CONSENSUS RECOMMENDATION No studies meeting inclusion criteria directly compared intraarticular (IA) corticosteroid to control. Two high-quality studies (Gomes 2023, Woo 2025) compared corticosteroid only to combination therapy, not control. The workgroup recognizes corticosteroid injections are commonly used based on anti-inflammatory mechanisms, clinical experience suggesting short-term benefit, and generally favorable safety profile. These injections can be used as short-term symptom relief to facilitate physical therapy, a diagnostic/prognostic tool or a bridge to surgical decision-making. These injections provide short-term pain relief (weeks to months), and while not disease-modifying, may still be clinically meaningful for selected patients when framed within shared decision-making.
Benefits/Harms: Clinical experience suggests potential short-term pain relief, though magnitude and duration in ankle osteoarthritis (OA) is not evidence-based. Well-documented adverse effects include steroid flare, theoretical cartilage damage with repeated injections, rare systemic effects, infection risk, and potential to mask progressive joint damage.
Cost Effectiveness/Resource Utilization: Relatively inexpensive compared to other IA injections. Cost-effectiveness cannot be determined without efficacy data versus placebo.
Acceptability: Widely accepted by surgeons and patients. Concerns about repeated injections and cartilage damage may limit acceptability for some.
Feasibility: Highly feasible - readily available, inexpensive, performed in office setting.
Future Research: High-priority RCTs comparing IA corticosteroid to placebo, dose-response studies, comparative effectiveness versus other treatments, long-term safety studies, patient characteristics predicting response, and optimal timing/frequency of injections.