Can Cortisone Shots Treat an Achilles Tendon Injury?

Cortisone is a powerful anti-inflammatory drug used in the treatment of many orthopedic conditions. When delivered by injection to the site of an injury, it can reduce inflammation and pain in joints of the ankle, elbow, hip, knee, shoulder, spine, or wrist. Even the smaller joints of the hands and feet can sometimes benefit.

Typical pain in a male jogger`s achilles tendon.
Jan-Otto / Getty Images 

So, it would seem reasonable to assume that a cortisone shot would be the ideal solution to treat injuries of the Achilles tendon, such as tendonitis (tendon inflammation) or bursitis (inflammation of the fluid-filled sac that cushions the heel and Achilles tendon).

But the evidence, in fact, has shown that this is not the case and that the negative effects of a cortisone shot may far outweigh the benefits.

Cortisone's Effect on the Body

Cortisone shots are meant for short-term relief of pain that is persistent and severe. Depending on its use, relief can last anywhere from six weeks to six months.

The problem with long-term use is that the effects of the drug tend to wane over time as the body becomes accustomed to it. And, if a person continues to use cortisone as the sole means of relief (as opposed to undergoing physical therapy), the shots can progressively—and sometimes rapidly—cause ligaments, tendons, and cartilage to weaken.

This is the main concern we have with regards to the Achilles tendon. Since this tendon needs to flex and retract whenever we walk, any softening can cause the structure to tear or rupture, sometimes completely. It is not only a serious injury but one that often requires surgery and lengthy rehabilitation.

Debating Cortisone in the Achilles Tendon

While most health authorities will advise against the use of cortisone shots to treat an Achilles injury, a recent survey of orthopedic surgeons found that as many as a third will use them for this purpose. As opposed to an outright ban, many of these surgeons believe that the judicious use of cortisone injected around, rather than into, the tendon has its place in treatment.

Others disagree, believing that there is no clear indication of how much cortisone is "too much" or how the treatment should vary based on the degree of injury. To these doctors, the use of cortisone is highly subjective and prone to error.

This belief has largely been supported by the research into the use of cortisone among athletes, a group inherently at higher risk of Achilles tendon injury. What researchers have found was that the drug often functioned more as a Band-Aid than a cure.

How Cortisone Affects the Achilles Tendon

With a normal injury, inflammation is part of the healing process wherein blood vessels will expand to allow immune cells and stem cells to flood the area of damage. By doing so, new collagen is laid down, the damaged tissue is remodeled, and the injury is repaired.

Whenever cortisone is injected, this process is stopped. By blocking the inflammatory response, the process of cellular repair is also stopped. As a result, weakened tissues remain vulnerable for longer periods of time, exposing the person to repeated stress and often worsening the injury. With an Achilles tendon rupture, the damage can often be permanent.

Making the Appropriate Choice

Generally speaking, cortisone injections should be avoided to treat an Achilles injury. There are exceptions, of course. They may be advised if all other treatment options have failed and the individual's quality of life has been significantly impaired.

In the end, cortisone shots should only be considered if a person fails to respond to the full range of standard therapies after trying them for no less than six months. This includes the use of anti-inflammatory drugs, activity modification, footwear changes, heel lifts, stretching, and physical therapy.

Even then, the decision to treat should be made with caution, weighing the benefits of treatment alongside the possible side effects.

If you know someone who has had surgery to repair an Achilles rupture, you will understand why this is so important. The rehabilitation from this surgery is extensive, and you would have to be in a cast or walking boot for weeks or months, after which physical therapy would be needed to fully restore your range of motion. All told, it could take six months to return to full activity and over a year before you are fully recovered.

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  1. Foster ZJ, Voss TT, Hatch J, Frimodig A. Corticosteroid Injections for Common Musculoskeletal Conditions. Am Fam Physician. 2015;92(8):694-699.

  2. Hauser RA. The Deterioration of Articular Cartilage in Osteoarthritis by Corticosteroid Injections. Journal of Prolotherapy. 2009;1(2):107-123.

  3. Madanagopal SG, Kovaleski JE, Pearsall AW 4th. Survey of short-term oral corticosteroid administration by orthopaedic physicians in college and high school athletes. J Sports Sci Med. 2009;8(1):37-44.

  4. Nepple JJ, Matava MJ. Soft tissue injections in the athlete. Sports Health. 2009;1(5):396-404. doi:10.1177/1941738109343159

  5. Serra MB, Barroso WA, da Silva NN, et al. From Inflammation to Current and Alternative Therapies Involved in Wound Healing. Int J Inflam. 2017;2017:3406215. doi:10.1155/2017/3406215

  6. Coutinho AE, Chapman KE. The anti-inflammatory and immunosuppressive effects of glucocorticoids, recent developments and mechanistic insights. Mol Cell Endocrinol. 2011;335(1):2-13. doi:10.1016/j.mce.2010.04.005

  7. Egger AC, Berkowitz MJ. Achilles tendon injuries. Curr Rev Musculoskelet Med. 2017;10(1):72-80. doi:10.1007/s12178-017-9386-7

  8. Childress MA, Beutler A. Management of chronic tendon injuries. Am Fam Physician. 2013;87(7):486-490.

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