The treatment of Achilles tendinopathy is a complex and difficult orthopedic pathology. Acute Achilles tendinitis typically responds well to nonoperative therapy including; rest, immobilization, anti-inflammatories, stretching, and physical therapy. However, sometimes the pain can become chronic and develop into tendinosis. Chronic Achilles tendinosis is a complex pathology involving microscopic degenerative injury to the tendon with local disruption of the collagen matrix. The tendon is usually affected within its midsubstance, 2 to 6 cm from the insertion point, but can also involve the insertion point itself. Because of the high failure rates and prolonged recovery from open surgical intervention. Platelet Rich Plasma (PRP) injection therapy is a promising alternative.
What is Platelet Rich Plasma?
Platelets are small, nonnucleated bodies found in peripheral blood. Platelet Rich Plasma is believed to enhance healing by the direct delivery of increased growth factors to the location of injury. Platelet Rich Plasma is concentrated from anticoagulated whole blood. Approximately 50ml of blood is required to about 5ml of PRP. A two step centrifugation process concentrates the PRP. The PRP is then injected into the location of injury under local anesthetic. The use of Platelet Rich Plasma has been utilized for chronic tendon pathology in orthopedic literature for decades. Ultrasound guidance should be utilized to verify that the injection is positioned directly into the affected area. Typical post procedure management includes immobilization for 2-6 weeks. Followed by ROM exercises, physical therapy, and gradual return to activity as tolerated. Filardo et al(1) published a case series with follow up at 4 years following PRP injection series. The study consisted of 34 Achilles tendons that failed conservative or surgical therapy. The authors found significant improvement in all scores from baseline at each assessment. They also found an 89% return to sport and 93% of the patients were satisfied and would repeat the treatment if needed. Deans et al(2) reported a case study of 26 patients with painful and ultrasound-confirmed Achilles tendinopathy with symptoms greater than 6 months. They reported significant improvements pain, activities of daily living, participation in sports activities, and quality of life. At University Foot and Ankle Institute we utilize Biomet Biologics plasma concentration system. Following local anesthesia, PRP concentrate is injected under ultrasound guidance. The patient is allowed to walk afterwards in a CAM boot. Patients are instructed to refrain from anti-inflammatory medication and icing the injection site as this can decrease the bodies’ response. Patients are followed after two weeks, then are usually referred after six weeks to physical therapy. Platelet Rich Plasma has become a promising non-surgical options for the treatment of chronic Achilles tendon pain. We have found great success with PRP therapy by following proper selection criteria and rehabilitation. A thorough examination and discussion with one of our foot & ankle specialist can determine how successful PRP therapy would be for improving your Achilles pain. At the University Foot and Ankle Institute, our physicians are always taking advantage of new techniques and products in order to treat the most complex foot and ankle conditions. It is our mission to have patients return to high levels of functioning with an expedited recovery. If you would like to schedule a consultation with one of our foot and ankle specialists, please call (877) 989-9110 or visit us at www.footankleinstitute.com. 1) Filardo, G. Kon, E. Di Matteo, B. Di Martino, A. Tesei, G. Pelotti, P. Cenacchi, A. Marcacci, M. Platelet-rich plasma injections for the treatment of refractory Achilles tendinopathy: results at 4 years. Blood Transfus. 2014 Jun 19:1-8. 2) Deans, Victoria M. et al. A Prospective Series of Patients with Chronic Achilles Tendinopathy Treated with Autologous-conditioned Plasma Injections Combined with Exercise and Therapeutic Ultrasonography. The Journal of Foot and Ankle Surgery , Volume 51 , Issue 6 , 706 – 710
Dr. Campbell enjoys the outdoors and shortly after he moved to Southern California took up surfing. However, when the waves are flat you can find him on the golf course or riding his motorcycle.
Dr. Campbell is available for consultation at our Santa Barbara office.
Learn more about Dr. Campbell by visiting our website: http://www.footankleinstitute.com/podiatrist-santa-barbara
Latest posts by Dr. Brayton Campbell (see all)
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- Achilles Tendinitis Treatment Do’s and Don’ts - July 14, 2015
- Platelet Rich Plasma for the Treatment of Chronic Achilles Tendon Pain - October 2, 2014