Last week Health & Exercise Forum presented Part 1 of PRP Updates: What is PRP? How is it Administered? How it Works? This week will present PRP effectiveness and appropriate foot and ankle conditions for PRP.
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.
Effectiveness of PRP for Ankle and Foot Injuries
Research studies are currently being conducted to evaluate the effectiveness of PRP treatment. At this time, the results of these studies are inconclusive because the effectiveness of PRP therapy can vary. Factors that can influence the effectiveness of PRP treatment include:
Chronic Tendon Injuries
Published clinical trials report success in treating chronic Achilles tendon injuries and tendonosis of the tendon which has been diagnosed through MRI studies. The Achilles tendon is often injured in runners or in “weekend warriors”. Conservative treatment includes rest and physical therapy. Injections of cortisone into the tendon are generally not considered as it can weaken the tendon and make it more prone to rupture. The Tendon injury can produce pain and swelling of the back of the heel. There can be other causes for pain in the area including heel spurs and tendon rupture. If conservative treatment fails, surgical intervention can be an option. PRP is proving to be a viable alternative to surgery.
This condition is seen in runners and walkers as well as those just starting out on a new or different exercise regimen. It can appear suddenly or over a period of time. The pain is generally worse in the morning and lets up somewhat during the first few hours of the day only to return later in the day after standing or walking during the day. Conservative treatment consists of aggressive physical therapy, stretching and either oral or injectable anti-inflammatory medication and orthotic therapy. Cases that don’t respond to this can go on to surgery. PRP is a good option to try prior to contemplating surgical intervention.
Chronic Non Healing Ulcerations.
If a wound is located on the bottom of the foot or in an area that is subject to increased edema or stress it should be evaluated by a wound care specialist. The doctor will determine the cause of the ulceration and the best course of action in order to heal the sore. Often times for longstanding ulcerations which have failed conservative methods of treatment, PRP can be used to try and give the wound a kick start and achieve healing. Sometimes, PRP can be used in conjunction with a skin graft or a biologic skin substitute to achieve healing.
In conclusion, platelet rich plasma presents a promising method of treating a variety of conditions from chronic tendon or ligament injuries to long standing non healing ulcerations. The use of PRP for ankle and foot injuries is gaining more widespread acceptance and new and interesting studies are being conducted to show the mechanism of action of the procedure. It is being used successfully to help patients heal by using their own natural injury healing cascade in a concentrated fashion.
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. 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: firstname.lastname@example.org. 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.