Prolotherapy for Ankle & Achilles Pain

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.

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.

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.

JC 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. JC said he felt better than he did in high school!

NA had been dealing with chronic Achilles tendonitis for more than three years prior to being seen at Caring Medical. At 40 years old, he was normally very active, but had to stop running and playing tennis due to pain. After the first two dextrose Prolotherapy treatments, he saw improvement in daily pain levels but he still had pain with exercise. NA was advised to wear a boot for two months while we continued to treat with the addition of Platelet Rich Plasma (PRP Prolotherapy) for his following four treatments. After the series of treatments, he reported significant improvement which was also visible when viewing the tendon under ultrasound!

JM complained of a “protruding marble” on his Achilles. He had received surgery with a screw insertion after rupturing his Achilles tendon in nearly two decades prior. His returning pain made walking almost impossible. An orthopedic surgeon recommended surgery to remove calcium deposits, but JM sought Prolotherapy instead in hopes of avoiding another surgery. 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.

SH injured her ankle while training for a half marathon when she was 26 years old. She developed pain and swelling during her run that caused her to start limping. After resting for a weekend, the pain and swelling continued with long distance walking. She was seen at Caring Medical for two treatments of H3 Prolotherapy while modifying her training schedule. Four months after her first treatment, she reported a pain free ankle and was back to training!

IG suffered with chronic ankle pain for more than 30 years after undergoing surgery for fracture. By his early 50’s, the pain had increased to the point of not being able to stand or walk at times. This was a terrible problem because he and his family relied on him as the primary provider, and he had a very physically demanding job as a builder. He experienced constant pain and swelling which would also interrupt his sleep. IG tried wearing braces which did not give enough support. He was diagnosed with osteoarthritis per his X-ray imaging but was not given any recommendations for treatment prior to being seen at Caring Medical. Due to the amount of degeneration present from years of instability, a comprehensive approach of Prolotherapy and Platelet Rich Plasma was recommended. IG reported improvement with each visit and needed a total of 6 visits to reach his goals. At his last visit, the pain was no longer constant or waking him up at night. IG may require maintenance treatments once or twice per year but if he wears supportive shoes and continues the recommended preventative exercises regularly, he should be able to avoid further surgery.

MD, a 59 year old school administrator from Alaska, had chronic right lateral ankle pain for three years after a severe ankle sprain. Initial x-rays were unremarkable. Her ankle inverted while dancing, significantly increasing her pain. She was treated with an extensive period of guarded weight bearing, crutches, and non-weight bearing for several months but noted no improvement. A corticosteroid shot produced no results. An MRI on 7/7/2010 then showed prominent AVN of the talar dome involving the central to posterior aspect. She was offered various surgical options including arthroscopy with debridement, allograft osteochondral transfer, core decompression and ankle fusion through external fixation. The prognosis for complete pain relief with these options was guarded so MD decided to seek more conservative treatment.

In February 2011, MD decided to seek treatment of her condition by Prolotherapy. She presented complaints of severe pain, stiffness, crepitation, and extremely limited ankle motion to Caring Medical and Rehabilitation Services. Her pain would dramatically increase with any weight bearing and continue to increase throughout the day. She could not even walk around her house without pain. She stopped all extraneous walking, exercise, and hiking. Her pain was further aggravated merely by standing on her feet. She complained of swelling around the ankle. On physical examination an obvious limp was noted. Notable tenderness was observed in the anterior and posterior talofibular, calcaneofibular, deltoid, and tibiotalar ligaments. Her active range of motion was as follows: dorsiflexion 10 degrees; plantar flexion 15 degrees; subtalar eversion 5 derees; and subtalar inversion 10 degrees.

The following areas in the right ankle joint and its medial and lateral bony attachments were injected with a 15% dextrose, 0.1% procaine and 10% Sarapin solution: medial and lateral malleolus, talus, navicular, calcaneus, cuboid, and calcaneus, deltoid, plantar calcaneonavicular, talonavicular, anterior and posterior tibiofibular, anterior and posterior talofibular and calcaneofibular ligaments. A total of 36cc of solution was utilized in 22 separate injections.

For the bone marrow aspiration, an EZIO-10 drill with 28mm bone marrow needle was used. Once the periosteum was reached, anesthesia in the area was confirmed. The EZIO-10 drill was turned on and once the periosteum was pierced, the drill was turned off. The stylet was removed from the neelde. A 12cc luer lock syringe with 2,000 IU of heparin (2cc) was attached to the cannula hub, then 10cc of bone marrow was extracted. The syringe was detached and an empty 10cc syringe was attached and with negative pressure the needle was removed. Pressure over the area was then applied with gauze for two minutes. A pressure dressing was then placed on the area and secured with tape.

Five ccs of direct bone marrow solution was then instilled into the ankle (tibiotalar) and subtalar joints after 1cc of 8% procaine (80mg of procaine) was injected. MD was instructed to follow-up every two months.

When MD came in for her second visit, she was pleased to report that her ankle felt stronger and more stable. She was able to be up on her feet for longer periods of time without pain and she could now walk about a half mile without pain. At her third visit, MD enthusiastically reported an even greater improvement. She was back to hiking up to three miles on hilly, uneven ground and she said that there were several days over the past couple months where she had absolutely no pain in her ankle. On her fourth visit, she reported being able to do activities of daily living without pain and could hike most days without any pain. She could now hike longer, more often, and go up mountains. Only with extreme strenuous hiking did she have symptoms. On physical examination she had only very minimal tenderness in the medial and lateral ankle ligamentous attachments and her active range of motion was as follows: dorsiflexion 15 degrees; plantar flexion 30 degrees; subtalar eversion 12 degrees; and subtalar inversion 16 degrees. She now walked, jumped, hiked, and ran with only minimal symptoms. She was phoned six months after her last visit and stated her pain on a 0 to 10 scale was 1 was aggressive activity, but had 0 pain with normal daily activities and no pain at rest. Her ankle swelling has completely resolved. She had no limitation of activities and has resumed aggressive mountain hiking. She is on no pain medication. Read the entire case report here.

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.