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Why corticosteroid injections may not be a good treatment option for Achilles tendinopathy

Updated: Jun 15

INJECTION SERIES:

Corticosteroid injections have traditionally been used for tendinopathies because they can provide excellent pain relief in the short term. Several research studies have shown this to be the case for a wide range of tendinopathies, including Achilles tendinopathy.


I've also discussed it in this video:



The problem is that corticosteroids also increases the catabolic action (breakdown of cells) in tendons. In studies where they looked at the long term effect that steroid injections have on tendons, they found that the patients who received these injections were actually worse off (several months and years later) than the ones who received other types of care.


There’s currently a lack of good quality long term follow-up studies for the effect of corticosteroid injections on Achilles tendons and Achilles tendinopathy. The current research suggests that you may be at a slightly higher risk of tearing your Achilles tendon after you’ve had a corticosteroid injection.



Summary of what we know about Corticosteroids and tendons


  • Steriods may weaken tendons by causing an increase in collagen breakdown.

  • It provides very good pain relief in the short term (first 2 to 4 weeks).

  • Tennis elbow is the only tendinopathy with high quality, long term follow-up studies and those show that, although steroids provide good pain relief for a few weeks, these patients are worse off after a few months. They found this to be the case at 6 months and 4 years post injection.

  • High quality, long term follow-up studies for Achilles tendinopathy is currently lacking.

  • The current research suggests that there may be a small increased risk of rupturing your Achilles tendon after you’ve had a corticosteroid injection.


My advice, as the research stands today, would be to stay away from steroid injections that are done into your Achilles tendon or it's sheath, unless you’ve exhausted all other treatment options.


Let me know if you have any questions. Need more help with your Achilles injury? You’re welcome to consult us online via video call for an assessment of your injury and a tailored treatment plan.

Best wishes

Maryke


About the Author:

Maryke Louw is a chartered physiotherapist and holds an MSc in Sports Injury Management. You can follow her on LinkedIn, Facebook, Twitter or Instagram.




References:

  1. Coombes, B. K., et al. (2010). "Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials." The Lancet 376(9754): 1751-1767.

  2. del Valle Soto, M., et al. "Consensus on the use of infiltration in sport. Document of Consensus of the Spanish Society of Sports Medicine."

  3. Orchard, J. W., et al. (2018). "The use of ultrasound-guided injections for tendinopathies." Current Radiology Reports 6(10): 38.

  4. Orchard, J. W. (2020). "Corticosteroid injections: glass half-full, half-empty or full then empty?" British Journal of Sports Medicine: bjsports-2019-101250.

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