Athletes treated with cortisone shots more likely to get osteoarthritis

By Stephen Beech

Professional footballers who have injuries treated with cortisone jabs are much more likely to develop osteoarthritis late in life, warns a new study.

Almost three out of four retired players (73%) with the painful condition had suffered "significant" foot or ankle injuries during their playing career.

And 75% of players with osteoarthritis reported treatment with corticosteroid injections over the course of their careers.

Osteoarthritis is a condition that causes joints to become painful and stiff, and it's the most common type of arthritis in the UK.

The new study found that retired British male professional football players who reported foot or ankle injuries during their careers were more likely to develop osteoarthritis in retirement.

Retired players treated routinely with cortisone injections for their injuries were even more likely to report osteoarthritis, according to the findings published in the journal Rheumatology.

Foot and ankle injuries are particularly common in professional football, with ankle sprains being the most common ankle injury and metatarsal fractures the most frequent foot injury.

Researchers found that injuries occur more often during matches than in practice due to the high speed, jumping, frequent changes in direction, and competitive nature of the game.

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Joint injury can lead to pain, swelling and damage to the articular cartilage and other joint tissues and result in subsequent foot or ankle osteoarthritis, which can result in disability or chronic pain.

Although injury is widespread among male professional footballers - almost 25% of players suffer foot or ankle injuries during their careers - the widespread use of injection therapies such as corticosteroids, local anaesthetics, platelet-rich plasma, and hyaluronic acid remains controversial due to concerns about their long-term side-effects.

Study chief investigator Professor Weiya Zhang said: "Injections can alleviate pain and allow players to return to games more quickly.

"However, the treatment may hide underlying joint damage and could accelerate joint structural deterioration over time.

"The frequent use of injections may also worsen cartilage damage, particularly when combined with the high physical demands required in professional football."

Zhang and his colleagues at the University of Nottingham examined retired UK male football players between August 2020 and October 2021 about cases in which a GP diagnosed foot or ankle osteoarthritis or performed foot or ankle surgery after the players’ retirement.

Of the 424 retired professional football players studied, the research team found that 73% of retired players with osteoarthritis reported foot or ankle injuries, and 75% of ex players with osteoarthritis reported treatment with corticosteroid injections over the course of their careers.

The researchers cautioned that while corticosteroid jabs are associated with higher rates of osteoarthritis, it does not necessarily mean injections are making osteoarthritis more likely, as injections are often given after injuries, which may have linked injections to osteoarthritis.

But they pointed out that retired players with osteoarthritis did report a higher number of injections into a single ankle during a season, and many received more than four injections a season, which is more than what is recommended by physicians.

Zhang added: “Our findings clearly show that a significant foot or ankle injury during a player’s career is a major, modifiable risk factor of osteoarthritis late in life."