Frequently Asked Questions

I had a very bad ankle injury when I was a teenager and now in my early 30s, I'm starting to have some significant pain and loss of motion in that ankle. Could this be early arthritis? (I hope not...)! What should I expect now?

Ankle osteoarthritis (OA) is not as common as hip or knee OA but it still occurs. And the people affected most often are indeed individuals who had a previous injury or trauma of some sort. Most are younger like yourself who were not expecting such a decline in function so early in life. The natural history (what happens over time) of ankle osteoarthritis following an earler trauma is one of accelerated functional decline. This means that the older the person becomes, the faster and greater the loss of motion and function in that joint. Teens who had ankle injuries suddenly discover in their mid-30s that they have reached a stage of severe ankle osteoarthritis (OA) referred to as end-stage OA. Conservative care with medications, physical therapy, and injection therapy tends to help more earlier on. The closer the patient comes to end-stage OA, the more likely that nonoperative care will fail to help. It is at that point that other approaches may be considered such as ankle fusion or ankle replacement. That's why researchers are continuing to search for more effective ways to treat ankle osteoarthritis. For example, there is evidence to support the use of hyaluronic acid injections into the ankle joint to reduce the painful symptoms of osteoarthritis (OA). Hyaluronic acid is a normal part of the matrix that makes up cartilage. It has two distinct properties that make it so important for smooth joint motion. It is both viscous (slippery) and elastic. The viscosity allows the tissue to release and spread out energy. The elasticity allows for temporary energy storage. Together, these two properties protect the joint, help provide joint gliding action (especially during slow movement), and act as a shock absorber during faster movements. Hyaluronic acid (HA) injected into a joint has some additional benefits. The HA replaces unhealthy synovial fluid, reduces inflammation of the synovium (lubricating fluid inside the joint), and therefore has an analgesic (pain relieving) effect. It also has a direct effect on the pressure inside the joint to separate the joint capsule where it is stuck together. Hyaluronic acid may be protective of the joint cartilage and prevent the formation of adhesions that keep the capsule from the smooth gliding action needed for normal joint motion. Optimal values for dosage of HA remain undetermined. From studies done so far, it appears that lower volume and higher number of injections seem to have the best results so far. With the new onset of painful symptoms, it may be a good time to see your orthopedic surgeon and determine the best treatment for you. A discussion of all the possibilities may include the use of hyaluronic (and other) conservative treatments.

Ke-Vin Chang, MD, et al. Effectiveness of Intra-Articular Hyaluronic Acid for Ankle Osteoarthritis Treatment: A Systematic Review and Meta-Analysis. In Archives of Physical Medicine and Rehabilitation. May 2013. Vol. 94. No. 5. Pp. 951-960.

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