CLINIC: Help Me Help My Arthritic Ankles
Wed, 22 Aug. 2012 - 10:54 p.m. MT
Credit: ARA Staff - American Running Association
I have arthritic ankle joints, and would like to know what the best self-administered treatments are. My hips are also affected by OA. Are there herbal, over-the-counter, and/or hot and cold therapies I can use at home?
The data on supplements is mixed. There was good support for the use of glucosamine, though a meta-analysis study in the New England Journal of Medicine did not demonstrate positive results. I have a number of patients who report improvement in joint pain while taking glucosamine. The form of glucosamine—pill vs. liquid—does not seem to matter, but liquid is much more expensive. Studies are being performed on chondroitin, ginger, and multiple other supplements. There is some reported improvement in pain with these supplements. NSAIDs are effective for decreasing pain, but chronic use increases the risk of renal or hepatic toxicity. Lab tests should be monitored if NSAIDs are taken on a chronic basis. Acetaminophen plays a role in pain control. Chronic use may cause hepatic toxicity, especially when used in conjunction with alcohol.
With regard to hot/cold treatments, try both heat and ice. Some people get much more relief with one compared to the other. It’s quite common to apply heat prior to activities and ice afterward. Make sure your running shoes offer good support and cushioning.
Since other joints in the same limb are affected by the loss of motion in an arthritic joint, as muscle strength increases, there is decreased stress on the joints. Therefore perform exercises that maximize flexibility and strength. Although stiffness and pain are usually present when exercise is started, symptoms commonly subside during the course of exercise.
Even though your pain is in the ankles and hips, a simple knee sleeve may provide some improvement in comfort. An unloader brace applies valgus stress to the knee and may be beneficial for someone with medial compartment arthritis.
Cathy Fieseler, MD
As far as self-administered, non-prescription treatments, the first and foremost treatment would be glucosamine/chondroitin, two triple-strength or three double-strength tablets per day. Capsaicin, ibuprofen (Advil, Aleve, Nuprin, Mediprin), Tylenol (Extra-Strength or Arthritis-strength), and topical salves like Tiger Balm, Ben Gay, or Mobisyl could also be considered. As noted above, heat brings blood to an area and is a vasodilator, so it can help before exercise or activities, while ice acts as a pain-reliever by vasoconstricting, and is therefore best used after activities, or if the joint is too painful.
There are also homeopathic remedies such as Arnica (in pill or gel form) that can be purchased in health food stores and/or homeopathic pharmacies.
Mark McKeigue, DO
(RUNNING & FITNEWS® July / August 2010 • Volume 28, Number 4)
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