Corticosteroid Injections in the Treatment of Foot & Ankle Disorders: An AOFAS Survey

Background: Evidence-based guidelines for the use of injectable corticosteroids are lacking, and the true incidence of complications is unknown. Materials and Methods: The 2007-2008 AOFAS membership (969 members) was electronically queried to identify corticosteroid injection practices for certain clinical entities and rates of complications. One hundred ninety-seven surveys were returned. Eleven clinical diagnoses were evaluated for number of injections per year per respondent, rate of injection, plans to change injection pattern, and use of immobilization. Thirteen possible complications were analyzed for observed frequencies and total number of complications. Results: Those in practice less than 5 years showed the lowest rate of injections at 14.1 per month, which increased to 26.1 for those in practice 6 to 10 years. An overall average of 20.6 injections per month per clinician was reported. Injections for midsubstance Achilles tendinopathy was largely avoided as demonstrated by a 98% no-inject rate. Insertional Achilles tendonitis was similar, albeit lower with an 88% no-inject rate. Non-Achilles tendonitis showed a varied response for injections. Posterior tibial tendonitis was injected 26% of the time, whereas peroneal tendonitis was injected 54% of the time. Complications including skin depigmentation were observed most frequently (5.1%), followed by atrophy (4%), flare reaction (3.5%), MTPJ dislocation (2.7%), plantar fascia rupture (1.5%), and heel pad atrophy (1.4%). Conclusion: Despite many case reports of complications, our survey indicates that the incidence of complications was perceived to be low and generally related to the injection site (skin depigmentation, atrophy, flare reaction).