Prolotherapy for Ankle & Achilles Pain

Did you know that once you have sprained your ankle, you are much more likely to sprain it in the future? Ankle sprains can easily, and often, lead to chronic ankle instability! This means that a “simple” sprained ankle quickly becomes a progressive, degenerative condition. Degeneration needs regeneration! If you are dealing with an acute ankle injury, such as an ATFL tear, or chronic ankle pain conditions, such as osteoarthritis, our specialists want to help you. Since 1993, Caring Medical has been a leader for Comprehensive Prolotherapy (including traditional dextrose, Platelet Rich Plasma, and Stem Cell therapy) for ankle pain and helped thousands of patients. Our team has continued to publish research and improve the Prolotherapy treatment regimens used to help ankle and Achilles tendon pain from a variety of conditions, including arthritis, sports injuries, Ehlers-Danlos syndrome, avascular necrosis, tendinosis/tendinitis, complex regional pain syndrome, and more. Navigate through the sections below for lots of ankle pain information or get help from our medical staff now.

ankle instability

Symptoms caused by Ankle Instability

  • Ankle discoloration
  • Ankle inflammation
  • Ankle pain
  • Ankle swelling
  • Arch cramping
  • Crepitation with movement
  • In mild cases, there may be a propensity for the ankle to continually turn inward
  • Inability to move the ankle properly
  • Popping
  • Loss of motion
  • Loss of muscle strength
  • Mild aching to sudden pain
  • Numbiness in toes
  • Pain even when no weight is put on the ankle
  • Referral foot and toe pain

These symptoms can be signs of the following ankle pain conditions caused by ankle instability that we commonly treat with Prolotherapy.

Chronic Conditions caused by Ankle Instability


Ankle Instability Forces

Inversion forces stress the lateral ligament complex; whereas eversion forces stress the deltoid ligament.

ankle ligament instability

Prolotherapy Treatment for Ankle Pain

Ankle pain is most commonly due to ankle joint instability, caused by ligament damage. Since ligaments do not heal well on their own, ankle instability quickly becomes a chronic, painful condition. It allows for destructive joint motions every time the ankle joint is used, wearing down the cartilage and causing further structural damage.

Ankle Forces

The stability of the ankle has to be made greater to run compared to slow walking on account of tremendous forces generated with running.

In Achilles tendon with walking 1.2 times body weight
Slow walking 2.1 times body weight
Fast walking 3-5 times body weight
Running Up to 13 times body weight

Stauffer RN, Chao EYS. Force and motion analysis of the normal, diseased and prosthetic ankle joints. Clin Orthop Relat Res. 1977;127:189-196. Proctor P, Paul JP. Ankle joint biomechanics. J Biomech. 1982;15:627-634. Burdett RG. Forces predicted at the ankle during running. Med Sci Sports Exerc. 1982;14:308-316.

Our providers understand the need for ankle stability to prevent the long-term damage of ankle instability. Therefore, we utilize Comprehensive Prolotherapy to restore the ligament integrity and strengthen the joint function. This prevents the continued cartilage degeneration through destructive joint motions and allows the ankle a chance to heal. Prolotherapy, in simple terms, stimulates the body to repair painful areas. It does so by inducing a localized, mild inflammatory reaction in the weakened ligament and tendon attachments. Since the body heals by inflammation, Prolotherapy stimulates healing. This can include traditional dextrose Prolotherapy and sometimes combined with Platelet Rich Plasma (PRP) and/or Stem Cell therapy, as these are all types of Prolotherapy.

Direct Bone Marrow Ankle Injection

direct bone marrow bone marrow Prolotherapy

For ideal results, the ankle must be treated comprehensively, meaning this is not just a one or two injection treatment. At Caring Medical, one of the reasons our Hackett-Hemwall technique is sought is due to it addressing more weakened areas per treatment than the average PRP/Stem Cell/Prolotherapy doctor who gives only one or two injections.

Chronic ankle sprains have been effectively eliminated with our Comprehensive Prolotherapy treatment series, usually taking just a short series of treatments for most patients to obtain long-term results. A physical examination and consultation with one of our Prolotherapists can identify the areas of the ankle that are most unstable and need treatment, as well as which Prolotherapy solution is best for your particular case, and approximately how many treatments should get you back to where you want to be.

Examination of Lateral Ankle

Excessive movement or soft end feel compared to non-painful side while inverting ankle is a sign of lateral ankle instability.

direct bone marrow bone marrow Prolotherapy

Our Research on the use of Prolotherapy for Ankle Pain

In our retrospective observational study of chronic unresolved ankle pain, Hackett-Hemwall dextrose prolotherapy helped promote a measurable decrease in the pain and stiffness of the treated joints and improvement in clinically-relevant parameters. The complete study and results can be read here: Hauser R, et al. Dextrose Prolotherapy injections for chronic ankle pain. Practical Pain Management. 2010;70-76.

Average pain level BEFORE Prolotherapy
Average pain level AFTER Prolotherapy

Pain scale is 1-10 where 1 = no pain & 10 = unrelenting pain.

We get patient satisfaction results. 100% of patients in this study felt that Prolotherapy changed their life for the better and 100% have since recommended Prolotherapy to someone else.

Our other studies on regenerative treatment outcomes for ankle pain

Patient Success Stories using Prolotherapy for Ankle Pain

Ankle Instability from Ehlers-Danlos Syndrome

Kristle Lowell, Double-Mini Trampoline World Champion, diagnosed with EDS was experiencing severe instability from multiple ligament injuries of her left ankle and received massage, physical therapy, cortisone and NSAIDS, from which she saw no long-term relief. In order to inhibit menstruation from interfering with training, she went on birth control pills, which caused a worsening of symptoms. Kristle suffered a career threatening injury to her ankle, which made gymnastics training unbearable. She came to Caring Medical and received 2 PRP Prolotherapy treatments, and discontinued the birth control pills. Her ankle was stabilized, enabling her to compete and place second in national championships and qualify for world championships.


Cortisone, NSAIDS, PT and MT do nothing to strengthen the ligaments of an unstable joint. Prolotherapy strengthens the injured ligaments and stabilizes the joint. Estrogen in birth control pills inhibits the fibroblastic proliferation necessary for the healing of ligaments. Fibroblastic proliferation is the mode of healing by which Prolotherapy repairs.

Avascular Necrosis of the Talus

JS was diagnosed at age 13 with Crohn’s Disease for which she had been prescribed Prednisone over numerous years. At age 34, she began experiencing pain, swelling, achiness, crepitus and burning in the ankle, and was diagnosed with avascular necrosis of the talus, for which her orthopedist recommended fusion surgery. JS decided instead to seek out Prolotherapy. After 5 treatments of Bone Marrow to the joint and Prolotherapy to the ligaments, her symptoms resolved, enabling her to walk on a strong, pain-free ankle.


Long-term anti-inflammatory use with corticosteroids makes it more likely a person will experience joint degeneration and ligament laxity, even to the point of causing bone death or avascular necrosis. In such scenarios, Prolotherapy should be sought as early as possible to resolve the condition.

Achilles Tendon Rupture

JM complained of a "protruding marble" on his Achilles. He had received surgery with a screw insertion after rupturing his Achilles tendon 18 years prior. The Achilles pain returned and made walking almost impossible. An orthopedic surgeon recommended surgery to remove calcium deposits, but JM sought Prolotherapy instead. Ultrasound showed small tears in the Achilles, with separate “pieces” of calcium deposits. After just one treatment of PRP Prolotherapy under ultrasound guidance, the pain resolved and the calcium deposits were broken up and reabsorbed.


While the average patient needs a few treatments, sometimes only 1 or 2 are needed. In this case, only 1 comprehensive PRP Prolotherapy treatment was needed to successfully remove calcium buildup in the Achilles tendon and alleviate the pain, without the need for another surgery.

Ankle Sprain Re-injury Risks

JN came to Caring Medical, approximately 1 month after spraining his ankle. Although he was not experiencing severe pain, the ankle became weak and greatly limited his ability to exercise. He had suffered chronic ankle injuries in his 20s and knew that the statistics for re-injury with ankle sprains are very high. As a runner, now in his early 50’s he did not want to chance further injury or eventual ankle surgery, and he really wanted to get back to running strong. After 5 treatments with Prolotherapy and Platelet Rich Plasma, he was able to return to trail running 16 miles without any pain or weakness. JN said he felt better than he did in high school!


The chance of re-injury to the ankle after an initial sprain is very high, especially when it is a few weeks out and activity is still limited due to pain or weakness, and/or the ankle swells, subluxes, or feels unstable. It is the ideal time to start Prolotherapy before further joint damage is done and the ankle joint starts quickly breaking down and the person loses the ability to walk and gets severe ankle arthritis.

Improvement of Ankle X-rays with Stem Cell Prolotherapy

This patient received several lipoaspirate Prolotherapy treatments between x-ray studies. The studies showed a gradual improvement in the ankle joint articular cartilage (arrows), which correlated to reduced pain and range of motion improvement.

Ankle X-ray Stem Cell Prolotherapy

More Information About Prolotherapy for Ankle Pain

Articles about Prolotherapy for Ankle Pain

Videos about Prolotherapy for Ankle Pain

More Ankle & Achilles Prolotherapy Videos

Books about Prolotherapy for Ankle Pain

Prolo Your Pain Away!Read about treating ankle pain with Prolotherapy in our free E-book, Prolo Your Pain Away! Curing Chronic Pain with Prolotherapy, 4th Edition. This edition explains all about Prolotherapy and how it is used to permanently alleviate pain from arthritis, sports injuries, and all types of chronic pain conditions! Plus, it takes an expanded look at the medical literature and patient studies on Regenerative Medicine: Prolotherapy, Platelet Rich Plasma, Stem Cell Therapy, and more!

We Get the Best Results

In 9/10 cases we meet or beat the patients expectations. Our results are long lasting and provide permanent pain relief. This is why for 25 years, patients have been traveling from all over the world to see our providers. Give us a call, or fill out the form below to get started.

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