Ankle Pain

Strong enough to bear your body weight, the ankle joint can be prone to injury and pain.Your ankle, the joint where your foot and leg meet, is an intricate network of bones, ligaments, tendons and muscles. Injury to any of these structures can cause pain.

Most ankle pain is the result of a sprain, which occurs when your ankle rolls over your foot, causing a ligament to stretch or tear. Though sprains are often sports-related, they can also occur when you walk on an uneven surface or simply take a misstep.You may feel pain on the inside or outside of your ankle or along the Achilles tendon, which connects the muscles in your lower leg to your heel bone. Because ankle pain can sometimes indicate a serious problem, severe ankle pain should be evaluated by your doctor, especially if it follows an injury. Though mild ankle pain often responds well to home treatments, it can take time to go away. See your doctor when any ankle pain does not improve in a few weeks.

Optimum Joint is currently one of a few practices authorized to conduct IRB (Institutional Review Board) clinical studies using Lipogems. Lipogems are fat clusters taken from the same patient they are used to treat, by use of a local anesthetic, with no sedation required in one single office visit.

The study is titled: Clinical Evaluation of Autologous Micro-Fragmented Adipose Tissue as a Treatment Option for Ankle Pain from Osteoarthritis and/or Tendon Tears.

The study is a non-randomized study to evaluate the effects of non-digested micro-fragmented adipose tissue (fat = Lipogems) on patients with complex joint pain from osteoarthritis and/or concurrent ankle joint abnormalities. Patients will be treated with by intra articular injection under ultrasound guidance and evaluated using follow up imaging, range of motion, pain, and functional scores for up to two years.

The early results are showing significant gains in the vast majority of cases treated.

Achilles Tendinitis

Your Achilles tendon is a large band of tissue connecting the muscles in the back of your lower leg to your heel bone. Also called the heel cord, the Achilles tendon is used when you walk, run, jump or push up on your toes.

Achilles tendinitis, a common cause of ankle pain, is inflammation of the Achilles tendoncaused by repetitive or intense strain on the tendon. It is often a running or other sport-related injury resulting from overuse, intense exercise, jumping, or other activities that strain the tendon and calf muscles.

The most common sign of Achilles tendinitis is pain that develops gradually and worsens over time.

Other signs and symptoms include:

  • Mild ache or pain at the back of the leg and above the heel after running or other sports activity
  • Episodes of more severe pain associated with prolonged running, stair climbing or intense exercise, such as sprinting
  • Tenderness or stiffness, especially in the morning, that usually improves with mild activity
  • Mild swelling or a “bump” on your Achilles tendon
  • A crackling or creaking sound when you touch or move your Achilles tendon
  • Weakness or sluggishness in your lower leg

Bursitis is a painful condition that affects the back of the heel. Small fluid-filled padscalled bursaact as cushionsas they lie between a tendon and a bone to prevent excess friction. Bursitis occurs when a bursa becomes inflamed.

If you have bursitis, the affected joint may:

  • Feel achy or stiff
  • Hurt more when you move it or press on it
  • Look swollen and red
  • Prevent you from weight bearing

Ligament injuries occurs when one of the ligaments most commonly on the outside of your ankle become strained or sprained by a slip, fall or rolling your ankle over. The area on the outside or inside of your ankle becomes painful.

If you have a ligament injury, the affected joint may have:

  • Pain and tenderness in your ankle, especially with certain ranges of motion
  • Swelling or redness at you ankle
  • Loss of range of motion
  • Pain with weight bearing


Osteoarthritis occurs when the surfaces in the joint begin wear down.

What Is Osteoarthritis?

The joints of the body are normally surrounded by a fluid that acts as a lubricant and shock absorber. This fluid is lacking in patients with osteoarthritis, and leads to pain and inflammation in the joints.

Osteoarthritis, also known as degenerative joint disease, is the most common form of arthritis. It occurs when the cartilage that covers the tops of bones, known as articular cartilage, degenerates or wears down. The roughened and jagged bone surfaces become inflamed causing swelling, pain, and sometimes the development of osteophytes or bone spurs when the ends of the two bones rub together.

What Is Osteoarthritis of the Ankle?

The ankle is made up of several joints on the top and sides of your ankle. Osteoarthritis can affect any of these joints causing chronic pain.

What Are the Symptoms of Ankle Osteoarthritis?

As with most osteoarthritis, pain is aprimary symptom. A person is likely to have pain with activity, certain ranges of motion and at rest due to inflammation-causing difficulty sleeping. Range of motion generally decreases over time.

Tarsal tunnel syndrome(TTS), also known as posterior tibial neuralgia, is a compression neuropathy and painful foot condition in which the tibial nerve is compressed as it travels through the tarsal tunnel on the inside of the ankle joint.

Patients with TTS typically complain of numbness in the foot radiating to the big toe and the first 3 toes, pain, burning, electrical sensations, and tingling over the base of the foot and the heel.

Some of the symptoms are:

  • Pain and tingling in and around ankles and sometimes the toes
  • Swelling of the feet
  • Painful burning, tingling, or numb sensations in the lower legs—pain worsens and spreads after standing for long periods and/or pain is worse with activity and is relieved by rest
  • Electric shock sensations
  • Pain radiating up into the leg, and down into the arch, heel, and toes
  • Hot and cold sensations in the feet
  • A feeling as though the feet do not have enough padding
  • Pain while operating automobiles
  • Pain along the Posterior Tibial nerve path
  • Burning sensation on the bottom of foot that radiates upward reaching the knee
  • “Pins and needles”-type feeling and increased sensation on the feet

Plantar fasciitis(PF) is a painful inflammatory process of the plantar fascia, the connective tissue on the bottom of your foot that causes foot, heel and ankle pain. It is often caused by overuse of the plantar fascia or arch tendon of the foot. It is a very common condition and can be treated effectively in most cases. Another common term for the affliction is “policeman’s heel”.

The pain is usually felt on the underside of the heel and is often most intense with the first steps of the day. Another symptom is that the sufferer has difficulty bending the foot so that the toes are brought toward the shin (decreased dorsiflexion of the ankle). A symptom commonly recognized among sufferers of plantar fasciitis is an increased probability of knee pain, especially among runners.

How Is Ankle Pain Diagnosed?

History and Examination: A history of your complaints including duration, what makes it better and worse is very important. Previous treatments and outcomes, as well as orthopedic examination of the muscles, joint, movement and strength are also used for diagnosis.

X-rays: Plain X-rays can reveal narrowing of the space in the two joints of the ankle, revealing wear and tear on the cartilage from arthritis like diseases and bone spurs that can interfere with movement.

MRI (Magnetic Resonance Imaging): Is a noninvasive procedure that can reveal the detail of the joints, ligaments and tendons.

Myelography/CT scanning: Sometimes used as an alternative to MRI

Diagnostic ultrasound Imaging: Unlike an x-ray, which emits radiation and shows only bone, diagnostic ultrasound is non-invasive and allows for viewing the causes of your ankle pain with great accuracy. With musculoskeletal ultrasound imaging (MSUS), the muscles, tendons, ligaments, cartilage and joint can be accurately examined at the time of your visit. This provides immediate information about the health of your joint and what factors are contributing to your pain. With this information in hand, specific treatment options can be established immediately!

New Treatment Using LIPOGEMS® Could Be the Answer for Arthritis Pain

LIPOGEMS® is a new treatment option for arthritis pain now offered by Dr. Norma Bilbool, M.D., a double board certified physician specializing in Physical Medicine and Rehabilitation and Pain Medicine and Richard D. Striano D.C., RMSK Registered in Diagnostic Medical Musculoskeletal Sonography. The combination of advanced imaging techniques with ultrasound to diagnose and precisely guide treatment, and physician experience with treating all joints with minimally invasiveLIPOGEMS® has led to the majority of patients treated having significant improvement with less pan, improved function and quality of life.

LIPOGEMS® could be the solution to those who suffer from pain in the shoulder, lower back, hip, knee, ankle and other joints including the rotator. Optimum Joint, is equipped and has been performing ongoing clinical studies on the shoulder, rotator cuff, lower back, hip and ankle pain where a patient’s own fat is used to alleviate arthritis related conditions many of which have failed to respond to other treatment methods including bone-on-bone joints. Optimum was among the first practices in the USA trained in the state-of-the-art treatment through LIPOGEMS® technology that is a minimally invasive same day procedure, performed in about an hour, using local anesthetic with no sedation required and no down time. This could be the answer for many of those looking to avoid surgery.

The Autologous (fat from you and put back into you) Micro-Fragmented Adipose Tissue (LIPOGEMS®) is a NEW technology where fat is taken from the patient, using a local anesthetic, washed, and micro-fragmented, using the LIPOGEMS® system. Micro-fragmented fat using the LIPOGEMS® system mechanically supports and cushions joints, and holds regenerative capabilities and when re-injected can decrease inflammation, cushion, repair or replace defects in damaged tendons and cartilage, or other tissue.

The fat is injected using continuous ultrasound guidance to ensure pin point accuracy in treating the joint and surrounding damaged tendons to repair and restructure damaged tissue with pin-point accuracy. Research has shown non-guided “blind” injections are accurate 36% – 60% of the time while ultrasound guided injections are 100% accurate. Accuracy in delivering regenerative treatments is essential. We are evaluating the LIPOGEMS®, made with an FDA cleared device, for their ability to cushion, repair, or replace damaged tissue and the regenerative effects of the fat it contains, to jump-start repair and decrease inflammation.

“This is an extraordinary study because of its use of micro-fragmented fat tissue, which makes it more bioavailable to the area we inject, and by using the precision of ultrasound guidance the treatment is visualized being delivered to each area of the joint and tissues in need of repair. This combination of support and regenerative regenerative elements with the precision of advanced ultrasound guidance is contributing to the long term impressive results.

 NEW STUDY: Adipose tissue contains Adipose Derived Stem Cells “ADSC’s” and more than 600 secreted proteins and included key molecules involved in tissue regeneration. Stem Cell Res Ther. 2015; 6: 221.

NEW STUDY: Lipogems Product Treatment Increases the Proliferation Rate of Human Tendon Stem Cells without Affecting Their Stemness and Differentiation Capability. Results showed that the Lipogems product significantly increases the proliferation rate of hTSCs (human tendon stem cells). Moreover, treated cells increase the expression of VEGF, which is crucial for tissue healing. Stem Cells International Volume 2016 (2016), Article ID 4373410, 11 pages

Dr’s Bilbool and Striano are among few doctors in the country offering IRB- approved regenerative treatment options, with a focus on minimally invasive alternatives to surgery. Their work has been recognized and new studies are being published this year.

Treatment Cortisone Injection:

Painful arthritic joints, chronic tendinitis, bursitis and inflammation respond quickly to cortisone. In many cases this is the head start patients need to allow for gains with more conservative care and no further treatment is required. Many patients think that cortisone is bad for you. Too much of anything is not good. Using cortisone infrequently, as much as several times per year will not do any harm. If the pain continues to return, other treatment options should be considered.

Cortisone is injected using continuous live ultrasound guidance exactly where it is needed to quickly reduce inflammation and pain.

Lubrication for Arthritis:

Why Hyalgan?

A squeaky gear needs the most oil!

The joints of the body are normally surrounded by a lubricant and shock absorber called Synovial fluid. Patients with osteoarthritis experience pain and inflammation because arthritic damage in theankle causes the Synovial fluid to break down over time.

This process causes increased friction and excess wear and tear on the cartilage cushioning movement that becomes rough and jagged causing the joint further deteriorate. Range of motion, walking, getting up from a seated position, climbing and descending steps and weight bearing is often painful. Pain is often increased during or after activity.

What is Hyalgan?

Hyalgan is a naturally derived lubricant that instantly cushions and lubricates painful arthritic joints. By restoring lubrication and cushion, your joints move more freely again with less friction and most importantly, less pain. Hyalgan is injected using continuous live ultrasound guidance ensuring pin-point accuracy exactly where it is needed.

The joints of the body are normally surrounded by a fluid that acts as a lubricant and shock absorber. This fluid is lacking in patients with osteoarthritis, and leads to pain and inflammation in the joints.

Platelet Rich Plasma Therapy (PRP): Jump starting the healing signals:

Why use PRP?

When there is damage, tissue tears or arthritis, this exciting new procedure (made popular by professional athletes) that heals damaged structures in a joint such as the labrum, tendons, muscle, ligament or cartilage is showing exciting results!

How does PRP work?

When you cut your skin and it bleeds, platelets collect and gather at the wound site. Once there, platelets act like a conductor in an orchestra. They release growth factors that signal the healing activities to begin, resulting in a cascade of events that restore the damaged tissue.

Joints, however, do not have a direct blood supply. Therefore, when a joint structure is damaged or torn, platelets do not gather and orchestrate the necessary events for that damage to be restored. Joint damage either heals slowly or not at all. That is where Platelet Rich Plasma Therapy (PRP) proves valuable!

How is the procedure performed?

By taking a small sample of your blood, a special centrifuge concentrates and separates the platelets, growth factors and specialized white blood cells from the other components of the blood. This super concentrated PRP is then injected using continuous ultrasound guidance into the cracks and crevices of the damaged area. The orchestra of events is stimulated and the tissue begins to heal. The result is reduced inflammation and pain.

Have you tried Physical Therapy in the past and it hasn’t worked for you?

A Different Approach Other Than Routine Painful Exercises:

We see many patients who come to us in chronic pain. Many have also had experience with physical therapy where they spent much of their sessions doing exercises and it hasn’t helped. Think of being in pain, having joint stiffness, loss of range of motion or chronic inflammation and then doing exercises to get rid of it. In most cases, you’ll feel worse not better.

Exercise is critical to maintain proper joint strength, but done at the wrong time and your pain often becomes worse. That is why we take an entirely different approach with treatment plans using three phases:

  • Therapeutic Modalities:

Our physical therapy team specializes in using certain modalities like electrical stimulation or ultrasound to reduce swelling and inflammation and increase local circulation to help the healing process. Different modalities can be applied to successfully address spasm, trigger points, inflammation, edema, swelling and damage from tendonitis and tears.

  • Joint Release Techniques:

Techniques are done by hand to gently stretch, massage and release the pressure in each of the muscles, tendons and ligaments surrounding the joint. The result is a soothing improvement in joint pain.

  • The Selective Functional Movement Assessment:

Our physical therapy team is certified in the Selective Functional Movement Assessment (SFMA), which is a series of 7 full body movement tests designed to assess fundamental patterns of movement such as bending and squatting in those with known joint pain. When the clinical assessment is initiated from the perspective of the movement pattern, our therapy team has the opportunity to identify meaningful impairments that may be seemingly unrelated to the main joint pain complaint, but contribute to the pain.

Think of having a painful right knee and favoring that side for an extended period of time. Following a period of uneven gait you may develop pain on the opposite unrelated side. This concept, known as Regional Interdependence, is the hallmark of the SFMA.

The assessment guides our clinical physical therapist to the most dysfunctional non-painful movement pattern, which is then assessed in detail. By addressing the most dysfunctional non-painful pattern, the application of targeted interventions (manual therapy and therapeutic exercise) is not adversely affected by pain.

When to see a doctor:

You should see your doctor if:

  • You’re experiencing severe ankle pain
  • You have swelling
  • You have ankle pain that’s lasted more than a week
  • If you have difficulty walking or weight bearing
  • Pain is increasing



Can an OptimumJoint traditional or regenerative medical procedure help me? To find out if you might be a candidate for an OptimumJoint medical treatment procedure, complete our Optimum Joint Procedure Candidate Form online.