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.
Masiello F, Pati I, et al. — Blood Transfus, 2023 · PMID 36346880
- Ultrasound guided injections in ankle and foot.
Ruiz Santiago F, Moraleda Cabrera B, 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.
Risks, costs and opinions
The three questions patients ask most often before deciding, with clear answers.
What are the risks of ultrasound-guided injection for tendinopathies and tendon sheath disorders?
It is an outpatient procedure performed with a thin needle under local anaesthesia and continuous ultrasound guidance, which makes it possible to see the needle, the target and the structures to avoid in real time. The most common issues are transient: pain or swelling for 24-48 hours, a small bruise. Joint infection is a rare event, prevented by sterile technique. In treatments with cortisone, facial flushing or a temporary rise in blood sugar may occur in diabetic patients. Personal risks and contraindications are assessed during the consultation.
How much does the ultrasound-guided injection for tendinopathies and tendon sheath disorders cost?
The cost depends on the setting in which the procedure is performed: some treatments are available through the National Health Service or under agreement, others privately or through insurance. The quote is given clearly before scheduling the treatment, and includes the assessment, the procedure and the planned follow-up. During the consultation I tell you which pathway is available in your case: you do not have to decide before knowing the cost.
Does it really work? What patients and the literature say
The most frequent questions are "how long does the benefit last?" and "can I repeat it?". The answer depends on the diagnosis and the stage: some injections resolve the painful episode, others serve to open a window in which rehabilitation becomes effective. Experiences read in forums concern cases different from yours. During the consultation we review your imaging and I tell you frankly what to expect, how many sessions may be needed and when another approach is better.
Want to know if it is right for you?
At the first consultation we review your clinical history and previous imaging together.