Therapeutic injections may provide relief from ankle osteoarthritis pain and other symptoms. This relief is usually temporary, though occasionally it is long-term. In general, injections have a low risk of side effects.
Injections are typically done in a doctor’s office. Medical imaging, such as ultrasound, may be used to make sure the injection needle is placed in the correct location.
The most commonly used injections are hyaluronic acid (hyaluronate) injections and corticosteroid injections. Platelet rich plasma (PRP) and stem cell injections may also be suggested.
Hyaluronic Acid (Hyaluronate) Injections
The goal of hyaluronic acid injections is to provide lubrication for the ankle joint, as hyaluronic acid mimics the viscous synovial fluid that naturally lubricates the ankle joint. Research suggests hyaluronic acid injections may provide longer-lasting symptom relief than steroid injections. 1 Khlopas H, Khlopas A, Samuel LT, Ohliger E, Sultan AA, Chughtai M, Mont MA. Current Concepts in Osteoarthritis of the Ankle: Review. Surg Technol Int. 2019 Jun 25;35. [Epub ahead of print] PubMed PMID: 31237341.
The goal of steroid injections (e.g. corticosteroid injections) is to reduce inflammation and thereby alleviate swelling, stiffness, and pain. Steroid injections can provide short-term pain relief but do not prevent ankle osteoarthritis from progressing. 1 Khlopas H, Khlopas A, Samuel LT, Ohliger E, Sultan AA, Chughtai M, Mont MA. Current Concepts in Osteoarthritis of the Ankle: Review. Surg Technol Int. 2019 Jun 25;35. [Epub ahead of print] PubMed PMID: 31237341.
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Platelet Rich Plasma (PRP) Injections
Derived from a sample of the patient's own blood, PRP contains higher concentration of platelets than is found in normal blood. The goal of PRP treatment is to use the blood's natural healing properties to repair damaged tissue.
A few small research studies suggest PRP injections may reduce ankle arthritis symptoms in some people. 2 Fukawa T, Yamaguchi S, Akatsu Y, Yamamoto Y, Akagi R, Sasho T. Safety and Efficacy of Intra-articular Injection of Platelet-Rich Plasma in Patients With Ankle Osteoarthritis.Foot Ankle Int. 2017 Jun;38(6):596-604. doi: 10.1177/1071100717700377. Epub 2017 Apr 11. PubMed PMID: 28399635. , 3 Henning PR, Grear BJ. Platelet-rich plasma in the foot and ankle. Curr Rev Musculoskelet Med. 2018;11(4):616–623. doi:10.1007/s12178-018-9522-z , 4 Mei-Dan O, Carmont MR, Laver L, Mann G, Maffulli N, Nyska M. Platelet-rich plasma or hyaluronate in the management of osteochondral lesions of the talus. Am J Sports Med. 2012 Mar;40(3):534-41. doi: 10.1177/0363546511431238. Epub 2012 Jan 17. PubMed PMID: 22253252. In general, though, PRP is still considered a new and controversial treatment. PRP injections are not considered standard practice.
Stem Cell Injections
Like PRP injections, the goal of stem cell injections is to encourage healing. Researchers theorize that, when injected into to an osteoarthritic ankle, stem cells might develop into cartilage cells; suppress inflammation; slow down cartilage degeneration; and/or decrease pain. The stem cells used in these injections are usually collected from the patient’s fat tissue, blood, or bone marrow. Some proponents believe stem cells derived from bone marrow may be more effective.
Whether stem cell injections are effective in treating ankle osteoarthritis is a controversial subject. Very little research exists regarding these injections and ankle arthritis. 5 Vannabouathong C, Del Fabbro G, Sales B, Smith C, Li CS, Yardley D, Bhandari M, Petrisor BA. Intra-articular Injections in the Treatment of Symptoms from Ankle Arthritis: A Systematic Review. Foot Ankle Int. 2018 Oct;39(10):1141-1150. doi: 10.1177/1071100718779375. Epub 2018 Jun 18. PubMed PMID: 29909689. , 6 Emadedin M, Ghorbani Liastani M, Fazeli R, et al. Long-term follow-up of intra-articular injection of autologous mesenchymal stem cells in patients with knee, ankle, or hip osteoarthritis. Arch Iran Med. 2015;18(6):336-344. Stem cell injections are not considered standard treatment.
Most doctors agree that more research needs to be done regarding the exact dosages—the potency and frequency of injections—and their effectiveness in treating ankle arthritis.
General Information About Therapeutic Ankle Injections
A joint aspiration may be done before a therapeutic injection. During a joint aspiration, excess fluid that has collected in the ankle joint is removed using a needle and syringe.
An injection should never be done if an infection is present. Doing so can encourage the spread of infection to other areas of the body.
Occasionally, home remedies, medical treatments, and therapeutic injections are not enough to adequately treat ankle arthritis symptoms. In these cases, surgical options may be considered.