When in Doubt Take It Out: Foot Pain

After 12 weeks in a walking boot with extreme pain in the ball of her foot, the surgeon informed AK that major surgery was necessary where he would make a wide incision extending across the base of her foot and remove any abnormal bones and tissue.  She declined and sought non-surgical options at the Centeno-Schultz Clinic.

AK is a school teacher who was involved in a serious car accident.  At time of impact she had her right foot on the brake which was severely damaged.  She had immediate onset foot pain which was initially thought to arise for fracture of two small bones in the foot (sesamoid bones). 12 weeks of conservative therapy failed to improve her foot pain.

Initial evaluation at the Centeno-Schultz Clinic was significant for tenderness along the SI joint, pain along the flexor ligaments in the foot,laxity of the ankle and foot ligaments and multiple trigger points.

AK underwent the prolotherapy of the ankle and tib-fib ligaments,  myofascial deactivation (IMS) in the calf and foot, ultrasound guided PRP injections into foot and treatment of her sacroiliac joint and supporting ligaments.  The problem was not a fracture in the seasmoid bone but rather injury to the ligaments and muscle in the foot, ankle and pelvis.  Dysfunction in these structures led to referred pain.

Yesterday in clinic AK reported 90% improvement in her foot pain and was able to avoid a large surgery.  She is out of her walking foot and back in the classroom.

Critical Differences in PRP: Laboratory Prepared vs Bedside

Not all platelet rich plasma (PRP) preparations are the same.   The majority of PRP preparations are created by bedside centrifuge units.  At Regenexx we are constantly striving to improve clinical results.  Our state of the art cellular laboratory enables us to experiment on different ways to get more platelets out of a given sample. 

We recently ran an experiment with 5 patient’s samples trying 5 different techniques to maximize platelet concentration in platelet rich plasma.  A flow cytometer was used to measure the number of platelets being isolated and how ‘clean” the isolation was in the mix..  A clean isolation was preferred since it meant it had little extra platelet matter( cell membranes.)

The results demonstrated that the centrifuge techniques similar to bedside PRP did NOT produce the best platelet concentrates.  In fact, they tended to produce less platelets and more non platelet matter than other techniques. 

A proprietary simple laboratory technique has been developed that provides more platelets and a much cleaner isolation.  It is called APC:  autologous platelet concentration so as to differentiate it from  PRP.  It produced 237% more platelets when compared with traditional bedside centrifuge units.

Below is a graph that demonstrates the significant differences.  The graph on the left has a wide mountain reflective of  significant non platelet matter whereas the graph on the right has a narrow tall peak reflective of a cleaner isolation.  Total number of platelets on the left is 200 vs 12oo produced by the laboratory.

Bottom line:  laboratory prepared autologous platelet concentrate provides a larger number of platelets in a cleaner isolation.  This difference translates to improved healing and faster recovery.

Essential Differences in PRP Therapies

Platelet rich plasma (PRP) therapy is the use of a patient’s own platelets to accelerate healing.  It is termed rich because the platelets are concentrated, typically 5-10x above the concentration that is circulating in your blood.

PRP therapy has been used for a number of different indications  including wound healing in surgery,tendinitis, cardiac care and dental health.

Platelet-rich plasma (PRP) therapy made headlines following the Super Bowl, when it was revealed that Pittsburgh Steelers Hines Ward and Troy Polamalu had undergone PRP injections in the days leading up to the game.

Are all PRP therapies the same?

NO.

There are distinct differences in platelet rich plasma .

Most PRP is created by a bedside machine that creates a platelet concentrate by spinning (centrifuge) the blood thereby separating the platelets from the other blood products.

A cell biologist in a laboratory, however,  is able to separate the platelet from other blood products and so much more.

A cell biologist can create PRP that is pure and free of any red or white blood cells.  A machine cannot.

A cell biologist can create PRP in a specific concentration for specific indications.  A machine cannot.

A cell biologist can make PRP that has a very high levels of specific, naturally occurring growth factors such as VGEF, vascular  growth endothelial factor.  A machine cannot.

At the  Centeno-Schultz Clinic we are not reliant on a machine.  Rather through the use of a state of the art lab with full-time cell biologists we are able to provide our patients with customized PRP therapies that are specifically designed for them.  This is the critical difference which translates to improved outcome.