As research and design continue its course to find a new and effective product for body pain, the new kid on the block is platelet rich plasma (PRP). Several high-elite professional athletes have used the treatment to allow continuation of their sport while healing occurs at the pain site. Example are Tiger Woods. Dwight Howard, and Kobe Bryant to name a few.
So what exactly is PRP? Platelet rich plasma is treatment used to heal injuries which involves a well orchestrated and complex series of events where proteins in the blood called growth factors act as messengers, regulating the pain process. These increase amount and concentrations of growth factors and other proteins, will lead to enhanced healing of bone and soft tissue on a cellular level. PRP therapy introduces platelets in four to ten times the concentration normally found in blood to the site of an injury delivering a highly concentrated of healing proteins directly to the location. The areas we see injury in the foot and ankle are the plantar fascia, Achilles tendon, peroneal tendon, and ligament. Generally, these structures do not great blood flow and PRP increases recovery and initiates and generates new tissue.
What is required to deliver treatment? The great thing about treatment is it is an office base procedure not requiring admission into hospital or surgery center, no preparation testing, no general and sedation anesthesia.
Below is a video detailing the collection and delivery of the PRP.
Prior to the injection of the PRP the local area is injected with local anesthesia to allow painless injection of the PRP. In our clinic we use ultrasound guidance to deliver the PRP to the accurate location of the damaged tissue. Post injection there is a detailed recovery phase that patient must be strict cooperating which includes at home physical therapy, elimination of certain medications, weightbearing support. Depending on how the patients initial symptoms are several injections must be given. Each patient is different.
So does this work? In a 2011 study in Journal of foot and ankle surgery ( @ACFAS ) showed in 4 weeks the tendons treated with PRP healed more rapidly and noted to be useful in tendon injuries. In anther study in July 2012 shows use of PRP and strict post injection protocol showed statistically significant improvements in terms of pain, activities of daily living, sports activities, and quality of life.
Currently studies are showing improvement in arthritic joints of the foot and ankle and wound healing with application of PRP.
What are some alternatives to PRP? Treatments consist of both conservative and surgical methods; however if conservative measures fail most surgeons offer surgical options for treatment. Which I also do. The biggest concern for patients is after surgery and the recovery phase. With plantar fasciitis or heel spur syndrome removal of the spur or cutting of the plantar fascia as it risk including new onset of different pain and edema. As for Achilles tendon develops a thickening and bulge, most surgeons offer debridement of the Achilles and or possible transfer a tendon. They are all good options; however, studies have shown an improvement with PRP which does not include non weightbearing, hospital surgery, and increase expense.
In our clinic the PRP injections take 30-45 minutes from initial blood draw to final dressing. It does not require time off work, has less post procedure pain and reduced need for pain medication. It is a cost effective treatment option before considering a foot and ankle surgery.