ANKLE INJURIES & PAIN

Osteoarthritis of the ankle usually occurs in ankles that have experienced trauma, infection, or injury. A smooth, slippery, fibrous connective tissue, called articular cartilage, acts as a protective cushion between bones. Arthritis develops as the cartilage begins to deteriorate or is lost. As the articular cartilage is lost, the joint space between the bones narrows.

As the disease progresses, the cartilage thins, becoming grooved and fragmented. The surrounding bones react by becoming thicker. They start to grow outward and form spurs. The synovium (a membrane that produces a thick fluid that helps nourish the cartilage and keep it slippery) becomes inflamed and thickened. It may produce extra fluid, which causes additional swelling.

In the past, when traditional treatments like anti-inflammatory and pain medications didn’t quite relieve ankle pain, doctors had no other alternative but to suggest surgery. Surgery to treat osteoarthritis of the ankle typically consists of bone fusion or complete replacement of the ankle joint. More times than not, the recovery process of the procedures are long and painful.

Stem Cell therapy now offers a much-needed alternative.

Every day an estimated one out of every 10,000 people sprain their ankle, an injury in which one of the two major ligaments on the outer portion of the ankle is stretched and/or torn. About 10% of these sprains develop into ankle instability, a condition in which the ligament has healed in a lengthened position. as a result, the person is prone to a feeling of the ankle “giving out” and to additional sprains.

Regenerative techniques using stem cells can be performed to rebuild the damaged ligament(s) and improve the ankle’s stability. This very short procedure will often allow the patient to carry on with their normal routines without experiencing any downtime.

Bunions are a progressive disorder that occurs when the big toe pushes against the next toe, forcing the joint of the big toe to get bigger and stick out. Bunions can be extremely painful and are vulnerable to excess pressure and friction from shoes that can lead to the development of calluses.

Another type of bunion which some individuals experience is called a tailor’s bunion, or a bunionette. This is a much smaller bump that forms on the outside of the foot towards the joint at the little toe.

Bunions are a common problem, experienced mostly by women caused by:

• an abnormality in foot function or arthritis.
• wearing improper fitting footwear. Tight, narrow dress shoes with a constrictive toe box causes the foot to begin to take the shape of the shoe, leading to the formation of a bunion. Too small shoes cause their toes to squeeze together, which results in the first metatarsal bone to protrude on the side of the foot.

Bunion deformities cannot be reversed, but there are many non-surgical methods to reduce the pain and inflammation. Stem cell therapy is an option for some patients suffering from bunion symptoms.

A ligament sprain is a stretch or tear in the bands of tissue that connect our bones at the joints. Ligaments stabilize and support the body’s joints. Sprains typically happen when the ankle is twisted or rolled to the point of overstretching or rupturing the ligaments.

The ankle is a hinge joint between the leg and the foot that allows up and down movement. The bones of the leg (tibia and fibula) form a slot, and the talus bone of the foot fits between them.

Ligaments are strong bands of tissue that hold the talus bone to the other two bones. Each ligament is made of many fibers of a material called collagen, which is extremely strong.

The ligament on the outside of the ankle, called the lateral ligament, is made up of three separate bands: one at the front, one in the middle, and one at the back. The front and middle bands are the ligaments injured in a sprain. Most ligament sprains are caused by the foot twisting inwards. All of the body’s weight is then placed on the lateral ankle ligaments. The fibers of the ankle stretch or tear in a sprain.

The more severe the sprain is, the more difficult it is to use the affected area. Someone with a mild ligament sprain may just favor that ankle slightly, while a more severe sprain may cause much more pain and make it difficult or impossible to walk.

The use of stem cell injections may allow the injury to heal itself from the inside.

The peroneal tendons are the two tendons on the outside of the ankle that attach the muscles to the bones. Peroneal tendon problems commonly occur from an ankle sprain. A tear or split in one or both of them can occur after repetitive trauma or overuse.

At times, it can cause the arch of the foot to increase in height.

Peroneal tendon tears are often due to persistent chronic injury, but may also occur from an acute injury. Repeated, stressful movements may wear the tendons down over time, causing them to tear or split. The tendon may also rupture if an injury puts greater force on the tendons than they can handle.

The injured tendon may be repaired through the use of stem cell therapy, using the patient’s own stem cells to heal the injury with a minimally invasive, same-day procedure. After the procedure, the patient experiences virtually no down-time and is able to go about their usual routine.

The use of stem cell injections may allow the injury to heal itself from the inside.

The plantar fascia is a long, thin ligament that connects the heel to the front of the foot. Plantar fasciitis occurs when the plantar fascia becomes irritated and inflamed, causing pain on the bottom of the heel.

Plantar fasciitis, which is particularly common in runners, causes a stabbing pain that occurs with your very first steps in the morning. Once the affected foot limbers up, the pain of plantar fasciitis normally decreases, but it may return after standing for a long period or getting up from a seated position. Aside from runners, people who are overweight, people who do a lot of standing on hard surfaces (teachers, factory workers, etc.), and those who wear shoes with inadequate support are at risk of plantar fasciitis.

Diagnosed with a physical exam and x-rays, plantar fasciitis will typically be treated with physical therapy, medication, foot-bracing, or cortisone injections. Unfortunately, symptoms often return in a high percentage of patients when treated in this fashion. While surgery to cut the plantar fascia is an option, it often results in a gradual destruction of the arch, which can eventually collapse. Surgery should be used as a last resort.

A much safer and long-lasting approach to heal the injury is through the use of regenerative treatments, like proliferation or stem cell therapy.

The subtalar joint is the joint below the ankle that allows us to bend the ankle back and forth and walk on uneven terrain. Arthritis or instability of the subtalar joint causes uncomfortable, sometimes excruciating pain in the back of the foot or ankle, typically described as being “deep.”

Subtalar arthritis is usually caused by a fracture in the foot, typically the heel bone. It can also be caused by excessive wear and tear on the joints resulting from too much activity.

Subtalar instability is difficult to diagnose. It rarely follows a complete dislocation, which more than likely results in pain, stiffness, and arthritis. Instead, it can be suggested by the patient’s feeling of ankle instability, or a sensation of the ankle giving out, as well as a need to look at the ground when walking.

Treatment usually involves limiting joint movement by wearing a brace or comfortable shoe, decreasing standing or walking on uneven terrain, or taking anti-inflammatory pain medication to alleviate any swelling or irritation.

Regenerative medicine, such as a stem cell injection is an option for some patients, with very little rehabilitation afterward.

Tarsal tunnel syndrome is caused by anything that produces compression on the posterior tibial nerve, which is the nerve that provides sensation to the bottom of the foot. Having flat feet or severe swelling from an ankle injury can create this compression.

The tarsal tunnel refers to the canal formed between the ankle bone and the band of ligaments that stretches across the foot. Inside the tarsal tunnel are the nerves, arteries, and tendons that provide movement and flexibility to the foot. One of the nerves in the tarsal tunnel is the tibial nerve, which provides sensation to the bottom of the foot. When this nerve is compressed, the resulting condition is called posterior tibial neuralgia, or tarsal tunnel syndrome. Causes include:

• Having flat feet or fallen arches
• Swelling caused by an ankle sprain
• Diseases such as arthritis or diabetes
• An enlarged or abnormal structure, such as a varicose vein, ganglion cyst, swollen tendon, or bone spur

It is necessary to determine the severity of the condition, so the appropriate treatment plan can be administered. Proper diagnosis of tarsal tunnel syndrome requires the expert attention of experienced neurologists and nerve specialists.

In less severe cases, non-surgical treatment is recommended by using steroid injections or anti-inflammatory medications to relieve pressure and swelling. Braces, splints, and other orthotic devices can be used to limit movement and reduce pressure on the foot that can cause compression to the tibial nerve. In more severe cases, a surgical procedure called a tarsal tunnel release may be performed to decrease pressure on the nerve from the overlying ligament.

Stem cell technology may help regenerate damaged tissue by injecting stem cells from the patient’s own fat cells or bone marrow directly into the injured tissue.