Chronic pain in the foot and ankle is one of the most common reasons for orthopaedic consultation. When first-line conservative treatments such as orthotic insoles, physiotherapy or footwear adjustments fail to provide sufficient relief, an injection is often the next step before considering surgery.
The procedure involves injecting a substance directly into the painful area, either to reduce inflammation or to lubricate the joint, depending on the condition being treated. Performed under ultrasound guidance, an injection delivers targeted local action that is faster and more powerful than oral medication, using a far smaller quantity of the active substance.
Dr Bruno Lévy incorporates injections into a comprehensive, personalised treatment strategy. It is never a routine or automatic gesture: it follows a rigorous diagnostic process, including imaging assessment and individual patient evaluation. The goal is always the same — to relieve pain effectively, preserve function, and only consider surgery when truly necessary.
What Is a Foot Injection?
Intra-articular vs. Peri-articular Injections: What Is the Difference?
There are two main categories of injections, defined by their anatomical target.
Intra-articular injections are performed inside the joint itself, within the synovial space. They target joint-related conditions such as osteoarthritis or acute inflammatory flare-ups with effusion.
Peri-articular injections are performed around the joint, targeting the surrounding soft tissues: tendons, bursae, synovial sheaths, and intermetatarsal spaces. Morton’s neuroma injections and certain tendinopathy treatments fall into this category.
In both cases, ultrasound guidance is essential when working on the foot and ankle, where the anatomical structures are numerous, densely packed, and sometimes difficult to access. It allows the needle to be positioned with millimetre precision, ensures the product is deposited in exactly the right location, and prevents any risk of diffusion into unintended structures.
When Should a Foot Injection Be Considered?
An injection is considered when conservative measures have failed to control the pain after several weeks of treatment. It may also be offered sooner when an acute inflammatory flare-up is too disabling to wait for the effects of standard treatments. Its main benefit is to break the pain-inflammation cycle, enable a return to active rehabilitation and, in many cases, avoid or delay surgery. It does not treat the underlying cause of the condition on its own: it opens a therapeutic window that the patient must use to the full, supported by appropriate physiotherapy.
Foot and Ankle Conditions Treated with Injections
Plantar Fasciitis
Plantar fasciitis is one of the most common causes of heel pain. It involves inflammation of the plantar fascia, the strong fibrous band connecting the calcaneus to the toes and supporting the arch of the foot. The pain is characteristic: most intense with the first steps in the morning or after a period of rest, it typically eases with walking before returning later in the day during prolonged activity.
When stretching, orthotic insoles and oral anti-inflammatory medication are not sufficient, a corticosteroid injection at the insertion of the fascia onto the calcaneus is an effective option. It is performed under ultrasound guidance to target the inflamed area precisely and reduce the risk of plantar fat pad atrophy, a possible side effect of repeated injections at this site.
Morton’s Neuroma
Morton’s neuroma involves thickening and inflammation of an interdigital nerve, most often located between the 3rd and 4th metatarsals, compressed by the transverse intermetatarsal ligament during walking. It causes burning pain or electric-shock sensations radiating towards the toes, aggravated by tight footwear.
A corticosteroid injection, delivered directly adjacent to the neuroma under ultrasound guidance, is most effective when the neuroma is small — generally under 7 mm — and the symptoms are relatively recent. For larger or long-standing neuromas, the results are more limited, and repeated injections carry a risk of fatty atrophy of the plantar fat pad, leading to painful loss of cushioning beneath the metatarsal heads. Dr Bruno Lévy carefully evaluates each case before deciding to inject, and offers percutaneous minimally invasive surgery when injections prove insufficient.
Tendinopathies of the Foot and Ankle
The foot and ankle are surrounded by numerous tendons exposed to significant mechanical stress: the posterior tibial tendon, the peroneal tendons, and the extensor tendons of the toes. These structures can become inflamed acutely or develop chronic degenerative lesions, causing pain during activity and sometimes at rest.
Corticosteroid injections can reduce local inflammation and facilitate a return to physiotherapy. One absolute rule applies however: the injection must always be performed around the tendon (peri-tendinous position), never into the tendon body itself. An intra-tendinous injection carries a serious risk of weakening and rupture. The Achilles tendon is subject to a strict and absolute contraindication to corticosteroid injections, given the high risk of rupture and its severe functional consequences.
Osteoarthritis of the Foot and Ankle
Foot osteoarthritis primarily affects the metatarsophalangeal joint of the big toe — producing what is known as hallux rigidus — as well as the small joints of the forefoot and the ankle. When it triggers an inflammatory flare-up with joint effusion, a corticosteroid injection can rapidly reduce inflammation and relieve pain. Outside of flare-ups, in a relatively dry joint with some cartilage still preserved, hyaluronic acid viscosupplementation is an interesting alternative, particularly suited to mild-to-moderate cases in patients wishing to delay surgery.
Substances Used in Foot Injections
Corticosteroids
Corticosteroids are the most commonly used substances for foot injections. As powerful anti-inflammatory agents, they act quickly — often within a few days — and can provide lasting relief for several weeks to several months, depending on the condition and the patient’s individual response. In line with the recommendations of the French National Authority for Health (HAS) and the French Society of Rheumatology (SFR), they should not exceed three to four injections per year in the same area, to limit potential side effects on surrounding tissues: tendon weakening, plantar fat pad atrophy, or ligamentous laxity. Dr Lévy adheres strictly to these limits in his practice.
Hyaluronic Acid
Hyaluronic acid is naturally present in the synovial fluid of joints, where it acts as a lubricant and shock absorber. In osteoarthritis, its properties gradually deteriorate. Intra-articular injection, known as viscosupplementation, aims to restore these altered mechanical properties. The effect is more gradual than that of corticosteroids, typically developing over seven to ten days, but considerably more durable, sometimes lasting up to six months. Hyaluronic acid carries no adverse effects on the surrounding tissues.
Platelet-Rich Plasma (PRP)
PRP is obtained from the patient’s own blood, which is centrifuged to concentrate platelets rich in growth factors. Reinjected at the site of the lesion, it stimulates the body’s natural tissue healing mechanisms. Its effectiveness depends on the healing potential of the target lesion: it is better suited to recent injuries than to chronic degenerative conditions such as advanced osteoarthritis. PRP can also be used alongside a surgical procedure to support bone or tendon consolidation.
How Does a Foot Injection Work?
The Pre-Procedure Consultation
No injection should be performed without a thorough prior consultation. Dr Bruno Lévy carries out a comprehensive clinical examination, reviews available imaging (X-rays, ultrasound, MRI) and checks for any contraindications. The main contraindications to be aware of are:
- an active local or systemic infection,
- unadjusted anticoagulant therapy,
- poorly controlled diabetes — as corticosteroids can cause a transient rise in blood glucose,
- a known allergy to the intended product.
This consultation is where the benefit-to-risk ratio is assessed for each patient and the choice of substance is made.
The Procedure and What to Expect
The patient is positioned comfortably. The area to be treated is carefully disinfected, and the ultrasound probe is positioned to visualise the anatomical structures in real time. The needle is introduced under direct visual guidance and the product is slowly injected at precise contact with the target structure. The procedure takes a few minutes and is generally well tolerated. A mild sensation of pressure or tension during the injection is normal and disappears within minutes.
Immediate Aftercare
In the forty-eight hours following the injection, a slight temporary increase in pain is possible, due to the mechanical reaction of the injection itself. It is advisable to limit intense physical activity during this period, apply ice intermittently, and elevate the foot when possible. Light walking is generally possible from the following day. The anti-inflammatory effect of corticosteroids typically becomes noticeable within two to five days. The injection should ideally be followed by a return to physiotherapy, to consolidate the results obtained and address the biomechanical causes of the pain.
Complications and When Surgery Becomes Necessary
Complications from foot injections remain rare when the procedure is performed under correct technical and aseptic conditions. The most common side effects are mild and transient: slight local redness, a small bruise at the injection site, and a temporary rise in blood glucose in diabetic patients. Infection at the injection site, while rare, is the most serious complication. In the event of intense or increasing redness, localised heat, or growing pain in the days following the procedure, it is essential to seek medical advice promptly.
When injections, correctly performed and combined with conservative treatments, fail to produce sufficient improvement, surgery becomes the most appropriate solution. For Morton’s neuroma, Dr Lévy offers a percutaneous minimally invasive technique that decompresses the nerve without removing it — leaving no visible scar and allowing immediate weight-bearing. The decision to operate is always made jointly with the patient, following a thorough review of their situation.
If you are experiencing persistent pain in your foot or ankle, do not allow it to become an established part of your daily life. An accurate diagnosis and a progressive treatment approach are the strongest foundations for a full recovery. Dr Bruno Lévy will guide you through every stage, from the initial assessment to your return to normal activity.
FAQ: Foot and Ankle Injections
Can I walk after a foot injection?
Yes. It is simply advisable to limit intense physical activity for the first forty-eight hours. Light daily activities can generally be resumed from the day after the procedure.
How long does the effect of a foot injection last?
Corticosteroids take effect within a few days and the relief can last from several weeks to several months, depending on the condition. Hyaluronic acid provides a more gradual but longer-lasting effect, sometimes up to six months.
How many injections can be given per year?
For corticosteroids, a maximum of three to four injections per year in the same area, in line with HAS and SFR guidelines. This number is always adjusted on a case-by-case basis according to the patient’s response to treatment.
Are there contraindications to foot injections?
Yes: active local or systemic infection, unadjusted anticoagulant therapy, poorly controlled diabetes, and known allergy to the intended product. Certain anatomical locations also carry specific contraindications — most notably the Achilles tendon for corticosteroid injections.
Are foot injections covered by health insurance?
Corticosteroid injections are covered by the French national health insurance (Assurance Maladie) for recognised indications. Hyaluronic acid viscosupplementation is reimbursed in certain specific indications. PRP injections are currently not covered and remain at the patient’s expense.
