Posterior Tibial Tendon Injection Therapy: What You Need to Know

When conservative treatments like rest, orthotics, and physical therapy aren’t giving you enough relief, injection therapies can be a useful next step. Here’s what you should know about the options.

Types of Injections for PTTD

Corticosteroid injections

Cortisone injections are the most commonly used injection for PTTD. They work by reducing inflammation in and around the tendon, which can provide significant pain relief.

Here’s how they help:

  • Quickly reduce swelling and inflammation
  • Provide pain relief that can last several weeks to months
  • Allow you to participate more fully in physical therapy

What to expect:

  • The procedure takes just a few minutes
  • You might feel some pressure or mild discomfort during the injection
  • Pain relief often starts within a few days

Important considerations:

  • Cortisone can weaken tendons if used too frequently, so doctors limit injections
  • Most patients receive no more than 2-3 injections per year per area
  • The relief is often temporary — it’s not a cure, but a tool to help you progress with other treatments

Platelet-rich plasma (PRP) injections

PRP therapy uses your own blood to promote healing. The process involves drawing blood, spinning it to concentrate the platelets, then injecting that enriched plasma into the tendon.

Here’s how it helps:

  • Delivers growth factors directly to the damaged tendon
  • May stimulate the body’s natural healing response
  • Some studies show promise for chronic tendon problems

What to expect:

  • The procedure takes about 30-45 minutes
  • You may experience soreness for several days after
  • Healing is gradual — it can take several months to see full effects

Considerations:

  • Research on PRP for PTTD specifically is still limited
  • It’s more expensive than cortisone and often not covered by insurance
  • Results vary significantly between individuals

When injections make sense

Injection therapy is typically considered when:

  • You’ve tried conservative treatments for several months without adequate relief
  • Inflammation is a major component of your symptoms
  • You need pain relief to participate effectively in physical therapy
  • You’re trying to delay or avoid surgery

Injections are usually part of a broader treatment plan, not a standalone solution. The goal is often to buy enough pain-free time to make progress with strengthening and rehabilitation.

The procedure

Getting an injection for PTTD is straightforward:

  1. Preparation — The doctor cleans the area and may apply a numbing spray
  2. Localization — They may use ultrasound to guide the needle precisely
  3. Injection — The medication is delivered to the affected area
  4. Aftercare — You’ll rest briefly and can typically resume normal activities within a day or two

Risks and side effects

All injections carry some risks:

  • Infection (rare, but possible)
  • Tendon weakening (more of a concern with repeated cortisone)
  • Temporary pain flare (especially in the first 24-48 hours)
  • Skin changes, like thinning or discoloration at the injection site

Most people tolerate injections well, but discuss your concerns with your doctor.

After your injection

To get the most out of your injection:

  • Take it easy for the first 1-2 days
  • Don’t suddenly stop using all support — use this time to rebuild strength
  • Start physical therapy exercises as directed once the initial soreness settles
  • Track your pain levels to understand how long relief lasts

Is injection therapy right for you?

The answer depends on your specific situation. Talk to a podiatrist or orthopedic specialist about whether injections fit into your treatment plan. They can help you weigh the potential benefits against the risks and costs.

Sources

  • American Academy of Orthopaedic Surgeons (AAOS)
  • American College of Foot and Ankle Surgeons

This content is for informational purposes only and is not medical advice. Always consult with a qualified healthcare provider for diagnosis and treatment specific to your condition.