Frequently Asked Questions

I'm overweight and my right ankle hurts all the time. X-rays have shown it's osteoarthritis. If I could lose weight, I would. I don't really want surgery -- for the ankle or to staple my stomach and help me lose weight. What do you suggest?

There are some possible treatment ideas for ankle arthritis you may want to explore. Physical therapy to help you regain strength, restore normal alignment, and even lose weight may not be a bad idea. Pain control through the use of medications, hypnosis, relaxation, and other alternative approaches have helped some people. There is also a nonoperative approach called viscosupplementation that might be a good option for you. An injection of a substance called hyaluronate into the joint helps restore the normal flow of fluid inside the joint. It is a joint lubricant. The natural result is to reduce pain and improve motion and function. Viscosupplementation of this type with hyaluronate has been done successfully with the knee. After three to five (once a week) injections, patients report considerable relief from pain. And with pain relief and improved ability for the joint to slide and glide comes a return in the ease of motion. The first study to try this out on painful arthritic ankles has been published. The authors of the study gave each of 50 patients who had ankle arthritis in one ankle one injection every week for three weeks. Then they measured results one to six months after the last injection. Standardized tests of pain, motion, and balance were completed. Patients were asked to rate their level of satisfaction. Complications and use of pain relievers were also recorded. The results were very encouraging. Patients improved in all areas, used less pain medication, and rated their satisfaction high. There were no serious side effects either! In particular, the improvement in balance was consistent when measured with four different tests. The possibility of fewer falls and reduced risk of additional injuries are added benefits of viscosupplementation. There is also a cost savings in not having the expense of surgery. All positive changes occurred within the first month following the injections. And the benefits remained when patients were checked at the end of six months. Younger patients (55 years old and younger) seemed to improve more than older adults. Weight loss was not required for good results. The authors concluded that the use of hyaluronate injections for ankle osteoarthritis is safe and effective. Further studies are needed to determine the optimum number of injections needed for the best results. It's possible that some patients would do better with five injections instead of three (and vice versa). Longer follow-up is also needed to see if the benefits last more than six months. With larger study groups, it might be possible to determine which patients with ankle arthritis are the best candidates for this type of treatment. It would be helpful to know the best timing of treatment. Earlier use of hyaluronate to lubricate the affected ankle might help patients maintain balance, strength, and proprioception (fine tuning that signals even the smallest change in joint position). And finally, hyaluronate injections must be compared to other conservative (nonoperative) treatment methods (e.g., physical therapy, antiinflammatories, weight loss, orthotics, activity modification). The result of different treatments combined together versus just viscosupplementation will be necessary. Perhaps comparing surgical results to hyaluronate injections would yield some additional helpful information for patients like yourself who are looking for an alternative approach to surgery.

Shu-Fen Sun, MD, et al. The Effect of Three Weekly Intra-Articular Injections of Hyaluronate on Pain, Function, and Balance in Patients with Unilateral Ankle Arthritis. In The Journal of Bone and Joint Surgery. September 21, 2011. Vol. 93-A. No. 19. Pp. 1720-1726.

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