Tibiotalar joint injection is a useful therapeutic procedure with inflammation secondary to osteoarthritis, rheumatoid arthritis, or chronic pain from instability. Pain most often occurs with ankle extension and flexion with weight bearing.
After informed consent is obtained, the patient is placed in the supine position with the leg extended and the ankle extended over the end of the examination table. The area just anterior to the medial malleolus at the articulation of the tibia and the talus should be palpated and marked. The patient is prepared in a standard aseptic fashion over an area large enough to allow palpation of landmarks, and sterile technique is used throughout the procedure. A 1½-in. (4-cm), 21-gauge needle is inserted at the mark perpendicular to the skin. The needle is advanced slightly laterally, penetrating the capsule of the joint. The needle is directed into the tibiotalar joint to a depth of about 2 to 3 cm. Aspiration is attempted until the needle has entered the synovial space. If there is an effusion of the joint, the aspiration is completed. After negative aspiration or if the aspirated fluid is noninflammatory (clear and viscous), the joint is injected with a 2-mL mixture of 10 mg of triamcinolone acetonide (or equivalent) and local anesthetic (Fig. 67-55).
FIGURE 67-55. Tibiotalar joint injection. Approach for tibiotalar joint aspiration and injection.
Injection of this joint is usually secondary to osteoarthritis resulting from trauma or from repetitive overuse injury such as from ballet dancing. If the swelling and tendonitis are around the lateral aspect of the joint, entry is accomplished just below the lateral malleolus. Gout is not an indication for injecting this joint.
Corticosteroids should not be injected if there is any suspicion that the joint is infected. If the fluid appears infected, then it should be sent for culture and sensitivity and the patient treated appropriately for the infection.