Ultrasound (US)-guided
corticosteroid injection has been shown to be safe and effective for varied causes of
plantar fasciitis; however, its use for Achilles
tendinitis is controversial. We studied the efficacy and changes in US findings at Achilles enthesitis after
corticosteroid injection in patients with
spondyloarthropathy (SpA). Patients with SpA with symptomatic Achilles enthesitis, refractory to 6 weeks of full-dose
NSAIDs, were offered US-guided local
corticosteroid injection. Injected entheses were examined by US (both B mode and power Doppler) at baseline and 6 weeks after injection. Standard OMERACT definitions were used to define enthesitis. Achilles tendon thickness >5.29 mm, 2 cm proximal to insertion in long axis, was considered thickened. Twenty-seven symptomatic Achilles tendons (in 18 patients) were injected with 20 mg
methylprednisolone under US guidance baseline, and 6-week follow-up US features were compared. All patients reported improvement in
pain (VAS) in the affected tendon after injection (p < 0.0001). Simultaneously, improvement in local inflammatory changes were noted, in the form of significant reduction in tendon thickness (p < 0.0001), vascularity (p < 0.0001), peritendinous oedema (p = 0.001),
bursitis and bursal vascularity (p < 0.001 and < 0.0001, respectively). There was no change in bone erosions and enthesophyte. None of the patients had tendon
rupture or other injection-related complications at 6 weeks of follow-up. US-guided local
corticosteroid injection is an effective and safe modality for refractory Achilles enthesitis in patients with SpA and leads to reversion of acute changes at entheseal site.