Commonly used injections for persistent achilles tendon pain offer no meaningful long-term benefit compared with a placebo treatment, according to a Monash University-led clinical trial.
Published in leading medical journal The BMJ, the study of 192 adults found that high-volume injections, which deliver fluid around the achilles tendon, did not significantly improve pain or disability after 12 months compared with a placebo injection.
The trial recruited participants with achilles tendinopathy, a condition that causes pain, stiffness and swelling in the tendon connecting the calf muscles to the heel.
It affects around six per cent of people during their lifetime and can make everyday activities such as walking difficult.
While exercise-based therapy is recommended, up to 44 per cent of patients don’t recover, leading many to seek alternative treatments, including injections.
Professor Peter Malliaras, a physiotherapist from the Monash School of Primary and Allied Health Care, said the findings highlighted the challenges faced by people living with persistent achilles pain.
“Achilles pain can be a frustrating and debilitating condition, particularly for people who have been dealing with it for years,” Professor Malliaras said.
“When exercise-based treatment hasn't provided the relief they hoped for, it's understandable that patients look for other options.
“That's why it's so important we have strong evidence about which treatments actually help.”
Participants were randomly assigned to receive either the placebo injection, a high volume injection without corticosteroid containing saline and local anaesthetic, or the same injection with an added corticosteroid, which is an anti-inflammatory medication.
All participants also received the same exercise program, education and advice on modifying their activities.
After 12 months, researchers found no clear difference in pain and disability between the three groups.
While injections containing corticosteroids provided small improvements in symptoms after six weeks, these benefits were not sustained and on some occasions they were associated with worse longer term clinical outcomes.
“Some patients may experience short-term relief from steroid injections, but our findings suggest this doesn't translate into lasting improvements,” Professor Malliaras said.
“While these findings don't support the routine use of these injections, there may be circumstances where short-term pain relief is particularly important.
“For example, someone who is self-employed and unable to work because of their pain may benefit from temporary relief, even if the injection doesn't improve their longer-term recovery.
“It's important that clinicians discuss these potential benefits and limitations with patients so they can make informed decisions about their treatment.”
Read the research paper: https://doi.org/10.1136/bmj-2026-100807
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