If your cortisone shots have stopped working for ankle arthritis, it is best to discontinue these injections and get re-evaluated for treatments that address the source of the pain. At Nervexa Orthopedics in Phoenix, this often means the three-step Nervexa Approach: musculoskeletal embolization, nerve transfer, and peripheral nerve stimulation, which are minimally invasive alternatives to ankle joint replacement.
Many patients follow a familiar path: the first cortisone shot works well for months, but each subsequent injection provides shorter relief. This shrinking window is a common reason people come to Nervexa and signals the need for a new approach.
Cortisone is a powerful anti-inflammatory steroid. Injected into the ankle, it calms swelling and irritation that drive arthritis pain. However, it does not repair cartilage, change joint alignment, or stop the underlying process that keeps the joint inflamed. It’s a fire extinguisher, not a repair crew.
With repeated injections, the joint becomes less responsive to the steroid, and the periods of relief grow progressively shorter. Meanwhile, the arthritis itself continues to advance. Each shot is being asked to control more damage with less effect, which is why relief that once lasted months can shrink to weeks.
Understanding what to do when cortisone shots for ankle arthritis stop working starts with widening the plan beyond injections – shifting from temporary management to long-term resolution.
Targeted strengthening of the calf, peroneal, and intrinsic foot muscles improves how the ankle absorbs load and stabilizes the joint. Balance and gait training reduce the awkward compensations that make arthritic ankles hurt more.
Non-steroidal anti-inflammatory drugs (NSAIDs), topical gels applied directly over the joint, and other pain-modifying options can take the edge off. They manage symptoms rather than change the joint, but they have a place in a broader plan.
Stiff-soled shoes with a rocker bottom, custom orthotics, and ankle bracing to limit painful motion
Cycling, swimming, or pool walking in place of high-impact activity
Modest weight reduction, which lowers the force crossing the ankle with every step
For patients who have failed conservative care, Nervexa Orthopedics offers an innovative three-step process known as the Nervexa Approach – a revolutionary alternative to joint replacement developed by our founder, Dr. Josh Hustedt, a Stanford-trained, double board-certified orthopedic surgeon.
Musculoskeletal embolization is the first step. Tiny microcrystals are injected into the small arteries around the ankle to block the abnormal blood flow feeding chronic inflammation, breaking the cycle in which the body keeps trying to heal a joint that can’t be healed. For patients whose pain is driven by persistent inflammation, this addresses a cause rather than masking a symptom.
The second step is nerve transfer, a specialized procedure where the sensory nerves responsible for sending pain signals from the ankle are meticulously rerouted into nearby muscles. This process effectively ‘tricks’ the brain; by converting the nerves from sensory to motor pathways, the brain’s cortex ‘shadows’ the area, causing the perception of pain to fade away.
Peripheral nerve stimulation uses a small, FDA-cleared implanted device that generates a subtle electromagnetic field to interrupt any remaining pain signals before they reach the brain. Patients control it directly from their smartphone. It also serves as a trial step, helping confirm that targeting the nerves will work for you before moving forward.
Ankle fusion and total ankle replacement are the traditional endpoints for advanced arthritis – invasive procedures with long, often grueling recoveries. Many patients are turned away entirely. If you’ve been told you’re not eligible for major surgery, you have not run out of options.
Our innovative treatment was built for exactly such patients, as an alternative to joint replacement:
Performed minimally invasively, with the procedure done under local anesthesia and peripheral nerve blocks rather than general anesthesia
Most patients rest about two weeks, return for stitch removal and follow-up, then begin physical therapy
Many feel meaningfully better by around six weeks
Cortisone quiets inflammation temporarily; it doesn’t change what’s driving your ankle arthritis. When relief fades faster each time, the productive next step is a reassessment that considers therapy, mechanical support, and treatments aimed at the inflammation and pain nerves themselves.
Our team evaluates patients at our Phoenix clinic through in-person and virtual consultations, including out-of-town patients traveling for care. We specialize in helping people who thought they were out of options get back to living their lives.
About the Author
Dr. Joshua Hustedt
August 17, 2026
