Intra-articular corticosteroid injections for the treatment of people with foot and ankle osteoarthritis: a systematic review

Intra-articular corticosteroid injections are commonly used in the management of foot and ankle OA. Although current clinical guidelines advocate the judicious use of corticosteroid injection as an adjunct therapy, none of these recommendations are specific to the foot and ankle. Therefore, the aim of this review is to examine the effectiveness of intra-articular corticosteroid injections in people with foot or ankle OA. Four databases (Cumulative Index to Nursing and Allied Health Literature [CINAHL], MEDLINE, EMBASE and CENTRAL) and one clinical trial register (International Clinical Trials Registry Platform [ICTRP]) were searched from inception to June 2024 for randomized control trials (RCTs) and quasi-RCTs evaluating corticosteroid injection in the treatment of foot or ankle OA on pre-specified outcomes: pain, function, quality of life, safety (adverse events) and/or cost-effectiveness. Two independent reviewers conducted record screening, data extraction (Cochrane data extraction tool) and assessment of methodological quality (Cochrane Risk of Bias tool [RoB 2.0]). From 1711 citations, two RCTs (57 participants, 49% males) were identified. There were no differences in pain or function over 8 weeks after a single injection of intra-articular corticosteroid compared with prolotherapy for treatment of first metatarsal joint OA. Pain and function significantly improved in people having three corticosteroid injections combined with hyaluronic acid compared with corticosteroid injections alone for treatment of post-traumatic subtalar OA. Methodological quality was graded as some concerns in both trials. There is insufficient evidence to guide the use of intra-articular corticosteroid injections for OA of the foot or ankle. Future robust research is needed to provide reliable evidence for this commonly performed treatment.