Arthritis of the Feet
Arthritis

What is Arthritis?

Arthritis simply put is inflammation of the joints. It is not really just one condition, but is actually a group of inflammatory conditions where there is damage to the cartilage in the joints that produces inflammation. Arthritis is the most common cause of disability of retired people.  Arthrtis affects about twice as many women as men.

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Arthritis in the Big Toe Joint explained by San Francisco Podiatrist

What is Arthritis in the Big Toe Joint? 

The medical term for the big toe joint is the first metatarsophalangeal joint. When arthritis affects this joint you can get pain, cartilage damage, stiffness and bone spurs. Over time the joint will typically get stiffer and more painful. Gouty arthritis, Rheumatoid arthritis, Psoriatoc arthritis, and Osteoarthritis are all different form of arthritis in the big toe joint. However a form of osteoarthritis called "hallux rigidus" is by far the most common typr oe painful arthritis in the big toe joint seen in our podiatry practice in San Francisco. There are many causes of arthritis in the big toe joint, but most can be effectively treated. 

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Supartz Injections for Ankle Pain
Why is Supartz better than surgery for ankle pain?
Supartz is meant to prolong the life of a damaged or arthritic joint by increasing the amount of cushioning and lubrication inside the ankle. Supartz is superior to surgery in many ways. 1) Supartz is much less invasive. It only involves a series of injections, instead of cutting the ankle open. 2) Supartz is much less expensive than surgery. 3) Supartz injections may decrease the pain and prolong the life of your arthritic ankle. 4) Supartz can be performed right in your home or office.

What is in Supartz Joint Injection Fluid?
SUPARTZ Joint Fluid Therapy (also called a viscosupplement) is a non-surgical, non-pharmacologic therapy for knee osteoarthritis. SUPARTZ therapy can help relieve your pain, improve your mobility, and get you back to your normal activities. It basically works as a joint lubricant and a fluid joint cushion.

Does Supartz come from roosters?
Hyaluronan is a natural substance found in your joint cartilage and in the synovial fluid that fills your joints. Synovial fluid is the lubricant that helps your joint move smoothly. In the ankle joint, hyaluronan acts like a lubricant and a cushion much the same way that oil lubricates and protects an engine. 

The goal of Supartz joint injection treatment to supplement poor-quality hyaluronan in your painful ankle with additional highly purified hyaluronan. Supartz therapy is an injectable solution made from highly purified sodium hyaluronate (also known as hyaluronic acid [HA]) that is actually extracted from rooster combs. The rooster combs used n Supartz are harvested from roosters that have been certified as suitable for human consumption via pre- and post-mortem veterinary inspection.

What exactly happens during the Supartz ankle injection procedure?
Dr. Segler will inject SUPARTZ joint fluid therapy directly into your arthritic ankle joint right in your home or office. You do not need to go to a hospital surgery center or doctor's office for the injection. 

How long does it take for the Supartz ankle joint injection?
The whole procedure takes only a 10-15 minutes:
Step 1: Dr. Segler will prep the area with betadine and use some very cold spray on the skin over the ankle joint to make the skin less sensitive. A small amount of local anesthetic is then injected in the skin over the ankleto make the area numb. 
Step 2: Dr. Segler will remove any excess joint fluid that is currently in your ankle joint (if it is swollen) with a process called arthrocentesis. 
Step 3: Dr. Segler will remove inject Supartz into the ankle joint space. TO get maximum benefit, you should stay home and take it easy, elevating the foot and ankle for the next couple of hours. Try not to spend much time walking around for the rest of the day. YOu should also avoid strenuous activities for 48 hours after the injection. Because Dr. Segler uses cold spray and local anesthetic, most Supartz patients experience little to no discomfort during the procedure. If you ever have questions about the Supartz treatment, call and talk to Dr. Segler about ways to reduce any pain or discomfort that could occur.

How many Supartz ankle injections do I have to have?
Supartz injection treatment is FDA approved for 5 weekly knee injections, but some patients report benefit from only 3 injections. (Some patients may experience benefit with as few as 3 injections given at weekly intervals. This has been noted in a study in which patients treated with 3 injections were evaluated for 90 days.)

Dr. Segler believes the best routine for ankle injections is to perform a series of 3 weekly injections and then wait 4-6 weeks before determining whether or not you should have two additional injections. This routine seems to provide the highest value for patients.  

Is there any patient education information from the manufacturer?  
Yes the Supartz package insert can be downloaded and reviewed here. 

What are the risks and the side effects of Supartz? 
The largest clinical trial injections involved a series of 5 knee injections.  Pain was the most common side-effect. 18.4% of Supartz injection patients reported pain as did 16% of control patients. Another common side-effect was arthralgia (defined as joint pain with no evidence of inflammation). This occurred in 12.6% of Supartz recipients and 15% of controls. 
Other reported side effects included:
Back pain: 11.5% of Supartz recipients, 12.5% of controls.
Headache: 3.4% of Supartz recipients, 5% of controls.
Injection site pain: 3.4% of Supartz recipients, 5% of controls.
Injection site reaction: 1.1% of Supartz recipients, 3.8% of controls.

How rigid is the Supartz treatment regimen?
It is best to do them weekly, simply because that is the most studied regimen. It is not recommended that we inject less than 3, simply because the effectiveness of less than 3 injections has never been studied at all. Having said all that, it will likely not make a huge difference if we have to make some time-frame adjustments to accommodate your work, social or travel schedule. 

Who should NOT have a Supartz injection?
Anyone with an allergy to eggs, poultry or feathers should NOT have a Supartz ankle injection.
Anyone who has previously had any previous allergic reactions to Supartz therapy or similar material (hyaluronate products) should NOT have a Supartz ankle injection.
Anyone with infections or skin diseases around the ankle area should NOT have a Supartz ankle injection.
If you are pregnant or lactating, Dr. Segler recommends that you NOT have a Supartz ankle injection, because its safety in pregnant/lactating women has never been studied.

Is Supartz a new ankle arthritis treatment?
Supartz injections for the foot and ankle are fairly new, but Supartz injections are not new at all. Supartz has been used for over 20 years with more than 170 million injections performed worldwide.

How much does a Supartz ankle injection cost?
House call in San Francisco: $225.00 (for follow-up patient)
Ankle injection/arthrocentesis with local anesthesia $125.00
Supartz Joint Therapy Fluid $125.00

Is Supartz covered by insurance?
In most cases, Supartz is covered by insurance for the treatment of osteoarthritis in the knee, but Supartz is often not covered by insurance carries for the treatment of ankle arthritis.
 
Dr. Christopher Segler is a an award winning foot ankle surgeon who performs house calls in San Francisco to save time for athletic patients. He is a nationally recognized expert on the diagnosis of subtle ankle fractures that are frequently misdiagnosed as ankle sprains. As an athlete himself, he believes that non-surgocal care is often the most effective way for athletes to maintain their fitness and preserve their active lifestyles.  If you have a question about Supartz as an alternative for ankle surgery, you can reach him directly at 415-308-0833
 


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Where Does It Hurt?

 Click in the  painful area to find out what is causing your foot pain.

Big Toe Joint Pain, Bunion

Heel Pain, Plantar Fasciitis, Planter Fashitis

Midfoot Pain, Upper Foot

Arch Pain

Ball of Foot Pain, Nueroma

Medial Ankle Pain, inside ankle

Tailors Bunion, little toe hurts

Lateral Ankle Pain

Side of foot hurts at the fifth toe base.

Achilles tendon pain, tendonitis