Platelet-Rich Plasma Therapy

In the world of sports injuries, healing time is of the utmost importance. The difference in a week for full recovery can mean the difference between making the playoffs and ending the season early. Because of this need for fast-tracking healing times, different innovations have become more popular in medicine. One of these innovations is the use of platelet-rich plasma.

Platelet-rich plasma (PRP) had been used previously as an adjunct to healing in spinal surgeries and in plastic surgeries with extensive soft tissue damage. The process involves drawing a small amount of blood from the patient (between 30mL and 60mL), putting the blood into a centrifuge, and spinning it down to separate the blood components. The plasma is separated from the cells, but the platelets are kept in the plasma. This platelet-rich plasma can then be injected back into the same patient, in the area that healing is needed. PRP has gained popularity, and has been used to treat tendon injuries, ligament injuries, cartilage injuries, muscle injuries, and for chronic wounds.

Part of PRP’s recent surge in popularity is due to its use in treating sports injuries. Professional athletes like Tiger Woods, Troy Polamalu, and Hines Ward have all received media attention from PRP therapy. Recently, Houston Texans wide receiver Andre Johnson has made the news for receiving platelet-rich plasma treatment. As more and more professional athletes use PRP therapy, it becomes more common for amateur athletes and weekend warriors to ask their doctors about the treatment.

The theory behind how PRP therapy works is somewhat simple. Platelets in the blood normally release chemical signals to promote healing at a specific site. These signals attract more platelets to the area, which increases the amount of signal being release, and thus the healing process continues. By removing blood from a person and concentrating the amount of platelets in a particular area, the healing time is theoretically increased.

In podiatry, common uses for PRP therapy include plantar fasciitis and Achilles tendon tears/ruptures. Both of these areas are prone to chronic injuries that can be very difficult to heal, and can often take a very long time for the symptoms to go away. Therefore, platelet-rich plasma therapy becomes an interesting option for these patients. These areas of injury can also have a relatively low blood supply, which may be why they are prone to injury in the first place. Injecting platelet-rich plasma into these areas can promote healing in an area that may be difficult for platelets to reach on their own.

While platelet-rich plasma seems to be a great therapy to boost the healing of certain types of injuries, there are certain limitations to its use. The studies that have been performed show inconsistencies in the method of use, as well as small sample sizes and a lack of control subjects. Additionally, there are many studies that show inconclusive results as to the efficacy of PRP. This takes away from the studies that show PRP to be an effective method of treatment, as the results may not be able to be repeated.

While there may be some controversy over its efficacy, PRP is still becoming a popular method of treatment for chronic injuries, particularly among professional athletes. This is due to a vast amount of resources for this patient group, as well as the desire to fast-track recovery time. As more studies are performed on the topic, watch for more solid results to be shown.

Central Florida Foot and Ankle Center, LLC.

101 6TH St. NW.

Winter Haven, Fl. 33881

863-299-4551

www.FLFootandAnkle.com

Metatarsalgia (Forefoot Pain)

The term metatarsalgia translates to “pain in the metatarsals”. It is most commonly used to describe pain in the metatarsal heads, at or near the ball of the foot. Though it is sometimes used as a discrete diagnosis, the term metatarsalgia is a very general term that does not offer a reason for the pain. There are a number of different conditions that can cause metatarsalgia, and many others that may mimic the findings.

True metatarsalgia results from increased pressure in the metatarsal heads. This is most commonly the result of biomechanical deformities such as hallux valgus or an elevated first ray. Conditions like this may also be associated with bunion formation. Most frequently it is associated with a flatfoot, or a foot that is prone to pronation syndrome. However, increased pressures through the metatarsal heads may also be seen in a high-arched foot, or pes cavus.

Another common cause of metatarsalgia is a thinning of the fat pads at the bottom of the foot. Fat pads are normally found underneath the heel and at the ball of the foot. These well-organized structures help to cushion the forces applied to the foot while walking. In older people, the fat pads can thin as a normal part of aging, a component of some disease processes, or with the use of some drugs such as oral steroids. When the fat pad at the ball of the foot thins, the cushioning underneath the metatarsal heads is lost, and metatarsalgia may ensue.

Pain in the metatarsal heads is also commonly seen with hammertoes, as the contracted digits force the metatarsal heads into the ground with excessive force. Over time, this can create a painful situation.

Other conditions of the foot may appear as metatarsalgia, but may actually be a different pathological process. Neuromas, particularly those found between the metatarsals such as Morton’s neuroma, can appear at first as metatarsalgia. Stress fractures of the foot may also lead to pain in the ball of the foot or at the metatarsal heads.

Rheumatoid arthritis may appear initially as metatarsalgia, and should be ruled out as a part of the clinical exam. This may include x-rays as a diagnostic study, which can also look for avascular necrosis of the metatarsal heads as a cause of the pain. Tendinitis, bursitis, and capsulitis (a swelling of the joint capsule) can also appear as metatarsalgia. It is up to the clinician evaluating the patient to differentiate between these pathologies.

The best treatment, therefore, for metatarsalgia, is to address the underlying cause of the condition. If it is a biomechanical etiology, such as from over-pronation, conservative therapy may address correcting the deformity. The use of custom orthotics or another type of shoe insert is commonly employed as a first-line treatment. Simply resting and icing the area while taking anti-inflammatory medications may alleviate the pain, but can also delay the proper and necessary treatment. Custom orthotics, specialized shoe inserts, a change in shoes, and possibly shoe modifications will all help the person with a loss of the protective fat pads found on the bottom of the foot as well.

Central Florida Foot and Ankle Center, LLC.

101 6TH St. NW.

Winter Haven, Fl. 33881

863-299-4551

www.FLFootandAnkle.com