Dextrose Prolotherapy Injections for Chronic Ankle Pain

Authors: Ross A. Hauser, MD; Marion A. Hauser, MS, RD; and Joe Cukla, BA, LPN

A B S T R A C T

In this 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.

Practical Pain Management. Jan/Feb 2010.

Ankle sprains, especially of the lateral ligaments, are extremely common injuries in the general and athletic populations. Approximately 25,000 people sprain their ankles daily.¹ Sprains constitute 85% of all ankle injuries and, of these, 85% are inversion sprains.² Sprains of the lateral ankle complex make up 38-45% of all injuries in sports.^3,4 The recurrence rate for lateral ankle sprains has been reported to be as high as 80%.⁵ Up to 40% of individuals have residual ankle symptoms due to chronic instability.⁶ A 2005 study from the University of Bassel in Switzerland found that 70% to 80% of patients with chronic ankle instability end up with arthritic ankles.⁷ Long term residual symptoms from ankle sprains that do not heal can result in ongoing problems including pain, stiffness, limited range of motion and the inability to exercise or walk long distances.

Options such as medications, physical therapy, steroid shots, bracing and surgery typically leave the patient with residual symptoms.⁸ While the response to acute ankle sprains is usually quick; treatment for chronic ankle pain has had limited success. According to a 1999 review, there are more than 20 different delayed surgical procedures available for chronic ankle pain and instability. While most of these procedures are reconstructive in nature, none really restore true anatomy.^9,10 Because of this, many patients with chronic pain, including ankle pain, are open to alternative treatments. One of the treatments they are receiving is prolotherapy since more physicians are getting trained to perform it.¹¹ Prolotherapy for ankle ligament injuries has even been mentioned in the Mayo Clinic Health Newsletter.¹²

While prolotherapy has been used for decades to treat ankle injuries and chronic ankle pain, no specific studies on the results of prolotherapy on patients with chronic ankle pain have been done.¹³ Because of this, we decided to measure the response of patients who received dextrose prolotherapy. Not only did we look at pain levels, but we also reported on a host of quality of life measures that are important to those with chronic ankle problems.

Table 1. Patient Characteristics Prior to Prolotherapy.