Most people suffering from ankle problems are between the ages of 35 and 85 years. Most go opt for surgical treatments, more out of familiarity with surgery than knowledge of alternative options. But did you know that the chance that you’ll develop post-surgery problems when being treated for foot and ankle problems is 10%? Depending on how your problem affects your life at the moment, you may or may not consider surgery.
Some of the problems that could as a result of ankle surgery include:
- Infection of the wound
- The bone heals slowly
- Depending on the foot being operated on your ability to drive could be affected
- If you need screws or pins a second surgery may be needed to remove them
- Infection of joint replacement parts
- Possibility of another surgery if some problems are too major among others
- Post-surgery pain which may last a long time, especially if the wound heals slowly
A long period in rehab. If you are the sole source of income for your family this could cause problems
Most of these issues will go away in the long term and do not affect whether the surgery helps you are not. The more serious issues like infections in the bone could result in a much longer recovery time. The “hassle” factor may be more of an issue for most people when considering ankle surgery than the potential for post-surgical problems.
Until fairly recently, alternatives for ankle surgery were virtually non-existent. Bone fractures and breaks were fairly easy to treat. Surgery or a cast was the normal course of action, but what about other types of ankle injuries?
Common Causes of Ankle Injuries
The most common injuries on the ankles are: Osteoarthritis, ligament tears, sprained ankle and instability of the joint.
This is usually an “aftermath” of trauma, infection or injury of the ankles. Between the ankle bones is the articular cartilage, a smooth and slippery fiber that acts as a connective tissue and a cushion protecting the bones. If the cartilage starts deteriorating or gets lost, the space between the bones at the joint narrows. This usually signifies osteoarthritis of the ankle. It can easily be seen in X-rays.
Ligament tears, sprained ankle and instability
Bones are connected to each other by tough bands of tissue known as ligaments. On the side of the ankle furthest from the other ankle are three ligaments: The ATFL, the CFL and the PTFL. These form the ligament complex on that side. The ATFL and the CFL are usually the ligaments involved in an inversion injury because the CFL prevents inward roll of the ankle while the ATFL prevents a forward slide of the ankle. An ankle sprain, if not attended to, result in the ligaments tearing or stretching. Depending on the degree of the sprain, all or part of the ligaments may be torn.
Ankle sprains are classified as grade 1, 2, and 3. Depending on the amount of damage or the number of ligaments that are damaged, each sprain is classified from mild to severe.
- A grade 1 sprain is defined as mild damage to a ligament or ligaments without instability of the affected joint
- A grade 2 sprain is considered a partial tear to the ligament, in which it is stretched to the point that it becomes loose
- A grade 3 sprain is a complete tear of a ligament, causing instability in the affected joint.Bruising may occur around the ankle
In the past the typical treatment options revolved around R.I.C.E. (Rest, Ice, Compression, Elevation), anti-inflammatory medication, ultrasound or physical therapy. Recent medical breakthroughs have now added two more treatment options for ankle injuries and postponed or alleviated the need for ankle surgery altogether.
These top two ankle surgery alternatives, Stem Cell and Platelet Rich Plasma (PRP) procedures, are usually simple office procedures and you don’t have the same risks associated with surgery. In fact, patients who undergo these procedures are normally encouraged to exercise (walk) that same day with little to zero downtime resulting from the procedure.
Stem Cell Therapy for Ankles
The entire procedure should involve the following steps:
Step 1. Prolotherapy Injection
In order to stimulate the healing response prior to injecting stem cells, a prolotherapy injection is performed two days prior to the stem cell procedure. A typical prolotherapy injection consists of a solution made of dextrose (sugar) and water—and sometimes other harmless substances such as vitamins—which can be used to temporarily increase inflammation and activates the natural healing mechanism in the body.
Step 2. Harvest the Stem Cells
Once you are found to be a good candidate, the first procedure is to draw the adipose fat tissue in order to prepare the stem cells. Typically, the fat will be taken directly from your stomach or hip area.
Step 3. Prepare the Stem Cells
The adipose fat that was taken is placed in a centrifuge and spun at high velocity to separate out the stem cells from the other elements in the fat. Once separated, they are placed back into a syringe and are now ready to be reintroduced into the affected joint.
It is important to note that once the stem cells are harvested, they should be reintroduced back into the body within a few hours. If a medical facility tells you to come back tomorrow to complete the procedure, the stem cells will have degraded to a point that will render them virtually useless. Ensure the medical facility performs the entire procedure during the same doctor’s visit.
Step 4. Inject the Stem Cells Back into the Body
This next step is very important and one that is often overlooked by patients. How the physician determines where to place the new stem cells is critical. In most joints, there are very small areas that will be targeted for reintroducing the stem cells into the affected joint. To ensure the accuracy of the injection, image guidance technology should be used by the doctor.
This technology will guide the doctor’s injection into the correct place. If the injection is just slightly off, the procedure will most likely fail and the patient will receive no benefit at all.
If your doctor tells you he manually injects the stem cells into the joint based on experience, it would be wise to seek a second opinion before starting any procedure.
Step 5. Aftercare
After 3 months and 6 months a PRP injection should be given to the patient to aid in the healing process.
Platelet Rick Plasma Therapy (PRP)
PRP therapy for ankles is a fairly similar process to stem cell therapy, except that the process uses your platelets rather than stem cells. The procedure starts out with the patient getting between 40 and 60cc of their blood drawn. That blood is then placed in a centrifuge, which spins it at a high speed for between 10 and 15 minutes. The result is that the different types of blood cells that make up the blood are separated; the portion with the platelets is then extracted.
The concentrated platelets are then injected back into the body at the site of the injury. Again image guidance is used to guide the needle to the precise point where the injection will be most helpful.
The PRP preparation may contain up to 10 times the amount of platelets found in blood.
PRP may be administered as one injection or in a series depending on the severity of the injury and how each person’s body responds to the therapy.
Types of Ankle Injuries That May Respond Well
If you have any of the following ankle injuries, you could be a very good candidate for Stem Cell Therapy of PRP Therapy:
- Peroneal tendon split or tear
- Instability of the ankle
- Sprain or tear of the ligament
- Tarsal tunnel syndrome
- Sub-talar arthritis (instability)
- Plantar fasciitis.
Contact your physician to learn more about the alternative treatments for ankle problems. Advancements in the treatment of such disorders is always progressing and may suit your condition better than surgery ever could.
As with any form of medical treatment, you should consult with your physician before embarking on any treatment plan. The information contained in this article is for informational purposes only and should not be deemed accurate for the purposes of diagnosing your particular medical condition