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ANKLE ISSUES FAQ

Q: I received special injections for arthritis in my knee that helped improve both pain and motion. Though it was costly, my insurance covered 80% of the expense. However, when I asked about getting the same treatment for my ankle arthritis, my insurance company refused to pay. What’s going on? Can I challenge their decision?

A: It sounds like the treatment you received for your knee arthritis involved injections of hyaluronic acid. Hyaluronic acid is a naturally occurring substance in the body, known to support the growth of healthy cartilage cells. When injected into a joint, it aims to rebuild and protect the joint cartilage.

About 15 years ago, the Food and Drug Administration (FDA) approved the use of hyaluronic acid injections specifically for knee arthritis. Since then, it has been a recognized treatment for pain relief in certain knee arthritis patients.

Recently, there has been interest in using hyaluronic acid injections to treat ankle arthritis. However, the FDA has not yet approved this treatment for ankle arthritis, and the research so far has shown mixed results. For example, in one randomized controlled trial, hyaluronic acid injections for the ankle didn’t perform any better than placebo injections using saline (salt) solution.

A key question is why hyaluronic acid seems to be effective for some patients with knee osteoarthritis but not for those with ankle arthritis. One theory is that most ankle arthritis stems from trauma, whereas knee arthritis usually does not. Additionally, ankle cartilage is generally stiffer, denser, and less elastic compared to knee cartilage, which might influence the treatment’s effectiveness.

Because the effectiveness of hyaluronic acid injections for ankle arthritis is still under investigation, insurance companies are hesitant to cover the cost, especially given the high price of the treatment. Without more evidence proving its effectiveness for ankle arthritis, it’s unlikely that insurance companies will change their stance on reimbursement.

Unfortunately, challenging this decision may be difficult until more conclusive studies demonstrate that hyaluronic acid injections are beneficial for ankle arthritis. In the meantime, it might be worth discussing alternative treatments with your healthcare provider.

Reference: Henry DeGroot III, MD, et al. Intra-Articular Injection of Hyaluronic Acid is Not Superior to Saline Solution Injection for Ankle Arthritis. In The Journal of Bone and Joint Surgery. January 2012. Vol. 94A. No. 1. Pp. 2-8.