Are there safer alternatives to a cortisone injection in the ankle?

Permanent harm caused by a cortisone injection
into an ankle

Hi. I just read your article about the dangers of cortisone injections in the ankle and I have decided no to do it.
The results of the MRI scan show a build up of fluid in the ankle. I have a defect in the cartilage, a hole probably caused by a small loose bone but the doctor does not know what cause the accumulation of this fluid. I understand the injection would take the pain away but is not better working on the cause? What other safe treatment are available? Thanks
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Gary:
Despite the resurgence in popularity of the cortisone injection in recent years, nothing has changed with regards to the risks of this therapy.  These risks are real and definitely not imagined.



Just what does a cortisone injection into an ankle joint actually do?  Cortisone kills cells.  In so doing there may be a dulling of pain and there may be a reduction in swelling and this may last for a number of weeks and even months.  But this may be at the cost of years of life being taken off the durability of that ankle joint.  This is because the joint surfaces may be thinned and "de-energised" by the injection.  The long term result may be a permanently weakened joint and premature onset of arthritis.

If there is a small bone fragment floating about (A "Joint Mouse") then it may have to be surgically removed; but only if the specialist is certain about this.  The fluid will most probably be from the irritation caused by this fragment (assuming there is one).

In my opinion, a cortisone injection into your ankle is short sighted therapy.  It should be banned for all but the most exceptional case (I can't think of any, btw).

I have written many articles about joint pain, including ankle pain so please follow the links at the bottom of this article and you will learn a lot from the read.  The most important principle to take on board for making a full recovery is to use therapies that energise your body to enhance healing and strengthening.  Avoid ones, like cortisone, which are destructive.  A good start is massage, gentle yet firm manipulation and good nutrition.  You can find lots of articles on this site about these topics.

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Do you have a question?  Email Gary: gary@myotec.co.nz. Include any relevant background information to your question.  Please be patient and be aware that I may not be able to answer every inquiry in detail, depending on workloads (My paying clients take precedence!). I will either reply by email or, most likely, by way of an article (Personal identifying details will be removed before publication).