Health & Exercise Forum

The body has an amazing capacity to heal itself. When the body becomes injured, a natural healing process occurs to repair the damaged tissue. The body signals platelets and other components in our blood to migrate to the site of injury. Platelets are the primary factor for stopping blood loss at the site of injury. They coalesce at the site of injury and form a clot to stop the bleeding. Under normal conditions, in addition to forming a clot, these platelets release a variety of growth factors that initiate and subsequently promote healing. New advances in medicine have been developed to harness and concentrate these platelets to be introduced to a precise injury site in an injectable form. The implantation of these platelets from a small amount of the patient's own blood has the potential to enhance the body's capacity for healing at the site.

During the past several years, much has been written about a preparation called platelet-rich plasma (PRP) and its potential effectiveness in the treatment of injuries. This column has presented this topic in the past; however, due to the growing popularity of the treatment, it seems appropriate to offer a PRP update. Specifically, PRP has become more common to promote healing of the soft tissues of the foot and ankle.

Many famous athletes — Tiger Woods, tennis star Rafael Nadal, and several others — have received PRP for various problems, such as sprained knees and chronic tendon injuries. These types of conditions have typically been treated with medications, physical therapy, or even surgery. Some athletes have credited PRP with their being able to return more quickly to competition.

What Is Platelet-Rich Plasma (PRP)?

Although blood is mainly a liquid (called plasma), it also contains small solid components (red cells, white cells, and platelets.) The platelets are best known for their importance in clotting blood. However, platelets also contain hundreds of proteins called growth factors which are very essential to heal injured tissues.

PRP is plasma with many more platelets than what is typically found in blood. The concentration of platelets — and, thereby, the concentration of growth factors — can be 5 to 10 times greater (or richer) than usual.

How is PRP Administered?

The procedure can be administered in an outpatient clinic. To develop a PRP preparation, a small amount of blood must first be drawn from a patient. The platelets are separated from other blood cells and their concentration is increased during a process called centrifugation. The red blood cells are separated from the plasma and the platelets.  An injectable solution of highly concentrated platelets is injected into the injured tissue with a local anesthetic block.

How Does PRP Work?

Although it is not exactly clear how PRP works, laboratory studies have shown that the increased concentration of growth factors in PRP can potentially speed up the healing process.  The injured area is flooded with a high concentration of platelets and growth factors which are released from the platelets.  This in turn begins the process of healing to the injured tissue.  The growth factors are chemical messengers which signal the body to begin the complex healing cascade. In the foot and ankle, PRP is most commonly used in the following manner:

• PRP for Injured Tissue: The most common areas treated with PRP have been rotator cuff tendons and quadriceps tendons. However, PRP to ankle/foot tendons such as the achillies tendon, are becoming more common for tendonitis or tendonosis. Achilles tendonitis is a condition commonly seen in runners and others who place great strain on the tendon, the heel cord can become swollen, inflamed, and painful. A mixture of PRP and local anesthetic can be injected directly into this inflamed tissue.
• PRP for Post-Operative Tissue:  PRP is also used to improve healing after surgery for some injuries. For example, an athlete with a completely torn heel cord may require surgery to repair the tendon. Healing of the torn tendon can possibly be improved by treating the injured area with PRP during surgery. This is done by preparing the PRP in a special way that allows it to actually be stitched into torn tissues.
• PRP for Chronic Non-healing Ulcers: Diabetics and people with venous stasis disease (poor circulation) or certain other metabolic conditions are more prone to developing ulcerations which do not heal. Some of these wounds benefit greatly from the infusion of platelets delivered by PRP.  In this instance, the concentrate can be applied to the surface of the wound with a skin graft or a skin substitute.

Sources: American Academy of Orthopaedic Surgeons (AAOS); American Orthopaedic Foot & Ankle Society.

Medical Contributor: Bill Brown, DPM practice podiatric medicine, including PRP for Ankle and Foot injuries, in Scranton, PA

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum” in the Scranton Times-Tribune. Next Week  Read Part 2 of 2 on PRP Updates. This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com. Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at The Commonwealth Medical College.