Ankle and foot
Ultrasound-guided injection for tendinopathies and tendon sheath disorders
Achilles tendon, posterior tibial and peroneal tendons: ankle tendinopathies and tenosynovitis are treated with precision under direct ultrasound visualisation.
How it is performed
The tendons crossing the ankle can become inflamed either within the tendon body (tendinopathy) or within the sheath surrounding them (tenosynovitis). Ultrasound distinguishes between the two conditions, identifies microtears and abnormal hypervascularity, and guides the needle exactly where needed: into the sheath in case of tenosynovitis, or into the peritendinous tissue in case of tendinopathy, avoiding injecting into the body of the tendon itself (which can weaken it). Low-solubility corticosteroids are used for the sheaths, or selected hyaluronic acid/PRP injections for chronic tendinopathies. Outpatient procedure.
Who it is for
- Achilles tendinopathy with weight-bearing pain not responding to physiotherapy
- Posterior tibial tenosynovitis (painful acquired flatfoot)
- Peroneal tenosynovitis (pain behind and below the lateral malleolus)
Recovery
Relative rest and ice for 48 hours; eccentric physiotherapy is started once pain has decreased. Benefit develops over the following weeks.
Conditions treated in this area: ankle (tibiotalar) osteoarthritis, sinus tarsi / subtalar joint osteoarthritis, plantar fasciitis and heel pain, achilles tendinopathy and tendon sheath disorders (posterior tibial, peroneal).
Scientific evidence
Systematic reviews confirm that ultrasound-guided injections for tendinopathies offer better accuracy and lower risk of tendon damage than a freehand injection. Ultrasound guidance is particularly recommended for ankle tendon sheaths, where precision prevents intratendinous injection and its complications.
References on PubMed
- Ultrasound-guided injection of platelet-rich plasma for tendinopathies: a systematic review and meta-analysis.
Andriolo L, Merli G, et al. — Blood Transfus, 2023 · PMID 36346880
- Ultrasound guided injections in ankle and foot.
Orlandi D, Sconfienza LM, et al. — J Ultrasound, 2024 · PMID 37518823
Published data describe average results in groups of patients and are not a prediction of an individual outcome. The indication for treatment must always be assessed during a consultation.
Want to know if it is right for you?
At the first consultation we review your clinical history and previous imaging together.