PRP Injection – A Non-Surgical Option For Foot & Ankle Pain

Plantar-Fasciitis

PRP Injection – A Non-Surgical Option For Foot & Ankle Pain

During the past several years, much has been written about platelet-rich plasma (PRP) injection and its potential effectiveness in the treatment of various injuries. Many famous athletes — Tiger Woods, tennis star Rafael Nadal, and several others — have received PRP injections for various problems, such as sprained knees and chronic tendon injuries. These types of conditions have typically been treated with cortisone injections, medications, physical therapy, or even surgery. Some athletes have credited PRP with their being able to return more quickly to competition. I am performing more and more PRP injections, in place of cortisone, for a variety of foot and ankle issues.

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.) Platelets are best known for their importance in clotting blood. However, platelets also contain hundreds of proteins called growth factors which are very important in the healing of injuries. 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. The PRP injection is derived entirely from the patients own blood, no foreign substance or chemicals, and injected back into the patient in the area of the injury or pain.

Where can PRP injection be used?

Injuries: Many foot and ankle injuries occur when people are playing sports, exercising or repetitively overusing a body part. Accidents, lack of warming up properly or stretching before activities, poor sport training and not being in shape can cause these injuries. One of the most common areas of the body that are affected by sport injuries are the feet and ankles. PRP is extremely effective in the healing of a variety of foot and ankle injuries.

Arthritis: Arthritis is basically inflammation of one or more joints. They are many different forms of arthritis. One of the most common is osteoarthritis, which is a degenerative condition due to age, trauma or infection of the joint. The pain associated with “arthritis” is usually constant and can create strains on the muscles connected to the affected joint.

Tendonitis: Tendons are the fibers that connect muscle to bone and allow us to move. There are two types of tendon injuries. Tendinitis is when the tendon is inflamed and tendinosis is when there are tiny tears in the tissue in and around the tendon, which is usually caused by overusing the tendon over a long period of time, common in the foot and ankle. An Achilles tendon injury can be caused by not stretching enough before strenuous physical activity, overuse, flat feet, wearing high heels and sports. Symptoms are usually pain, swelling, difficulty flexing or pointing your toes, stiffness and a popping noise during an activity. People who suffer from flat feet often have pain at a tendon called the posterior tibial tendon, located on the inner side of the arch and ankle area.

Plantar Fasciitis: Plantar Fasciitis is when you experience pain on the bottom of your arch and/or heel. The plantar fascia is the ligament that connects your heel bone to your toes. If you strain the plantar fascia it can cause tiny tears which lead to pain and swelling. It is more likely to happen if you are overweight, stand or walk for long periods of time, or wear shoes that don’t fit correctly or support your feet adequately. Classically, the worst pain is the first step out of bed or after periods of inactivity.

Ligament Injury: Ligaments are the fibers that hold your bones together which in turn stabilizes the joint and range of motion. When ligaments are damaged, they are no longer able to provide the same support thereby causing joint instability, weakness and pain. Typically, I see patients complaining of pain following an ankle sprain and PRP is utilized to treat this nagging problem.

How is PRP performed?

A small amount of blood is taken from the patients arm and processed either in the office or the operating room. The processing requires approximately 20 minutes. Platelets are separated out, concentrated many fold, and includes the patient’s own immediate and delayed growth factors to be ready for injection back into the painful or injured area or areas.   This stimulates a healing process. Unlike steroids or cortisone shots, PRP stimulates and modulates the necessary healing within the body. Steroids or cortisone are potent anti-inflammatories; however, most issues that require medical intervention are chronic and not inflamed. Steroid or cortisone injections may provide short-term relief, but cause weakening of the tendons and ligaments over time. PRP eliminates the need for prolonged physical therapy, surgery and may restores normal function. PRP does not result in an “instant fix” even if the pain is improved or resolved. The healing process takes time, usually 6-8 weeks, and patients will be monitored for a return to full, unrestricted activities. It is very important to avoid anti-inflammatory medications such as Motrin, ibuprophen or Aleve as they can interfere with the healing process. Generally, immediate activity after the procedure is similar to what the patient’s pain limited them from doing before the procedure. Approximately a month after the procedure a short course of physical therapy may be initiated.

Benefits of PRP

  • Eliminates the need for prolonged physical therapy
  • Eliminates the need cortisone injection
  • Restore normal function
  • Eliminate the need for Surgery
  • Avoid Inactivity and Deconditioning

I am finding, as patients become more education regarding treatment options, many are inquiring about PRP as an option and most have heard of it, and I am performing this simple and effective procedure quite frequently. PRP injection is moving to the forefront of treatment for a variety of foot and ankle conditions. For more information, or to make an appointment for a consultation, please call our office at 201-261-0500.

 

 

Platelet Rich Plasma (PRP) Injections

Dr. Vincent Giacalone

Dr. Vincent Giacalone

Podiatric Medicine & Surgery

466 Hook Rd., Suite 24D, Emerson, NJ 07630

Phone: 201-261-0500

Platelet Rich Plasma (PRP) Injections

What is Platelet Rich Plasma (PRP)?

Platelet rich plasma, abbreviated PRP, is a new treatment used for some common podiatric and orthopedic conditions. PRP is a concentration of platelet cells taken from your blood. The platelets have growth factors that may help in the healing process of chronic injuries. Growth factors are natural occurring body proteins that signal the body to initiate a healing response. By injecting PRP into areas of an injury, the hope is to stimulate and optimize your body’s ability to heal the chronic conditions.


What PRP Can Be Used For?

PRP has been used in operating rooms for several decades to help with wound healing, and to stimulate bone formation in spinal fusion surgery. Recently, PRP has been used in outpatient settings, such as doctor’s offices, for treatment of common overuse conditions including:

Achilles Tendonitis

  • Heel spur syndrome
  • Plantar Fasciitis
  • Posterior Tibial Tendonitis

How PRP Is Obtained?

PRP is obtained from you, the patient.  Your own blood is withdrawn from a vein in your arm and the blood is placed in a centrifuge, a machine that spins at a high speed to separate the different types of blood cells. Dr, Giacalone then extracts the platelet-rich portion of the blood, and injects this into the area of injury.

How PRP Is Injected?

PRP injections are given as soon as the blood has been spun and the platelets separated. Some physicians may choose to add an “activating agent,” usually either thrombin or calcium chloride, while some inject just the platelets. Studies have shown that the tendons being injected can also activate the PRP, so the activating agent may not be necessary. There is no clear science to justify a particular quantity of PRP and number of injections needed. Most physicians perform one injection, although sometimes PRP injections are given as a series of injections over a span of several weeks.

What is the Effectiveness?

We know from laboratory studies that PRP can help increase certain growth factors that are important in the healing process. In a recent study comparing platelet-rich plasma versus steroid injection in the treatment of plantar fasciitis, there was a significant improvement in pain scores in patients who received the PRP injection. Another study evaluating the use of PRP in the treatment of Achilles tendonitis found the PRP provided significant improvement. In many instances we cannot inject the standard cortisone, such as in the cases of Achilles tendonitis, PRP injection may be most beneficial.

If You Want PRP?

PRP injections can be done in Dr. Giacalone’s office. The procedure takes about 30 minutes in order to withdraw the blood, spin the blood in the centrifuge, and inject the PRP into the injured area.

Risks of PRP

Side effects are uncommon, but they are possible. Whenever a needle is inserted through the skin, infection can occur. The other more common side effect of PRP injections is an increase in inflammation and pain after the injection. PRP injections are not recommended in individuals with bleeding disorders, those taking anti-coagulation medications (e.g. Coumadin), or those who have cancer, active infections, or are pregnant.

Dr. Giacalone has been trained specifically and extensively in the diagnosis and medical and surgical treatment of foot disorders.  Dr. Giacalone has been board certified by The American Board of Podiatric Orthopedics and The American Board of Podiatric Surgery since 1993 and 1995 respectively and is a Fellow of the American College of Foot and Ankle Surgeons. Dr. Giacalone performs surgery at Hackensack University Medical Center in Hackensack, Hackensack University Medical Center @ Pascack Valley in Westwood and Surgicare Surgical Center in Oradell.