Table 4.
Conservative management options for posttraumatic ankle arthritis
| Nonpharmacologic | |
| Activity modification, weight loss, physical therapy (e.g., exercise, heat/cold therapy) | |
| Shoe modification (Orthotics, Comfort shoes with a single rocker sole**) | |
| Assistive devices: cane, walker, knee scooter | |
| Ankle bracing (OTC vs. custom) | |
| Pharmacologic | |
| Anti-inflammatory medications (Oral NSAIDs, Topical NSAIDs) -Avoid use of selective and nonselective NSAIDs in patients with CVD. -Avoid routine use of NSAIDs in patients who are concurrently taking low-dose ASA as cardioprotective prophylaxis -Avoid use of oral NSAIDs in patients with diabetes mellitus, especially if complicated by CVD or kidney disease | |
| Acetaminophen | |
| Nutritional supplements: nutraceuticals (chondroitin sulfate*, glucosamine), vitamin D, diacerin, avocado soybean unsaponifiables*, fish oil* -Limited studies have shown oral glucosamine to be safe in patients with DM [20] | |
| Corticosteroids (oral, injection) -GC injections are absolutely contraindicated in the presence of local infection, bacteremia, fracture, joint prosthesis, tumor, achilles or patellar tendinopathy, and history of allergy to any of the injectable components [21] -Associated with a transient (usually 1–2 days) elevation in blood glucose levels secondary to increased insulin-resistance -Insufficient data exists to characterize the effects of GC injections regarding location, dose, and formulation [21] -Corticosteroid flare is among the most commonly reported adverse effects, with a rate of 2–50%; although, studies have assessed various formulations of GC with nonsteroid solutions (e.g., balanced pH with bicarbonate) and found no differences in occurrence rates [21]. | |
| Duloxetine |