Weak or Loose Ankle – Repairing Cartilage Loss
A weak ankle or a loose ankle is one of the common complaints patients bring to the specialists at DeLoor Podiatry. These “weak ankles” are so easy to sprain. It usually happens after one sprain– the rest follows afterward. Or there is simply pain when using the ankle, so it’s of no use to the patient.
Your ankles are weight-bearing joints. Essential to a joint’s efficiency is the cartilage, which is the cushion between the two bones. The many types of arthritis is usually about damages or degeneration in the cartilage.
When there’s damage or loss of cartilage, the two bones of the joints rub together, or a piece of cartilage rubs in between them, causing inflammation and pain. Depending on the extent of the damage in your ankle cartilage, the discomfort happens when you walk for long distances, climb stairs, or when you simply put weight on the ankle.
“70% of those who suffer ankle sprains suffer from repetitive sprains, and go on to have chronic ankle instability”
Weak ankles– repeated sprains OR an ankle’s lack of usefulness because of pain– are usually due to cartilage loss and chronic ankle instability, which itself also leads to cartilage loss.
Chronic Ankle Instability
Chronic ankle instability (CAI) deserves a section in this article because many athletes come to DeLoor Podiatry for this condition.
70% of those who suffer ankle sprains suffer from repetitive sprains, and go on to CAI, according to an ankle injury study. Dr. Loor adds, “This is due to the fact that 50% of people who get an ankle sprain don’t go to doctors for medical treatment or evaluation. Let me stress that ankle sprains should always be checked. Or else you develop CAI, and CAI develops in the long-term into ankle osteoarthritis: cartilage loss.”
The importance of your ankles and cartilage
The ankles are weight-bearing joints when you stand or walk. The ankles are also hinged joints that move the foot away from the body (plantar flexion) and toward the body (dorsiflexion). These movements flex your foot up and down when you climb, walk, run.
In between the joints, the cartilage functions as a cushioning support and it’s what holds the two bones of the joint together. Cartilage is not bone. It’s a tough, flexible tissue, but easy to damage. Every ankle sprain and injury damages the cartilage, not the bones.
DeLoor Podiatry is committed to patients understanding the function of ankle and cartilage, which leads to an understanding the symptoms.
Patients who chronically overeat (genes and metabolic syndrome) produce too much leptin, the hormone that tells you when you’re full, and the hormone related to cartilage breakdown.
Aside from being prone to ankle sprain, “weak ankles” or ankle instability symptoms include any of the following:
- Inflammation (redness and swelling) of the ankle
- Ankle pain and difficulty climbing or going down inclines (hills and ramps) and stairs
- Ankle pain when walking or running
- Ankle pain when standing/inability to stand with any duration
- Inability to wear heeled shoes
- Inability to jump
Cartilage loss: Causes and treatments
Obesity and diabetic genes
More weight places more pressure and therefore more wear and tear on cartilage. Aside from this mechanical cause and effect is a metabolic syndrome involving high blood pressure and early diabetes: the changes in the patient’s insulin response system destabilizes the chemical structure of the cartilage, breaking it down.
Patients who chronically overeat (genes and metabolic syndrome) produce too much leptin, the hormone that tells you when you’re full, and the hormone related to cartilage breakdown. With too much leptin, the body loses its perception of leptin and the metabolic syndrome goes back to its cycle. Lack of response to leptin is associated with more cartilage loss.
Solution: Dr. Jose Loor recommends patients to prevent the damage (or the worsening of damage) through weight loss and low carbohydrate and sugar loads.
Reducing food intake steeply for a day or two would “reset” your body’s leptin sensitivity.
Take supplements and shift your diet. MRI studies show that vitamin C and E, 1,500mg of glucosamine and 1,200mg of chondroitin protects cartilage from wear and tear caused by obesity. Resveratrol, famous and found in grapes, red and white wine, peanuts, pistachios, blueberries, cranberries, and in cocoa and dark chocolate, reverses cartilage structure breakdown caused by Metabolic Syndrome.
Trauma and repetitive trauma
Naturally, an injury like a bad ankle sprain damages the cartilage and gives it a weak spot, which becomes more vulnerable to more damage or breakdown.
Normal, healthy joints thrive on and are protected by exercise like running– but damaged joints don’t. If you’ve already had cartilage damage and/or ankle and foot surgery, repetitive use in activities like running and high-impact sports (basketball, tennis, football, etc) would only worsen the existing damage, and lead to cartilage loss.
Treatment: Moderate “load” activities like walking protects cartilage, but running can only add to the damage. Switch to low-impact sports like cycling, swimming and rowing.
For athletes and patients with an active lifestyle, and really, for anyone who likes being able to walk, DeLoor Podiatry recommends cartilage rejuvenation: cell-based cartilage repair before the damage becomes worse. This include platelet-rich plasma (PRP) or stem cell injections. More on this below.
Inability to wear high heels, shifting, popping, cracking ankles, too much extra movement in the joint– this is caused by ligament damage, and in turn can cause cartilage damage and loss.
If the cartilage is a cushion between bones, the ligaments are like duct tape also holding the bones together. When the ligament is damaged, the joint doesn’t move as it should.
Treatment: Dr. Loor recommends PRP and stem cell injections. “It improved symptoms and greatly reduced instability in patients. The improvement is even visible in the MRI. For more severe instability, ankle surgery may be needed for correction.”
Paradoxically, medications injected into arthritic joints are also found toxic to cartilage. Steroids and local anesthetics containing epinephrine cause cartilage cell death (apoptosis). Even NSAIDs may have a negative impact on cartilage cells. One study found celecosib hurting the production of cartilage protective chemicals and increasing the production of damaging chemicals.
Solution: Try alternative anti-inflammatories like fish oil and avoid cortisone shots.
Body alignment problems wear down certain joints faster, i.e., one ankle, one knee. The treatment for alignment issues are orthopedic correction and care systems.
Ageing and weaker cartilage genes
We lose cartilage and bone mass as we age, and some people have the genes for weaker cartilage, or faster degeneration. Keeping an active lifestyle maintains joint health and delays bone loss, but there’s nothing much you can do with genetic composition.
Cartilage rejuvenation in New York
Your options for weak ankles or ankle instability are orthotics, physiotherapy and exercise tools, and cartilage rejuvenation.
Orthotics are ultra-thin sleeves made of carbon fiber, worn around the ankles to provide arch support and shock absorption, aligning the ankle and heel, reducing pain, and encouraging proper gait.
Physiotherapy and tools provide specific foot exercises for targeted stretching, which you can use for stretching and strengthening exercises for your plantar fascia (the flat band of ligament connecting your heel to your toes) and your calf, increasing your flexibility and improving your ankle performance.
Cartilage rejuvenation involves injections to regenerate cartilage.
While difficult to repair because of its lack of blood vessels, DeLoor Podiatry can coax your cartilage to regenerate and repair itself. The foot and ankle surgery involved is minimally invasive, and, depending on the extent of damage, you can go back to your regular activities as soon as you are able after recovery and therapy.
Stem cell regeneration
If your cartilage and bone damage is minor, or if you have osteoarthritis, you may be a candidate for stem cell replacement at DeLoor Podiatry.
Stem cells live in our bone marrow and in adipose tissue (fat), and they have not yet become a specific cell. When you place stem cells near a cell that has already become a specific cell–for example, cartilage cells– the stem cells WOULD become cartilage cells.
The procedure is simple:
- DeLoor Podiatry specialists would first examine your gait and use imaging procedures (MRI, X-ray, CT scan) and arthroscopy to assess and repair cartilage damage.
- If you are a candidate for stem cell injections, you would be scheduled for surgery.
- Dr. Loor would make a small incision and collect bone marrow from your leg or heel bone. Or stem cells can be collected from fat through a mini-liposuction from the lower abdomen.
- This marrow is spun in a centrifuge, collecting mesenchymal cells: the highest concentration of stem cells. PRP (platelet-rich plasma) from your own blood also activates stem cells.
- This is turned into a gel and injected, or glued onto the area of damaged cartilage and/or bone through arthroscopic guidance.
- These cells become cartilage and repair your ankle joint over time.
After the injection, there may be local inflammation that lasts from 2 days to a week. Targeted physiotherapy helps in returning your ankle to its normal flexibility and range of motion, and maximizes the benefits of the cartilage cell renewal.