The ankle joint, designed for maximum stability while allowing the essential flexion movement needed for walking, endures more load and is injured more frequently than any other joint in the body. This joint bears significant stress and weight, especially when a person is active. While walking, the ankle supports 2-3 times the body’s weight, and with running, this load can escalate to as much as 13 times body weight. Such immense pressure can be particularly challenging for individuals carrying extra weight, making the ankle susceptible to injuries and chronic conditions.
The Prevalence and Impact of Ankle Osteoarthritis
Advanced osteoarthritis (OA) of the ankle is less common than OA in other weight-bearing joints like the knee or hip. However, when it occurs, it can be particularly debilitating. Ankle OA is especially difficult to treat surgically, making it a significant concern for those affected.
Ankle pain, whether associated with serious arthritis or not, is often due to ankle joint instability caused by ligament damage. Ligaments, when stretched or torn, do not heal well on their own. This instability can lead to a chronic, painful, and progressive condition. A loose ankle permits destructive joint motions with every step, accelerating wear and tear on the cartilage and causing further structural damage.
Chronic Sprains and Ligament Damage
Repeated ankle sprains are a common precursor to chronic ankle instability and OA. When the ankle becomes unstable due to repeated injuries or the development of serious OA, it spells serious trouble. In such cases, exploring regenerative approaches first is crucial, as surgery should be considered a last resort.
As a regenerative doctor, I have dedicated myself to using Regenerative Injection Therapy (RIT) to help patients achieve optimal nonsurgical results. However, the ankle poses unique challenges. Unlike the knee or hip, where arthroplasty (joint replacement) surgery offers a viable Plan B if regenerative treatments fail, the surgical options for the ankle are not as promising. Both arthrodesis (fusion) and arthroplasty procedures are challenging, and their functional outcomes are often suboptimal.
Regenerative Treatments for the Ankle
Given the challenges associated with ankle surgeries, it is essential to exhaust all regenerative options before considering surgical interventions. Regenerative treatments for the ankle can be more complex than those for the knee or hip. In cases of serious damage, I almost always recommend stem cell therapy. Stem cells promote natural healing and tissue regeneration, offering a promising solution for chronic ankle conditions.
The Role of Prolotherapy and PRP
In some instances, I may recommend two or three prolo primer sessions with dextrose to initiate the healing process. These primer sessions help tighten the joint and set the stage for stem cells to be effective. Additionally, a Platelet-Rich Plasma (PRP) booster session may be necessary to achieve the desired results. PRP involves injecting a concentrated form of the patient’s platelets, rich in growth factors, to further stimulate healing.
Understanding the Ankle Joint Complex
The ankle joint is comprised of three joints: the tibiotalar joint, the subtalar joint, and the talofibular joint. The tibiotalar ankle joint is the body’s only mortise-and-tenon joint, designed for maximal stability under serious load. The main ligaments involved are the deltoid ligament on the medial aspect and the lateral ligament complex on the lateral aspect. The subtalar joint is accessed by injecting through the sinus tarsi on the lateral aspect of the ankle.
For best results, the ankle should be treated comprehensively and aggressively. This means injecting all three joints in the ankle and addressing the supportive accessory ligaments through palpation testing. If these ligaments are found to be weak, they should also be injected. The interconnected nature of the connective tissue structures, as demonstrated by models of biotensegrity, underscores the importance of strengthening the entire area.
Comprehensive Regenerative Approach
A comprehensive and aggressive regenerative approach is essential for treating chronic ankle pain and instability. Unfortunately, some practitioners who are not dedicated regenerative specialists may provide suboptimal treatment by administering only one or two shots here and there. This approach is unlikely to yield successful results. Instead, the ankle often requires several sessions of aggressive RIT, potentially including multiple primer or booster sessions in addition to stem cell therapy.
Importance of Orthotics
In addition to regenerative treatments, it is crucial to use optimal orthotics to support the ankle during the healing process. Orthotics can help stabilize the ankle, reduce stress on the joint, and prevent further injury.
Conclusion
The ankle joint, despite its robust design, is vulnerable to significant stress and injuries due to its role in supporting the body’s weight during various activities. Chronic ankle pain, whether from repeated sprains or advanced OA, poses a serious challenge due to the joint’s complex structure and the limited success of surgical interventions.
Regenerative treatments, including stem cell therapy, prolotherapy, and PRP, offer promising solutions for those suffering from chronic ankle pain. These treatments aim to restore stability, reduce pain, and promote natural healing, offering hope for a return to normal activities without the need for invasive surgery.
If you are experiencing chronic ankle pain or instability, consult with a qualified regenerative specialist to explore your treatment options. By addressing the underlying causes and utilizing advanced regenerative techniques, you can achieve lasting relief and improved function, allowing you to enjoy an active and pain-free life.
