Ankle Fusion

Ross Hauser, M.D., presents a case history of a patient who has chronic ankle pain and was offered ankle fusion. Dr. Hauser talks about this patient case where Prolotherapy was offered as an alternative

THE CASE OF PW
PW came to Caring Medical about 18 months prior to his latest visit, he had almost no ankle movement. Both of his ankles were a mess. The right one worse than the left. He thought that his only option was an ankle fusion. This not a great option for someone weighing 250 pounds. He was hopeless. He was surprised when he walked off the elevator to our office and saw the sign “Hope Practiced Here”. Prolotherapy gave him hope.
 

The protocol I used was Prolotherapy with human growth hormone (HGH) and glucosamine for the severe osteoarthritis. Physical examination on PW’s first visit confirmed basically no ankle movement. At his latrest examination he had about 50 degrees of dorsiflexion and plantar flexion and 10 degrees of eversion/inversion on his “bad” ankle.

Besides Prolotherapy, I instructed PW to walk on a Bosu ball and do other exercises, including cycling, to build up his ankle/foot strength. I also prescribed some supplements to aid the healing.
 

Why Prolotherapy instead of ankle fusion? When someone has a severely arthritic joint like the ankle, what they need besides pain control is (Ankle) stability. Fusion does provide this. The problem is when you fuse a joint, other joints have to move more or take up the force that is transmitted from the fused joint. Prolotherapy gives a person the option to get pain control and stability, but also provides the possibility of improving the joint motion, all without a major operation.

While the person undergoes Prolotherapy, he/she can also be active, so there isn’t the loss of work time. Typically in our office for severely arthritic joints a full year of Prolotherapy is needed. This would be one visit/month.
 

How does a person with a severely arthritic ankle get more motion, but yet more stability and less pain with Prolotherapy? Prolotherapy is given into the subtalar joint and all the ligaments and tendons around the ankle. Clearly some of the pain is from the ligaments and tendons. Prolotherapy is a regenerative injection technique. Studies have shown that it helps regenerate and strengthen ligaments and tendons. Some anecdotal studies have shown cartilage regeneration. We presume that there is cartilage regeneration in ankles, but studies to prove or disprove that have not been done. All I can say is having done a lot of ankles that the results have been fantastic with Prolotherapy.