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Ankle Arthritis

Arthritis in the Ankles

Your ankle is located where the distal ends of the tibia and fibula bones (lower-leg bones) meet the talus bone at the foot. Between these bones are the ankle joints (e.g., tibiotalar, tibiofibular, subtalar, etc.). The ankle joint also consists of strong supporting tendons and ligaments. If you consistently experience ankle pain with walking or running or carrying a heavy load, this could be tendon inflammation, ligament instability, or arthritis in one of those joints.

Causes of Ankle Arthritis

By far, ankle instability is the most common cause of ankle arthritis that we experience with patients in our clinic.

Ankle instability occurs when the protective ligaments become stretched out, usually due to a previous ankle sprain or even normal wear and tear. Oftentimes with a sprained ankle, the pain subsides and the patient believes they have recovered, but if those ligaments have stretched out, this can create instability over time. This instability causes the ankle joint to deteriorate, and in time, arthritis develops.

Tackling instability before it becomes ankle arthritis is plan A, and these loose ligaments can be treated without surgery by your interventional orthopedic physician. Watch Dr. Centeno’s video below to learn more:

If your instability has progressed to ankle arthritis, there are regenerative medicine treatments for this as well.

Moving on down the lower limb to the toes, instability due to an old toe injury can also lead to arthritis in the toes. Surgery for toe injuries tends to make matters worse, creating more instability, and leading to faster arthritis down the road. Regenerative medicine solutions can work for the small toe joints with instability or arthritis as well.

Common Symptoms of Ankle Arthritis

Achilles Tendon Pain

The Achilles tendon, the thickest and strongest tendon in the body, originates from the calf muscles ( gastrocnemius, soleus, and plantaris) and inserts upon heel bone (calcaneus). Achilles tendonitis, an inflammation of the tendon, is painful and can be difficult to treat. Conservative therapy includes trials of NSAIDs, orthotics, and physical therapy. Physical examination was significant for weakness in the left big toe and abnormal neurologic exam consistent with nerve root irritation of a lumbar nerve root.  After being tapering off his cholesterol medication, RC underwent myofascial deactivation(IMS), x-ray guided injections of platelet-derived growth factors into the lumbar spine, ultrasound-guided injections of PRP, and physical therapy.

Read More About Achilles Tendon Pain

Ankle Pain After Walking

More than any other joint, our ankles bear the burden of all of our body weight. The ankles aren’t large weight-bearing joints, like our hips or knees; comparatively speaking, the ankles are rather small for the tasks they are assigned to do. If the ankles are normal and healthy and there isn’t a weight issue placing excess stress on the ankles, the ankles can typically bear the forces of walking, running, hiking, and so on quite well. However, when the ankles are weak or carrying too much weight, any additional forces placed upon them—even something as simple as walking—can create problems. Do your ankles get sore after walking? What about foot and ankle pain after hiking? If so, it’s a good idea to proactively address it now, before it gets worse, rather than resigning yourself to it and decreasing or stopping the activities you enjoy. We’ll explain more in a moment, but first let’s take a closer look at the structure of the ankle.

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Ankle Pain When Running

There are multiple causes of ankle pain while running. The six major causes are: Stress Fracture A stress fracture is a small crack in the bone due to overuse and repeated impact. They are a common cause of pain in runners, accounting for up to 16% of injuries. The shin bone (tibia) is the most commonly affected bone accounting for approximately 40 % of stress fractures. Pain is the most common symptom. Plantar Fasciitis. The plantar fascia is the thick connective tissue that extends from your heel to your toes. Plantar fasciitis is the inflammation of the plantar fascia and is the most…

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Navicular Bone Pain

There are 26 bones in the foot. The Navicular Bone is a small C-shaped bone located on the inside portion of the midfoot. It is nestled between the talus, the three cuneiform bones, and is a structural link between the midfoot and forefoot. It provides important support of the foot and arch during movement. The Tibialis Posterior is the only muscle that attaches to the Navicular Bone and is also important in supporting the arch. Ligaments are thick bands of connective tissue that connect one bone to another. The 26 bones in the foot are held together by ligaments and muscles. The spring ligament spans between the heel bone and the Navicular Bone and is an important ligament as it provides support for the arch and foot.

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Outside Ankle Pain

We often see patients with outside ankle pain who have no idea how it happened; they just know their ankle suddenly started hurting. One patient was a classic example of this. As an athletic hockey and Lacrosse player, however, it’s highly possible he experienced sprains and other ankle injuries, even minor ones, over the years, and these, rather than one big traumatic episode, could have been the catalyst to his sudden outside ankle pain. Outside ankle pain can be treated without surgery by an interventional orthopedics physician. Loose or torn ligaments usually can be treated nonsurgically with ultrasound-guided high-dose platelet-rich plasma (PRP) injections…

Read More About Outside Ankle Pain

Treatments for Ankle Arthritis

Treatment options for arthritic ankles include:

  • Activity modification
  • Bracing
  • Corticosteroid injection into the joints of the foot and ankle
  • Pain medication and anti-inflammatories
  • Physical therapy
  • Platelet-rich plasma injections
  • Bone marrow concentrate (containing stem cells) injections
  • Ankle replacement surgery

Non-surgical treatment options include conservative care (like activity modification, bracing, and physical therapy), corticosteroid injections, PRP, and bone marrow concentrate. When conservative care fails, medication, surgery, and corticosteroid injections are often recommended. However, these only treat the symptoms and not the condition. Whereas regenerative treatment options prompt your body’s own healing mechanisms to treat your ankle condition.

At the Centeno-Schultz Clinic, we have learned over the years that BMC injections have positive outcomes, but that wasn’t always the case. We’ve spent years studying our own outcomes to understand the best methodologies for treating certain conditions

Jim was a firefighter who had ankle pain for the past eight years, making his job as a firefighter, carrying heavy backpacks, particularly challenging. He was also a hiker who struggled with ankle swelling when he was on the trail.

When Dr. Centeno first saw him, Jim’s MRI showed severe ankle arthritis. In one ankle he had bone cysts and a bone marrow lesion (BML). A BML is a swollen area in the bone that is often a sign of microfractures, and it can cause pain, in this case in the ankle. He was facing a highly invasive surgery called an ankle fusion in which screws are placed across the many tiny ankle joints to fuse them together and permanently disable ankle movement. His other ankle was also a problem as deltoid ligament had stretched, creating instability and some mild arthritis. In additions, he had low back nerves that were irritated.

Patient outcomes collected in our registry help us determine candidacy for our patients, and based on this registry data, Dr. Centeno determined Jim wasn’t a good candidate for bone marrow concentrate injections specifically in the ankle with severe arthritis. This was based at the time not only on the experience of treating hundreds of ankle patients throughout the years but also on reviewing our registry data to figure out which types of patients have successful outcomes. However, there is one problem with looking at large amounts of data: outliers can happen, such as the case with Jim, where one person who might not be a good candidate can, for whatever reason, experience very successful outcomes.

In 2016, Dr. Centeno treated all of the damaged areas in Jim’s ankles using precise image-guided BMC injections into the arthritic ankle joints. He also treated his stretched ligaments and bone lesions. And this is Jim giving us feedback on how the treatment worked:

Patients often make their way to us who are seeking a last chance at avoiding major orthopedic surgery, and in most cases, they are good candidates for interventional orthopedics solutions. Our dedication to honesty, however, means sometimes we have to give our patients news they don’t want to hear—that they aren’t very good candidates for interventional orthopedics treatments. Every case is different, however, as Jim’s successful treatment for his severe ankle arthritis proves!


The other day I was evaluating a patient and reviewing the treatment options for their spine condition.  After discussing prior treatments, we got to the topic of medications taken for pain relief. She explained that she mainly utilized anti-inflammatory (NSAID) medications and then she told me to hold much she takes and has been for many years…..she takes close to 2 grams (2000 milligrams) on a daily basis which equated to about 9-10 capsules of medication per day.  I was shocked, considering she was pre-diabetic and with high blood pressure plus the kicker of it is that her PCP (primary care physician) is ok with this…

Read More About NSAIDs

PRP for Osteoarthritis

To discuss PRP for Osteoarthritis we need to define Osteoarthritis. Arthritis is a general term for painful conditions that involve one or more body joints such as the knee and hip. Most types of arthritis involve pain, swelling, and stiffness. There are more than 100 types of arthritis. Osteoarthritis is the most common form of arthritis affecting more than 30 million adults in the united states (1). It involves the breakdown of the protective cartilage. In 2013 osteoarthritis was the second most expensive condition treated in US hospitals accounting for more than $165 billion in hospital costs (2). Other types of arthritis include rheumatoid arthritis, juvenile arthritis, and gout.

Read More About PRP for Osteoarthritis

Our Doctors Who Can Assist with Ankle Arthritis

Christopher J. Centeno, MD

Christopher J. Centeno, M.D. is an international expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate in orthopedics. He is board-certified in physical medicine and rehabilitation with a subspecialty of pain medicine through The American Board of Physical Medicine and Rehabilitation. Dr. Centeno is one of the few physicians in the world with extensive experience in the culture expansion of and clinical use of adult bone marrow concentrate to treat orthopedic injuries. His clinic incorporates a variety of revolutionary pain management techniques to bring its broad patient base relief and results. Dr. Centeno treats patients from all over the US who…

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John Schultz, MD

My passion and specialization are in the evaluation and treatment of cervical disc, facet, ligament and nerve pain, including the non-surgical treatment of Craniocervical instability (CCI). I quit a successful career in anesthesia and traditional pain management to pursue and advance the use of PRP and bone marrow concentrate for common orthopedic conditions. I have been a patient with severe pain and know firsthand the limitations of traditional orthopedic surgery. I am a co-founder of the Centeno-Schultz Clinic which was established in 2005. Being active is a central part of my life as I enjoy time skiing, biking, hiking, sailing with my family and 9 grandchildren.

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John Pitts, M.D.

Dr. Pitts is originally from Chicago, IL but is a medical graduate of Vanderbilt School of Medicine in Nashville, TN. After Vanderbilt, he completed a residency in Physical Medicine and Rehabilitation (PM&R) at Emory University in Atlanta, GA. The focus of PM&R is the restoration of function and quality of life. In residency, he gained much experience in musculoskeletal medicine, rehabilitation, spine, and sports medicine along with some regenerative medicine. He also gained significant experience in fluoroscopically guided spinal procedures and peripheral injections. However, Dr. Pitts wanted to broaden his skills and treatment options beyond the current typical standards of care.

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Jason Markle, D.O.

Post-residency, Dr. Markle was selected to the Interventional Orthopedic Fellowship program at the Centeno-Schultz Clinic. During his fellowship, he gained significant experience in the new field of Interventional Orthopedics and regenerative medicine, honing his skills in advanced injection techniques into the spine and joints treating patients with autologous, bone marrow concentrate and platelet solutions. Dr. Markle then accepted a full-time attending physician position at the Centeno-Schultz Clinic, where he both treats patients and trains Interventional Orthopedics fellows. Dr. Markle is an active member of the Interventional Orthopedic Foundation and serves as a course instructor, where he trains physicians from around the world.

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Matthew William Hyzy, D.O.

Doctor Hyzy is Board Certified in Physical Medicine and Rehabilitation (Physiatry) and fellowship-trained in Interventional Orthopedics and Spine. Dr. Hyzy is also clinical faculty at the University of Colorado School of Medicine in the Department of Physical Medicine and Rehabilitation; In addition, Dr. Hyzy is an Adjunct Clinical Assistant Professor at The Rocky Vista University College of Osteopathic Medicine. Dr. Hyzy also maintains an active hospital-based practice at Swedish Medical Center and Sky Ridge Medical Center. He is also recognized and qualified as an expert physician witness for medical-legal cases and Life Care Planning. He is published in the use of autologous solutions including…

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Brandon T. Money, D.O., M.S.

Dr. Money is an Indiana native who now proudly calls Colorado home. He attended medical school at Kansas City University and then returned to Indiana to complete a Physical Medicine and Rehabilitation residency program at Indiana University, where he was trained on non-surgical methods to improve health and function as well as rehabilitative care following trauma, stroke, spinal cord injury, brain injury, etc. Dr. Money has been following the ideology behind Centeno-Schultz Clinic and Regenexx since he was in medical school, as he believed there had to be a better way to care for patients than the status quo. The human body has incredible healing capabilities…

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Other Resources on Ankle Arthritis

  • 8 Years Of Severe Ankle Arthritis Addressed Without Surgery

    At the Centeno-Schultz Clinic, honesty and integrity forms the foundation of everything we do. As with any medical procedure and treatment, not every patient will be a good candidate for stem cell therapy. This is why we provide a candidacy status to our patients right up front. You need to be able to make an … Continued

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