Ankle & Foot Pain

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.

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.

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.. 

For conventional surgical approaches, 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 (replacement) procedures are challenging, and their functional outcomes are often suboptimal. 

Using Stem Cells to Treat Ankle OA and chronic Sprain 

Since ankle surgery has such poor outcomes, it makes it all the more important to optimize regenerative healing before even considering surgery. For this reason I often choose to be quite aggressive with my regenerative healing approach and lean heavily towards stem cell / PRP as treatment of choice. In some cases, to help improve results I might even suggest a couple of Prolo primers a few weeks prior to stem cells. This starts the tightening process and lays the groundwork for the regenerative healing of stem cells. I follow up my ankle cases quite closely and will often suggest a PRP booster at 6 or 8 weeks following stem cell/PRP treatment. Optimal orthotics are critical for optimal results so patients can rehab properly and walk with minimal stress on the ligament tissue that’s forming in the ankle joint. 

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.

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, PRP and Prolotherapy offer promising solutions for those suffering from chronic ankle pain. These treatments can restore stability, reduce pain, and promote natural healing, offering hope for a quick 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.

Foot Pain and Morton’s Neuroma 

A very common condition is Morton’s neuroma. The term neuroma means that there is swelling in a nerve and Morton’s neuroma is swelling in the interdigital nerve of the foot. These travel between the bones called the meta-tarsals. When one of these nerves gets pinched between the metatarsal heads, it gets irritated and swells. This swelling causes the sensation of walking on a pebble or more severe radiating pain that can be made worse by wearing tight-fitting shoes.

The most common treatment for Morton’s neuroma is changing shoe type (i.e., avoiding high heels or shoes with a tight toe box), physical therapy, and/or activity restriction until the area is no longer painful. If that fails, then a steroid shot is often used, but the evidence that this is effective is of low quality, even though this is a common treatment. The other issue is that the results of steroid injections are commonly short-lived, and new research demonstrates that this type of therapy, in general, may lead to a higher likelihood of chronic pain. Alcohol injections to kill the nerve are also used. Finally, surgical excision of the interdigital nerve (neurectomy) is often performed if the problems persist. The rehab after surgery can take many weeks and even after this procedure, most patients have to be careful on their choice of shoes. As always, there are risks of complications after the surgery including chronic pain due to nerve injury, infection, or foot numbness.

The Regenerative Approach 

I have treated many cases of Morton’s neuroma over the years. Here’s the deal. The root cause of the problem is not due to the nerve, it’s an entrapment syndrome. As ligaments loosen at the Metatarsal- phalangeal joint (MTP) the metatarsal heads subluxate and put pressure on the nerve that runs alongside. Over time this irritation causes swelling of the nerve. The solution is to inject the MTP joints and tighten them, thus alleviating the pressure on the nerve. At the same time, proper orthotics and a wide enough shoe will help the rehab. Once you’ve corrected the root cause of the problem, the pain resolves. In my opinion, regenerative approaches make a lot more sense and give far superior results than steroid injections or surgery.