Ross Hauser, MD, Danielle Matias, PA-C, Demi Foster, APRN
In 2010, our research team published findings in the journal Practical Pain Management (1) on the use of dextrose prolotherapy injections. We found these injections to “be very effective in eliminating pain and stiffness and improving the range of motion and quality of life in this group of patients with unresolved ankle pain. This included the subgroup of patients told by their doctors that there were no other treatment options for their pain or that surgery was their only option.”
We go on to explain that prolotherapy involves injections into all of the various ankle ligaments that stabilize the part of the ankle where the person is experiencing symptoms. “For lateral ankle pain, this involves the ligaments of the lateral ankle complex, including the anterior talofibular, calcaneofibular, and posterior talofibular. For anterior ankle pain that is higher, the syndesmotic ligament complex is injected. The ligaments involved include the anterior tibiofibular, posterior tibiofibular, and the distal interosseus membrane between the tibia and fibula. For medial ankle pain, the deltoid ligament with its complex of very strong thick ligaments is injected. Prolotherapy gets at both the superficial and deep deltoid ligaments including the posterior tibiotalar and anterior tibiotalar ligaments.”
How it works
“Prolotherapy is the injection of a solution for the purpose of tightening and strengthening weak tendons, ligaments, or joint capsules. Prolotherapy works by stimulating the body to repair these soft tissue structures. . . One explanation for the lack of response of chronic ankle pain sufferers to traditional conservative therapies is that their underlying problem, ligament laxity, is not being addressed. . . Since prolotherapy is given at the ligament/ bone interface, it presumably stimulated ankle ligament repair in this patient population, causing a marked decrease in pain and improvement in patient’s quality of life.”
Injections administered to the anterior talofibular ligament can improve chronic ankle instability
A December 2025 study in the journal Archives of physical medicine and rehabilitation (2) examined whether dextrose prolotherapy injections administered to the anterior talofibular ligament can improve chronic ankle instability. A total of 114 individuals diagnosed with chronic ankle instability were randomly allocated to either the dextrose prolotherapy group or the normal saline group in a 1:1 ratio. Participants in the dextrose prolotherapy group and the saline group received injections of 5 ml of 15% dextrose and 5 ml of normal saline into the anterior talofibular ligament at weeks 0, 4, 8, and 16, respectively.
Main outcome measure: The primary outcome was assessed using the Cumberland Ankle Instability Tool (CAIT, scoring 0-30 points) at the 52-week mark. Secondary outcomes included the Star Excursion Balance Test (SEBT), the incidence of ankle re-sprains, health-related quality of life (evaluated using EQ-5D), and treatment satisfaction. All outcomes were measured at baseline, as well as at 16, 26, and 52 weeks.
Results: Randomization resulted in two groups, each consisting of 57 participants, while no statistically significant difference was found between the groups for CAIT, participants receiving dextrose prolotherapy exhibited a statistically significant enhancement in Star Excursion Balance Test (SEBT) compared to those in the saline group. Furthermore, individuals in the dextrose prolotherapy group experienced a reduced risk of re-sprains.
Neurofascial (treating nerve inflammation) prolotherapy
The concept of inflammation on the nerve causing pain and even degeneration of tissues has been documented in articles in the 1950s and 1960s by Dr. George Hackett, the person who coined the term Prolotherapy. He noted that inflammation neuritis and other antidromic impulses (nerve impulses that are traveling in the wrong direction and cause confusion) are transmitted to blood vessels in nerves and surrounding tissues stimulating a release of excess neurohumoral mediator substance (the nerves are over-reacting as in panic) which cause a neurovascular vasdilation-edema-sterile inflammation neuritis (immune breakdown which contributes to radiating nerve pain). This neurogenic inflammation can also lead to ligament weakness and bone decalcification.
Patients with chronic ankle ligament injury entered this uncontrolled before-after study based on eligibility criteria. Patients who consented to participate in the study filled out the prepared questionnaire containing demographic data, the Cumberland ankle instability tool (CAIT), and the Visual Analogue Scale (VAS). The initial CAIT score of less than 25 indicated functional instability following an ankle sprain. Patients underwent neurofascial prolotherapy with dextrose 12.5%. Two injections within one month were done. The CAIT was completed one, three, and six months after the intervention.
In a February 2022 study (3) published in the journal Anesthesiology and Pain Medicine, twenty-five patients with chronic ankle ligament injuries were treated with neurofascial prolotherapy. The patients in this study were 20 to 75 years old with a history of ankle sprain or injury whose magnetic resonance imaging confirmed ligamentous injury, with no pain and disability improvement after conservative treatments.
The outcomes “indicated that neurofascial prolotherapy significantly improves pain and functional instability in chronic ankle ligament injury. The (pain and disability scores) decreased significantly after one month, and this trend continued till the sixth month after the intervention.”
Read our published research
Evidence-Based Use of Dextrose Prolotherapy for Musculoskeletal Pain: A Scientific Literature Review: This paper has been cited by 45 research studies as we were able to demonstrate level 1 and 2 evidence to support the use of dextrose Prolotherapy for osteoarthritic pain and function, tendinopathies, myofascial pain syndrome, sacroiliac pain, and myofascial pain syndrome. There is level 3 evidence in support of the use of dextrose Prolotherapy for diffuse muscusloskeletal pain involving the spine, pelvis and peripheral joints. Dextrose Prolotherapy should be recommended for such musculoskeletal conditions as tendinopathy, ligament sprains, Osgood-Schlatter disease and degenerative joint disease, including osteoarthritis.
More articles
Chronic Ankle Instability Surgery
In the patients we see, they have at some point considered surgical intervention for their chronic ankle instability because they are basically done with treatments that are not effective. The reason they have not jumped right into surgery is because of its risks and the possibility that it will not help. But clearly, surgery does address ligament and tendon problems. These problems can also be addressed in a non-surgical manner.
References
1 Hauser R, Hauser M, Cukla J. Dextrose prolotherapy injections for chronic ankle pain. Practical Pain Management. 2010;Jan/Feb. [Google Scholar]
2 Sit RW, Wu RW, Reeves KD, Chan DC, Fung CL, Wang B, Law SW, Yip BH, Rabago D. Dextrose Prolotherapy injection improves dynamic postural balance and reduces risk of recurrent sprains in Chronic Ankle Instability: A one-year randomized placebo-controlled trial. Archives of Physical Medicine and Rehabilitation. [Google Scholar]
3 Mofrad MK, Rezasoltani Z, Dadarkhah A, Panah SH, Tabatabaee SM, Azarakhsh A. Neurofascial dextrose prolotherapy for managing chronic ankle ligament injury. Anesthesiology and Pain Medicine. 2022 Feb;12(1). [Google Scholar]