What is Arthritis?
Each part of the body that moves has a joint between the bones that move. The joint is made up of the cartilage lining the bones, synovial fluid, which is a thick gel-like substance that acts to cushion, lubricate the joint, and nourish the cartilage, as well as a layer of soft tissue that surrounds the joint, called synovium, which produces synovial fluid.
Arthritis is a disease of joints which results in damage to the cartilage of the affected joint as well as loss of synovial fluid in the joint. This disease is very common and is not a single disease. There are actually over 100 forms of arthritis that exist, with the small joints of the feet and ankles enduring this condition often!
Two forms of arthritis that commonly affect the foot and ankle are:
Early diagnosis and treatment of arthritis are the keys to successful treatment, faster recovery and painless lifestyle. Non-surgical techniques such anti-inflammatory drugs (NSAIDs), corticosteroid injections, physical therapy, bracing, or viscosupplementation can slow the progression of the disease and lessen or eliminate symptoms.
What is Viscosupplementation?
Although there is no cure for arthritis, viscosupplementation refers to the concept of synovial fluid replacement with injections of hyaluronic acid (HA) for the relief of joint pain associated with arthritis.
Synovial fluid (or joint fluid) is the thick gel-like substance responsible for cushioning joints and providing lubrication to reduce joint friction. Hyaluronic acid is a naturally occurring component of synovial fluid and articular cartilage and helps promote anti-inflammatory factors or proteins in the joint. It is a major component and one of two natural lubricants found to increase the viscosity of synovial fluid. It is also present in a membrane around each cartilage cell (chondrocyte), contributing to its resilience and protecting the cartilage on a cellular level. Hyluronic acid has been used to treat osteoarthritis through a series of injections into the joint cavity. These injections are thought to supplement the viscosity of the joint fluid (viscosupplementation), lubricating and cushioning the joint and producing an analgesic (pain reducing) effect by stimulating the production of anti-inflammatory molecules. It has also been suggested that hyaluronic acid has some direct positive biochemical effect on the cartilage cells. Please note that our understanding of hyaluronic acid injections, including its exact mechanisms of action, is currently evolving.
Viscosupplementation is recommended for patients for whom traditional non-operative treatment has been unsuccessful, and as an alternative to surgery. The treatment typically consists of 3 to 5 five weekly injections of Sodium Hyaluronate into the affected joint. The effect of the treatment can be variable, however, when it is successful, symptomatic improvement can last up to six months or longer. We offer this therapy for symptomatic arthritis of the ankle, subtalar and big toe joints!
What are the risks or side effects?
The most commonly reported side effects associated with the injections are temporary injection-site pain, swelling, heat and/or redness, rash and itching, bruising around the joint and/or fluid accumulation in the injected knee. These reactions are usually mild (but occasionally are severe) and do not last long. You should avoid any strenuous activities or prolonged (more than 1 hour) weight-bearing activities (such as jogging or tennis) for 48 hours following the injection.
Will my insurance pay for this procedure?
The United States Food and Drug Administration classifies viscosupplements as a device (a medical product) rather than a drug. Medicare and private insurance companies typically reimburse the cost of devices and procedures that are medically necessary to treat your condition and are used according to the labeled uses approved by the FDA. Unfortunately, at the present time, these injections are currently approved by the FDA only for the knee, and are deemed not medically necessary for other joint. That being said, hyaluronic acid injections they are widely studied and used off-label in joints of the shoulder, hip, ankle, and foot.
For additional information on this therapy, please consult with one of our doctors today!