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Corticosteroid Injections and the Treatment of Achilles Tendonitis: A Narrative Review

This review sought to examine the literature concerning Achilles tendonitis (AT) and the application of local corticosteroid injections in the treatment of this condition. The works analyzed were retrieved from the Medline, Cinhal, and Sports Discus databases over the period 19662003. All Englishlanguage studies or reviews of this topic were eligible. Several case reports were identified, but among those that documented negative outcomes of corticosteroid usage, none could adequately establish a unique causeeffect relationship between AT, corticosteriod injections, and Achilles tendon ruptures. Of the three clinical studies located, the first found corticosteroid injections of no value in treating Achilles paratendonitis, the second found corticosteroid therapy improved many patients symptoms but did not contribute to an earlier return to sport, and the third suggested pain relief without increased rupture rates for peritendinous injections. However, all three studies had extensive design limitations. At present, it is impossible to verify whether local corticosteroid injections may be helpful or harmful in treating painful AT. However, evidence favors (a) their restrictive usage to the peritendinous region of an inflamed Achilles tendon, (b) a cautious resumption of physical activities after peritendinous steroid injection, and (c) prevention or minimization of AT symptoms using an array of alternate adjunctive therapies.