Peroneus Tendon Tear Successfully Treated with Prolotherapy

At the Centeno-Schultz Clinic we acknowledge that ankle pain can be disabling.  Ankle pain can arise from multiple sources which include ankle osteoarthritis, ligament laxity, tendon tears and  degenerative lumbar disorders.   Stem cell therapy is an alternative to ankle surgery.  Surgery is associated with risks and can often times accelerate the degeneration. 

JW is an active nurse who sustained an ankle injury while participating in Cross-Fit. Her pain was constant with weight-bearing, non progressive in nature, localized on the lateral aspect of the ankle with radiations into the little toe.  Physical examination was signficant for tenderness in the lateral ankle, laxity and multiple trigger points in calf and lumbar spine.

MRI was signficant for a partial tear in the peroneus brevus tendon and injury to the anterior talo-fibular ligament.

She declined surgical recommendations and opted to prolotherapy which is the injection of an irritant intended to initiate an inflammatory response and strengthen ligaments.

At the Centeno=Schultz Clinic prolotherapy is performed utilizing MSK ultrasound guidance which ensures accurate needle placement.  Treatment was targeted at both the peroneus tendon but also the other critical ankle ligaments.  Stability is a central element as discussed in Ortho 2.o.

Adjunct therapies included IMS, flexion/extension examination of the lumbar spine, deep water immersion exercises and low carbohydrate diet. Carbohydrate restriction and proper nutrition has been linked with improved stem cell numbers and function. 

After three prolotherapies, IMS treatment and 15 lb loss JW reports a 90% improvement and has resumed her running and cycling.

Great job Jennifer.

Ankle Pain: Tarsal Tunnel Syndrome

At the Centeno-Schultz Clinic we acknowledge that there are many causes of ankle pain.

Ortho 2.o discusses the key concepts in evaluating  the ankle:  Stabilization, Articulation, Neurological and Alignment.

Tarsal tunnel syndrome (TTS)  is an entrapment of the tibial nerve  on the medial side of the ankle and is characterized by numbness and pain in the toes and sole of the foot.

The tibial nerve, artery and tendons of the flexors travel as a bundle through the tarsal tunnel.  the tarsal tunnel is delineated by bone on the inside and the flexor retinaculum on the outside.  In the tarsal tunnel the tibial nerve divides into three different segment:. calcaneal, medial and lateral. 

Anything that creates pressure in the Tarsal Tunnel can cause TTS. Common causes include cysts, bone spurs, varicose veins, ganglia, inflammation of tendons or swelling from trauma.

Symptoms include burning pain, tingling or numbness typically worse after prolonged standing.

Tarsal tunnel syndrome is diagnosed by clinical examination and based on findings such as area of sensory disturbance and positive Tinel sign over the tarsal tunnel.

Ultrasound imaging is utilized at the Centeno-Schultz Clinic for both diagnostic evaluations and therapeutic injections of prolotherapy and platelet derived growth factors.  Below is short axis  ultrasound image of the tarsal tunnel and tibial nerve.

Legend:  Abdh:  abductor hallucis muscle,

curved arrow:  tibial nerve,

fhl: flexor hallucis  longus tendon,

ST: sustentaculum tali,

straight open arrows:  flexor digitorum longus tendon,

void arrowhead:  tibial artery,

white arrow heads:  posterior tibial veins.

College Track and Field Athlete’s Success with Stem Cell Therapy

Stem cell therapy is an alternative to traditional ankle surgery as highlighted in the case discussed below.

KW is 21 y/o Oklahoma State University field and track athlete who was unable to compete due to ankle pain.

Pain was constant, 5/10 in severity and localized deep in the joint.  Aggravating factors included running, weight-bearing and bending of the ankle.

Patient had a longstanding history of ankle sprains and had undergone high dose aspirin therapy as child due to a  diagnosis of juvenile arthritis.

Treatment to date included NSAIDs, oral steroids, steroid and Synvisc injections into the ankle without x-ray and ultrasound guidance.

Ankle MRI was significant for degenerative changes in the joint, inflammation of the synovium and sprain of the 2 principle lateral ankle ligaments.

Patient initially  underwent prolotherapy and Regenexx SCP  in an effort to stabilize and strengthen the loose ankle joint followed by Regenexx SD to treat cartilage loss.  Stabilization is critical as discussed in Ortho 2.0.

6 months after starting regenerative therapy I received this e-mail which she has allowed me to share.

“Besides that minor flare, I have had really promising results.  I understand that my body has set limitations, and I may never be permitted to run 60 miles or more a week like before, but I am just grateful that I am back on the track completing workouts with my team.  I run every other day (which are “work-out” days consisting of heavy pounding on a hard track surface) and cross train on days in between.  I have also began doing olympic (short reps, but heavy and explosive) weight training without any irritation.  I started doing ladder speed drills and hurdles drills this week, and have noticed no pain.”