform a steroid injection directly into the area of swelling in the ankle joint. So, if pain and swelling are localised in the outer part of the ankle joint, we direct the cortisone into this part.
Generally, we suggest injections are performed with ultrasound guidance to improve the accuracy and effectiveness of a cortisone shot. Ultrasound reduces side effects as the cortisone is directed into the right area.
How long does a cortisone shot for an ankle sprain take to work?
A cortisone shot generally takes 1-2 weeks to start working, although some cases take up to 3 weeks.
Side effects of a cortisone shot for sprained ankle
Cortisone injections have side effects like any procedure.
These potential side effects include:
- Allergic reaction (rare)
- infection (1/100000)
- Skin thinning and discoloration. We can reduce this side effect by using ultrasound.
- Bleeding into joints.
- Temporary increases in blood sugar in people with diabetes. This increase lasts for two weeks.
- Cortisone flare causes increased pain for the first few days.
- Some worry about long-term side effects such as weakened tendon strength or further joint damage. For example, recent studies suggest that repeated cortisone injections can damage cartilage. Moreover, a cortisone injection can weaken tendon strength for a few weeks. However, we can reduce these concerns by using cortisone shots sparingly and for the right reasons. Also, using ultrasound to direct the injection into the right spot reduces the chances of a poorer result.
How long does a cortisone shot for an ankle sprain last?
Usually, a cortisone shot lasts for 6-8 weeks, but sometimes it can last much longer.
Other commonly asked questions about a cortisone shot for a sprained ankle:
Are there any alternatives to a cortisone shot for an ankle sprain?
Yes. We use hyaluronic acid or PRP in some cases of persistent swelling after an ankle sprain. Generally, we would use these options if cortisone injections have been tried and the ankle joint contains other damage, such as cartilage damage or early arthritis.
What happens if the steroid injection doesn’t work?
If ankle pain and swelling are still issues after a cortisone shot, you may try a repeat injeciton. In some cases, keyhole surgery is needed to remove the inflamed tissue.
Final word from Sportdoctorlondon about a cortisone shot for a sprained ankle
A cortisone shot for a sprained ankle is an effective tool for ankles that remain painful and swollen despite rehab. You should see your doctor to ensure a correct diagnosis and indication for a steroid injection.
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