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Woo, Kim, Son, and Shin: Triamcinolone Acetonide Injections for Lateral Malleolar Bursitis of the Ankle
Original Article

J Korean Foot Ankle Soc 2019;23(1):12-17.

Published online: 14 January 2019

DOI: https://doi.org/10.14193/jkfas.2019.23.1.12

Triamcinolone Acetonide Injections for Lateral Malleolar Bursitis of the Ankle

Seung Hun Woo, Jung Shin Kim, Seung Min Son, Won Chul Shin

Department of Orthopedic Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea

Corresponding Author: Won Chul Shin Department of Orthopedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan 50612, Korea Tel: 82-55-360-2125, Fax: 82-55-360-2155, E-mail: dreami3e5t@naver.com ORCID: https://orcid.org/0000-0002-6918-3015

Received 12 November 2018       Revised 26 December 2018       Accepted 7 January 2019

Copyright © 2019 Korean Foot and Ankle Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

This study examined the clinical outcomes and usefulness of triamcinolone acetonide (TA) injections as an option in the conservative treatment of patients with lateral malleolar bursitis of the ankle.

Materials and Methods:

A total of 27 patients (27 ankles), in whom TA injection had been performed between March 2016 and June 2017, were reviewed retrospectively. After the aspiration of fluid in the lateral malleolar bursal sac, 1 mL (40 mg) of TA was injected into the malleolar bursal sac. After the injection, the ankle was compressed with an elastic cohesive bandage for 2 to 4 weeks. The clinical outcomes and side effects were evaluated at the following time points: 2 weeks, 4 weeks, 3 months, 6 months, and 1 year after TA injection therapy. The responses to treatment were assessed according to the degree of fluctuation, shrinkage of the bursal sac, and soft tissue swelling.

Results:

The mean age was 62.1 years (range, 41∼81 years); there were 19 males and 8 females. Complete resolution was observed in 26 patients (96.3%) after the first or second application of a TA injection, and a partial response was observed in 1 patient (3.7%) after the first TA injection. The physical component scores of Medical Outcomes Study 36-item Short-Form Health Survey improved from 71.1 to 76.0 at the last follow-up (p=0.001). Associated complications were 1 patient (3.7%) with skin atrophy and 3 patients (11.1%) with transient hyperglycemia in diabetes mellitus.

Conclusion:

TA injection is a useful and safe procedure for patients not responding to the usual conservative treatment of lateral malleolar bursitis of the ankle.

Keywords: Ankle, Lateral malleolus, Bursitis, Triamcinolone acetonide

REFERENCES

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Figure 1.
Triamcinolone acetonide (1 mL; 40 mg).
jkfas-23-12f1.tif
Figure 2.
(A) Aspiration of left ankle lateral malleolar bursitis with 21-gauge needle of 20 mL synringe. (B) Injection of 1 mL triamcinolone acetonide through the same needle used for aspiration.
jkfas-23-12f2.tif
Figure 3.
(A) 12 cm×20 m size of elastic cohesive bandage. (B) Application of elastic cohesive bandage.
jkfas-23-12f3.tif
Table 1.
Demographic Characteristics and Clinical Outcome of the Patients
Patient no. Sex Age (yr) Affected foot Duration of disease (mo) Size (cm) (horizontal/ width/vertical) No. of previous aspirations No. of triamcinolon injections Follow-up (mo) Comorbidity Clinical outcome SF-36 PCS SF-36 MCS
Pre Post Pre Post
1 M 73 R 22 3.5/1.0/3.1 2 1 12 - CR 74 80 72 73
2 M 79 R 10 3.6/0.8/3.0 4 1 12 - CR 68 72 75 75
3 M 59 L 3 3.5/1.2/3.8 5 1 14 DM CR 68 72 71 70
4 M 81 L 1 4.2/1.5/3.5 1 1 14 DM, CKD CR 60 65 74 74
5 M 71 L 12 2.8/1.0/3.4 2 1 14 - CR 72 78 68 68
6 M 72 R 3 3.5/1.1/2.5 3 1 12 - CR 70 78 72 72
7 M 59 R 5 3.8/1.2/3.7 1 2 14 - PR 74 80 75 80
8 M 51 L 0.25 4.8/2.2/4.5 0 2 14 - PR 72 76 70 70
9 M 55 R 0.25 3.1/0.9/4.2 0 1 14 - CR 72 74 62 62
10 F 55 L 3 3.5/1.0/2.1 4 1 14 - NR 72 72 70 68
11 F 53 R 1 3.1/1.1/2.2 5 1 12 - CR 70 72 70 70
12 M 63 R 28 2.7/1.5/2.5 6 1 14 - CR 72 75 80 80
13 M 44 L 6 3.2/1.5/2.8 2 1 14 - CR 84 86 84 84
14 M 75 L 12 5.8/1.4/3.5 3 1 14 - CR 70 72 70 70
15 F 74 R 1 2.2/2.0/3.1 0 1 12 - CR 72 78 72 72
16 F 58 L 1 2.3/2.5/3.2 1 1 14 Breast cancer CR 68 74 70 70
17 M 70 R 4 2.4/1.2/1.2 2 1 12 - CR 70 74 71 71
18 F 80 L 3 3.2/3.1/2.5 1 1 12 - CR 66 68 68 68
19 M 81 L 1.5 2.1/3.2/2.5 1 1 12 - CR 64 72 70 72
20 F 45 L 2 2.0/2.3/2.0 1 1 16 LC (HCV) CR 68 72 76 77
21 M 61 L 3 2.9/2.5/2.8 2 1 12 DM CR 65 78 74 75
22 M 62 R 1 3.1/2.4/2.7 0 1 12 - CR 68 80 72 72
23 F 41 R 13 3.5/2.2/2.6 5 1 13 - CR 80 84 84 88
24 F 44 R 5 3.2/2.5/3.2 4 1 12 - CR 84 86 82 84
25 M 47 R 4 3.6/2.6/2.6 3 1 12 - CR 84 88 86 88
26 M 61 L 3 3.5/2.5/3.1 2 1 12 - CR 64 72 78 78
27 F 63 R 2 4.1/2.0/2.8 1 1 14 DM CR 70 75 71 71
Mean±SD 62.1±12.3 5.6±6.7 2.3±1.8 1.1±0.3 13.1±1.1

M: male, F: female, SD: standard deviation, R: right, L: left, -: no comorbidity, DM: diabetes mellitus, CKD: chronic kidney disease, LC: liver cirrhosis, HCV: hepatitis C virus, CR: complete response, PR: partial response, NR: No response, SF-36: Medical Outcomes Study 36-item Short-Form Health Survey, PCS: physical component score, MCS: mental component score, Pre: preinjection, Post: postinjection.

Table 2.
Response Evaluation Criteria for Malleolar Bursitis of the Ankle1)
Response to treatment Shrinkage Fluctuation Soft tissue swelling
Complete response Complete No None or minimal
Partial response Partial Yes Yes
No response No change Yes Yes

Adapted from the article of Park et al. (Foot Ankle Int. 2013;34:1389-94) 1) with original copyright holder’s permission.

Table 3.
Clinical Outcomes of Triancinolone Acetonide Injection for Lateral Malleolar Bursitis
Response to treatment No. (%) of patients
Complete response 26 (96.3)
Partial response 1 (3.7)
No response 0 (0.0)
Table 4.
SF-36 Scores before and after Triancinolone Acetonide Injection for Lateral Malleolar Bursitis
Preinjection Last follow-up p-value
SF-36 PCS 71.1±6.0 76.0±5.5 0.001
SF-36 MCS 73.6±5.6 74.1±6.4 0.056

Values are presented as mean±standard deviation. SF-36: Medical Outcomes Study 36-item Short-Form Health Survey, PCS: physical component score, MCS: mental component score.

Table 5.
Side Effects of Triancinolone Acetonide Injection for Lateral Malleolar Bursitis
Side effect No. (%) of patients
Skin atrophy 1 (3.7)
Skin color change 0 (0)
Transient hyperglycemia 3 (11.1)
Septic arthritis 0 (0)
Facial flushing 0 (0)
Scar or deformity 0 (0)
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