Marc Darrow MD,JD

In this article I will focus on the problem of avascular necrosis in the ankle, mainly the talus bone in the ankle, and to suggest if stem cell therapy may be an effective treatment in helping you avoid ankle replacement or ankle fusion surgery.

Many people that contact me asking about their ankle pain tell me about a terrible accident or injury that they had in the past. Their ankle was damaged and surgery or long bouts of casting and immobilization was able to put their ankle back together as best as possible. Over the years these people managed along managing various bouts of pain and stiffness. At some point osteoarthritis developed in the ankle and their surgeon recommended an ankle replacement or an ankle fusion. Many declined these surgeries as they saw the surgery as the end of their activities and the welcoming point of a sedentary lifestyle.

Once having declined the surgery, these people now resorted to ankle braces, cortisone and hyaluronic acid injections. Treatments and remedies that had now become ineffective for them.

I also have people contact me who have had a degree of success in pain alleviation with stem cell therapy but have plateaued, they still cannot return to activities such as work, golf, or even stand for any length of time. These people want to know how they may get closer to their treatment goals of being near of fully functional again.

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Marc Darrow MD,JD

We do get many emails about ankle pain. Some people write that they are on a waiting list for an ankle fusion, sometimes one, sometimes both ankles, and while they are waiting, they want to know if stem cell therapy can be an option. Others write that the are bone on bone and have lost all the cartilage in their ankle, can we help?

I usually respond asking about the limitations the person has. If the ankle can still bend and rotate? Generally speaking, if your ankle is not locked in place by bone spurring and you can still move your foot around, we would think that stem cell therapy could help. I discuss this below.

Treatment options for advanced ankle osteoarthritis

A study published in March 2019 (1) discusses the problem orthopedists and surgeons have in presenting treatment options to their patients with advanced ankle osteoarthritis. As many doctors and patients are aware, ankle osteoarthritis treatment protocols have no real guideline recommendations of its own. Researchers say most doctors treat an ankle problem as they would treat a knee or hip and follow hip or knee treatment protocols when treating the ankle. Is this really such a bad thing?
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Marc Darrow MD,JD

Someone who has a medical history including numerous ankle arthroscopic procedures will usually contact out office looking for options to their next surgery which would be an ankle fusion or a total ankle replacement. Usually, someone being told they need one more surgery will lead these people to more exhaustively research alternatives. This includes the various types of ankle injections.

A July 2020 paper (1) compared various injection treatments for ankle pain caused by osteochondral lesions (loss of cartilage leading to a bone on bone situation) and osteoarthritis. The injection treatments included were hyaluronic acid, Platelet-rich plasma (PRP), saline, methylprednisolone (steroid), botulinum toxin type A, mesenchymal stem cells (MSCs), and prolotherapy.

This was a review study where researchers combined studies and the study data to form an opinion on which of these treatments would work best. The problem with the results of this study? There were not enough studies of good evidence in direct comparisons of ALL the treatments for the researchers to review to give any opinion. While we then cannot offer a direct comparison of the treatments, we can review the research in this article where there is a direct comparison and give a broad over view of these treatments for ankle pain.
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Marc Darrow MD,JD

Systemic and local side-effects of corticosteroid injections including joint destruction

A patient will often come into our office with conflicting ideas about cortisone injections. The patient will tell us that his/her other doctors told them that cortisone injections are safe, effective, and will help their pain, if used sparingly. But, intuitively, the patient had doubts and concerns.

But as this patient continued to wait for a surgery, decisions had to be made as to how much pain management would be needed to “hold them over,” until the surgical date.

Corticosteroids are powerful anti-inflammatory substances. They are not used to relieve pain, but rather, to reduce inflammation, which in turn can lessen a patient’s level of discomfort. Numerous studies over the years have shown that prolonged use of cortisone will eventually cause degenerative joint disease in the joints they are injected into.

Understanding the possible complications of corticosteroid injections

Here are some of the most recent papers reminding doctors about the possible side effects of corticosteroids:

A January 2021 (1) study issued this statement:

“The current evidence would suggest that the use of corticosteroids provides moderate short-term benefit for reducing pain and improving functioning. These benefits generally last several weeks without long-term effectiveness. In addition to its limited short-term effectiveness, there are multiple potential adverse effects including toxicity to articular cartilage and numerous systemic side effects such as increases in blood glucose levels, a reduction in immune function, and an increased risk of infections.”

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