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Orthovisc or Synvisc injections for the Ankle?
Section:  Foot Conditions

Working in an orthopedic practice, I have observed my colleagues utilizing orthovisc and synvisc injections for patients with knee arthritis as a treatment prior to total or partial knee arthoplasty. 

I have found myself wondering about the possible opportunities to utilize this modality in the ankle for those patients who present with mild to moderate ankle degeneration recalcitrant to ankle arthroscopy.  Could this be ulitized to provide relief for those patients with significant ankle pain who are looking for an alternative therapy prior to ankle arthrodesis or total ankle arthroplasty?

ORTHOVISC® (High Molecular Weight Hyaluronan) is an FDA-approved non-drug therapy and is the only non-avian sourced viscosupplementation with lasting efficacy for up to 6 months. ORTHOVISC® is derived from baterial cells, and is adminstered via injections given as 1 injection for 3 consecutive weeks to restore healthy joint fluid to cushion, thus protecting and lubricating your knee joint.

Synvisc® elastic and viscous substance made from hyaluronan which is found in normal joint fluid.Synvisc®  injections are typically given once a week, 7 days apart, over a 15-day period, for a total of three injections.


Does anyone have any experience utilizing these in the foot and ankle?

MEMBER COMMENTS
Re: Orthovisc or Synvisc injections for the Ankle?

Ryan,

I have tried to use Supartz off-label in the ankle joint for exactly the reasons as you put forth.  I informed the patient and the patient paid for the product.

I did not see the expected results with the 5 injections.  I then tried Synvisc, with the same results.  I think it has to do with the lack of vascularity at the talus, but I cannot be so sure. It's possible that in a different patient it may work, but I would have to do more research to really see if the ankle joint can handle ORTHOVISC.

I agree with you, we should try to use more viscosupplementation for foot and ankle, but we need to have more EBM for it to make it mainstream.

 

Re: Orthovisc or Synvisc injections for the Ankle?

There is indeed a lack of EBM on the topic --I have been working through trying to design a study which might shed some light on these issues.....

Re: Orthovisc or Synvisc injections for the Ankle?

I have used Supartz in sequential ankle joint injections on a few patients with some beneficial results.  I also had the patients purchase the injectable on their own by Rx and sign consents regarding its off-label use.  Perhaps more podiatrists are using this than previously suspected.  This forum may illustrate the use of these materials in the ankle.

Re: Orthovisc or Synvisc injections for the Ankle?

I called the company years ago for using Synvisc in first MPJ arthritis.  I never got a good response from them.

Re: Orthovisc or Synvisc injections for the Ankle?

Ryan,

 

I am not a doctor, but I have had surgery on my ankle twice.  It was chronically swollen and stiff and so painful I could not sleep at night.  I couldn't walk without a limping, go camping with my kids or do any of the activities I enjoyed before my injury and surgeries.  My life was pretty much a living hell in which every little thing I did had to revolve around my ankle and my pain level and all the things I could no longer do.

 

I first tried Orthovisc injections two years ago and have found that one injection every four months can control my pain, stiffness and swelling.  I feel like myself for the first time in 6 years.  I can walk without limping and even wear shoes with small heels like a normal woman. My best guess would be that my pain has been reduced by at least 70%.  This effect wears off, of course, but four months of pain free living is a blessing from God and well worth the one day of achiness experienced after the injection. 

 

This treatment gave me my life back.  My only other option was more, probably less successful, surgeries and a life time of uncontrolled pain.

 

I only wish it was easier to get workers comp to pay for it.

 

Thank you for your time.

 

Amber

 

 

 

Re: Re: Orthovisc or Synvisc injections for the Ankle?
Quote:

Ryan,

 

I am not a doctor, but I have had surgery on my ankle twice.  It was chronically swollen and stiff and so painful I could not sleep at night.  I couldn't walk without a limping, go camping with my kids or do any of the activities I enjoyed before my injury and surgeries.  My life was pretty much a living hell in which every little thing I did had to revolve around my ankle and my pain level and all the things I could no longer do.

 

I first tried Orthovisc injections two years ago and have found that one injection every four months can control my pain, stiffness and swelling.  I feel like myself for the first time in 6 years.  I can walk without limping and even wear shoes with small heels like a normal woman. My best guess would be that my pain has been reduced by at least 70%.  This effect wears off, of course, but four months of pain free living is a blessing from God and well worth the one day of achiness experienced after the injection. 

 

This treatment gave me my life back.  My only other option was more, probably less successful, surgeries and a life time of uncontrolled pain.

 

I only wish it was easier to get workers comp to pay for it.

 

Thank you for your time.

 

Amber

 

 

 

 

Amber,

 

I'm sorry to hear that you had such a rough go of things, although I am glad that you're doing better now.  Your case certainly makes sense --the challenge becomes in the purchasing of the product and the application.  How did your physician go about it?  Previously in this thread it was mentioned that the patient was given a prescription to fill and then brought it to the office for injection.....

 

 

Re: Orthovisc or Synvisc injections for the Ankle?

Ryan,

 

Workers Comp is a bitch to deal with.  The neutral doctor (I have seen him four times now, so I doubt he is "neutral" anymore) had to write a supplimental report that stated the benefits of Orthovisc and the number of injections that would be reasonable (three) to judge effectiveness.  My doctor and attorney are in the process of making this "experimental" series of injections a part of my treatment plan.  This will take forever, as the court gave me life-long medical benefits and Workers Comp doesn't want to get involved in actual life-long care.  With them, there is no real difference between denying care totally and simply trying to postpone care indefinitely.  But, I am relentless and I will get what I need.  It pains me, but sometimes you can't be nice.  Orthovisc works for me and the inside of my ankle is an ugly mess. The pain was so bad that my ankle would sometimes just collapse because my body couldn't cope with the pain anymore.  I would have no warning - just suddenly go crashing to the ground.  My doctor was more worried about the falling - I slammed my knee into the ground several times and smacked my elbow pretty good as well - than any re-injury to my ankle.  The Orthovisc gives me much better control over my ankle and I can even go up and down stairs without holding the railing.  I feel more confident that my ankle is going to do what I want it to do and not let me randomly fall at odd times for no apparent reason.  The injection is not painful, but my ankle is sore for a day or so and I usually wear a brace for a couple of days.  It takes about a week for the effects to totally kick in, but it is more than worth it.  If you have not experienced constant pain, it is very hard to explain the damage it does to your whole self.  What I go through with Workers Comp or a little post-injection soreness is nothing compared with the benefits I have gleaned.

 

My advise to your patients is to not ever take no for an answer.  My advise to you medical folks is to be very careful how you word your reports.  Workers Comp is a slippery, snakelike creature and they will pick and poke at your words until they think they have found a loop-hole.  Denials are to be expected, but don't accept them.  My doctor is pretty relentless too, although I suspect I am much louder about it than he is.

 

Good luck.  I am so pleased to know that other doctors are seeking this treatment for the patients.

 

Amber

Re: Orthovisc or Synvisc injections for the Ankle?

Yeah, do it.  And also, have them give you whatever's left over every time so you can put it into your 1st MTP Joint patients too.  Provides relief to varying degree, depending on the patients severity of OA/DJD, HL/HR, HAV w/ OCD's, Sesamoiditis w/ OCD.  Spray the Gebaur's generously, perform a 1st ray block, and then do it... the intra-articular pressure in many symptomatic patients can be a bit painful.  They'll love you for it.  But then, you knew all this already.  Just say yes.  And chart your results: you could get a paper out of it.  I'd help with that.  As a former tech writer and retired military podiatrist who did this, we could combine results.