Amniotic Injections for Foot & Ankle Arthritic Conditions

Amniotic products have been used successfully for over a century in the setting of problematic tissue healing and have enjoyed a stellar safety record. Following recent clinical success with treating orthopedic injuries, there has been renewed interest in the treatments for musculoskeletal disease and injury. An abundance of scientific and clinical evidence has demonstrated the relationship between the molecular healing mechanisms and the clinical success of treatment in the setting of chronic inflammation where amniotic products have been used.

While some authors aggressively point out that amniotic fluid products do not have any living stem cells, we can’t agree that it doesn’t play an important clinical role. The fact that amniotic fluid doesn’t have any living stem cells, however, shouldn’t preclude us from acknowledging its potential value in treatment, given the excellent safety record and demonstrated scientific efficacy of the product when used in the correct setting. In some patients, amniotic fluid treatment has been the ideal tool to restore their ability to enjoy their recreational and vocational pursuits almost immediately after injection and without surgery.

Amniotic Injections Potential:

Many believe the value of the amniotic product may be in it’s ability to neutralize the toxic healing environment of the degenerative joint. It has been clearly demonstrated that concentrations of tissue degrading enzymes (MMPs) that destroy cartilage and cause painful symptoms are elevated in arthritic joints.

Amniotic fluid contains regulators for healing and inflammation promoting tissue regeneration and repair.  The fluid contains growth factors which can help promote new tissue growth and also help to call in the body’s stem cells. Amniotic fluid contains important anti-inflammatory properties from biochemicals called cytokines that help relieve pain.  Amniotic fluid also contains hyaluronic acid (a prominent component of joint fluid important for lubricating cartilage and promoting growth of new cartilage).  This allows Amniotic Injections to also provide protection for joints for long term relief.

Amniotic fluid is heavily concentrated in important healing molecules, growth factors, hyaluronic acid, antimicrobial components and stem cell activators that have been proven to be effective in patients with arthritic conditions without producing an immunologic rejection response.

Dr. Jose Rivera is a Board Certified Foot & Ankle Specialist specializing in the field of regenerative foot & ankle orthopedics.  He currently practices at OrthoRegenX in Orlando, FL area and is focused on providing minimally invasive and effective regenerative treatments to provide his patients an alternative to invasive surgery.

Is PRP or Steroid injection more effective against Plantar Fasciitis?

What You’re Really Getting with an Injection of Steroids
Most patients are familiar with steroid injections, but most have no idea that PRP injections are an alternative to treat many of the same issues.

Let’s review what you’re really getting when you get a steroid injection.

Cartilage Damage
High-dose steroid injections destroy cartilage. That steroid injection into your knee, for example, might provide you with some temporary pain relief, but behind the scenes it’s wreaking havoc on your joint-cushioning cartilage. If you think you’re off the hook because your steroid injections are being injected into your foot for plantar fasciitis, think again. Your foot contains many tiny joints, all cushioned with cartilage to help provide smooth movement.

Diminishing Relief
Repeated steroid injections have been shown to provide diminishing relief with each subsequent injection. Why? Possibly because of the toxic effect steroids have on the local repairing stem cells…

Poisoned Stem Cells
Your body’s own stem cells are powerful cells that respond to damage and immediately get to work repairing it when it occurs. One study found that when mesenchymal stem cells are exposed to steroids, this, in effect, poisons the cells, stifling their ability to become bone and to repair bone. With no strong stem cells to stop it, wear and tear sets in and bone damage occurs.

Increased Risk for Bone Loss
Bone loss and osteonecrosis are well-known potential risks of steroid treatments.

Decreased Blood Supply
In order to stay healthy and effectively heal, tissues need a good blood supply. One study, however, found that when comparing patients who were undergoing rotator cuff surgery and had steroid injections prior to the surgery to those who didn’t have steroids, the steroid patients had one-third fewer blood-supply vessels.

So if you have plantar fasciitis, is there an alternative for steroid injections? Yes! Platelet rich plasma, or PRP…

What You’re Getting with an Injection of PRP
Platelet rich plasma (PRP) is concentrated from blood platelets, which are the body’s natural growth factors and healing molecules. When you have an open wound, such as a finger laceration or a skinned knee for example, it’s your platelets that rush in and start clotting your blood to stop the bleed. Your growth factors also kick in to encourage healing. It’s how the body heals itself when minor injuries occur.

To obtain PRP, blood is drawn from a vein and the whole blood is centrifuged, or rapidly spun. Centrifuging separates the plasma serum where the platelets are concentrated; hence, the result is a platelet rich plasma.

Injections of a patient’s own PRP stimulate the body’s local stem cells to wake up and start repairing damaged tissues. So PRP is like a shot of espresso for our repairman cells. PRP is used to treat many orthopedic conditions, such as muscle, ligament, and tendon tears, sprains, arthritis, and much more.

Study Favors PRP vs Steroids for Plantar Fasciitis
The purpose of the new study (http://www.footanklesurgery-journal.com/article/S1268-7731(18)30023-7/fulltext?rss=yes) was to compare the impact of PRP versus steroid injections on chronic plantar fasciitis. Both outcomes and imaging (ultrasound and MRI) were analyzed in 40 patients with plantar fasciitis—20 received PRP and 20 received steroids. Subjects were evaluated at three and six months following treatment.

The results? While there were improvements in both groups, the PRP group showed significant improvement over the steroid group. Researchers concluded that PRP injections are a “more effective therapeutic method” than steroid injections. In addition, the study goes on to say that not only is PRP safe, but that PRP treatment provides a longer-lasting solution than steroids.

The upshot? This is one of many studies that now show that PRP is better than steroids and doesn’t have the nasty side effects. If you’re a patient who is getting or about to get a steroid injection, spend a little on yourself and upgrade to a PRP shot. You’ll be glad you did!

Mechanism of Action of Amniotic ECM Treatment

Dr. Jose A. Rivera, DPM, FABFAS

Director, Foot & Ankle Services at OrthoRegenX

While traditional amniotic products don’t have live stem cells, they do have two interesting things going for them. First, they may have unique cytokines and growth factors that may help tissue healing.  Second, and likely more important, is that they are likely an all-purpose ECM.

It has been demonstrated that various ECM products help change the environment for healing. Basically, they are able to take local macrophages (the cells that help repair by taking out the garbage) to go from an M1 state (pro-inflammation and breakdown) to an M2 state (pro-growth and repair). So the efficacy of amnion may be more about its ability to shift a chronic injury site from scarring, swelling, and poor repair to lower inflammation and repair.

Our OrthoRegenX providers have the ability to offer patients a variety of Regenerative treatment options. For more information, you may visit us at www.orthoregenx.com or contact us at 407-720-4253 or [email protected]

What is EPAT (Extracorporeal Pulse Activation Technology)?

Extracorporeal Pulse Activation Technology (EPAT®) is the most advanced and highly effective non-invasive treatment method cleared by the FDA. This proprietary technology is based on a unique set of pressure waves that stimulate the metabolism, enhance blood circulation and accelerate the healing process. Damaged tissue gradually regenerates and eventually heals. This non-invasive office based procedure represents a breakthrough treatment option for a broad range of musculoskeletal conditions.  Over 80% of patients treated report to be pain free and/or have significant pain reduction.

What disorders can be treated?

Generally, EPAT can be utilized to treat acute or chronic musculoskeletal pain and/or pain that significantly impairs mobility or quality of life. Areas include: Foot and Ankle, Shoulder, Elbow, Knee, Lower Back and Myofascial Trigger Points.

What are the possible side effects/ complications?

The non-invasive EPAT® treatment has virtually no risks or side effects. In some cases, patients may experience some minor discomfort which may continue for a few days.

What is the duration of the treatment and how many treatments will I need?

Treatment sessions take approximately 15-30 minutes depending on the disorder to be treated. Generally, 3 treatment sessions are necessary at weekly intervals.

Contact Us

Contact OrthoRegenX at 407-720-4253 or visit us online at www.orthoregenx.com to schedule your evaluation and start your road towards recovery and optimal function!

Stress Fractures in Females

STRESS FRACTURES IN FEMALES
Jose A. Rivera, DPM, FABFAS

Females are 3.5 times more likely than men to develop stress fracture with approximately 13% of female runners developing a stress fracture at one point during their lifetime.

Common causes can be divided to training factors and female specific factors.  Training factors can include training errors such as increasing mileage too quickly or “over” training, change in training surface, and starting speed work.  Female specific factors can include
menstrual disturbances, Osteoporosis/decreased bone density, and Endocrine Factors (Calcium deficiency, Vitamin D deficiency).  The “Female Triad” is a common term utilized for females who suffer a stress fracture and present with amenorrhea, decrease bone density, and an eating disorder.

Work up should include diagnostic testing (such as Xrays, CT Scan, MRI), Laboratory work up (Vitamins, Thyroid, etc), and proper history.

Treatment will require avoidance of all high impact activity and often immobilization in a walking boot.  Return to activity/running can take up to 8 weeks.

If you are a female runner experiencing chronic pain and swelling on your foot, contact OrthoRegenX for a detailed work up and to learn how our advanced therapies can help you recover faster!

OrthoRegenX

407-720-4253

www.orthoregenx.com

 

Common Running Injuries

SIX COMMON RUNNING INJURIES

Dr. Jose A. Rivera, DPM, FABFAS

Advanced treatments offered at OrthoRegenX such as  Prolotherapy, PRP, Cold Laser, and EPAT (Extracorporeal Pulse Activation Technology) can be of great benefit in reducing inflammation and helping the body regenerate healthy tissue in patients suffering from the following common running injuries.

1. Patellofemoral Pain Syndrome (Runner’s Knee)
Approximately 13% of runners suffer from Runner’s knee pain. It is an irritation of the cartilage on the underside of the patella (kneecap) and
typically flares up during or after long runs, after extended sitting, or when descending hills or stairs.  Risk factors include excessive pronation during gait or running, weak quads, weak hip flexors, and/or weak gluteal musculature.

Treatment is directed towards rest by taking some days off, reducing your mileage by 50% or running a distance you can sustain without pain.
Incorporating a dynamic warm up with Gluteal and Hip Flexor strengthening exercises and self myofascial release techniques is important in off-loading the stress at the knee joint. Cross training and shortening your stride during running are also options to consider.

For patients with chronic symptoms, advanced therapies such as Prolotherapy, PRP, Cold Laser, and EPAT (Extracorporeal Pulse Activation Technology) are of great benefit in reducing inflammation and helping the body regenerate healthy tissue.

2. Achilles Tendonitis
Approximately 11% of runners suffer from Achilles tendonitis.  Risk factors include training errors (ie. increase in mileage too quickly, surface), tight Achilles tendon, weak calf or gluteal musculature and excessive pronation.

Treatment is directed towards rest by taking some days off, reducing your mileage by 50% or running a distance you can sustain without pain.
Incorporating a dynamic warm up with Gluteal strengthening exercises, self myofascial release techniques, and eccentric stretching exercises is also important in the recovery. Cross training and shortening your stride during running are also options to consider.  Immobilization may be required depending on severity and chronic nature of symptoms.

3. Plantar Fasciitis (Heel Pain)
Approximately 15% of runners suffer from Plantar Fasciitis.  Risk factors include excessive pronation, training factors (ie. increase in mileage too quickly), weak core musculature and history of low back pain, and tight calf musculature.

Treatment is directed towards rest by taking some days off, reducing your mileage by 50% or running a distance you can sustain without pain.
Incorporating a dynamic warm up with Core strengthening exercises, self myofascial release techniques, and eccentric stretching of calf musculature exercises is also important in the recovery. Cross training and shortening your stride during running are also options to consider. Over the counter orthotics may be used as a temporary method to off-load the plantar fascia.  Immobilization may be required depending on severity and chronic nature of symptoms.

4. Shin Splints (Medial Tibial Stress Syndrome)
Approximately 15% of runners suffer from Shin Splints.  Common in beginner runners or when undertaking a new training program.  Risk factors include runners with very low arches, training factors, and shoes with poor support.

Treatment is directed towards rest by taking some days off, reducing your mileage by 50% or running a distance you can sustain without pain.
Incorporating a dynamic warm up with Core strengthening exercises and self myofascial release techniques is also important in the recovery.  Over the counter orthotics may be used as a temporary method to off-load the lower leg musculature .  Supportive shoes with anti-pronator bar may be considered.

5. Illiotibial Band Syndrome (IT Band)
Approximately 12% of runners suffer from IT Band Syndrome.  It is characterized by pain along the outside of the thigh running from hip to the outside of the knee.  Risk factors include weak gluteal muscles, weak hip abductor muscles, and weak hip flexor musculature.

Treatment is directed towards rest by taking some days off, reducing your mileage by 50% or running a distance you can sustain without pain.
Incorporating a dynamic warm up with Gluteal and Hip strengthening exercises and self myofascial release techniques is also important in the recovery.

6. Stress Fracture
Approximately 6% of runners suffer from stress fractures.  It is more common in females than males with approximately 13% of female runners developing stress fractures.  It is most common in metatarsals of the foot, heel, and tibia.  Common risk factor in all populations includes increasing mileage/training too quickly.  Specific risk factors in the female population include nutritional factors (insufficient Vitamin D, Calcium levels), decreased bone density and low estrogen levels.

Treatment is directed towards avoiding all high impact exercise and immobilization.  It usually requires immobilization in a walking boot or use of a rigid sole shoe.  Recovery time usually involves a 4-6 week period prior to being able to return to running activities.

 

Heel Pain: Regenerative Therapy options to heal Plantar Fasciitis

Plantar Fasciitis injuries affect both seasoned athletes and every day people that are simply on their feet all day. It is a condition where thick connective tissue that supports the arch on the bottom of the foot, running from heel bone forward to the ball of the foot, becomes inflamed. The reason for inflammation varies but is commonly due to repeated trauma from overuse or injury.

While treatments such as foot bracing, strapping and cortisone injections can provide some relief, the best way to actually heal the injury and provide long-lasting improvement is through biologic regenerative treatments.   Treatments options include Prolotherapy, Platelet Rich Plasma or Extracorporeal Pulse Activation Technology (EPAT).

Prolotherapy contains a solution of concentrated dextrose and local anesthetic (steroids are not used). This solution stimulates the body’s natural ability to repair damaged tissue, encouraging new growth and creating a positive environment for healing.

Platelet Rich Plasma initiate tissue repair by releasing growth factors. These growth factors start the healing process by attracting cells that repair, including critical stem cells. Platelet Rich Plasma therapy intensifies this process by delivering a higher concentration of platelets. The therapy involves a small sample of the patient’s blood placed in a centrifuge to separate the platelets from the other blood components. The concentrated PRP is then injected into and around the point of injury, significantly strengthening the body’s natural healing. Our process for PRP is much different and sets us apart.  Our samples are hand processed allowing us to produce PRP that is free of contaminating red and white cells, which can inhibit repair. It also allows us to customize the concentration and volume for each individual and each injury type greatly improving outcomes.

EPAT is a treatment based on a unique set of pressure waves that stimulate the metabolism, enhance blood circulation and accelerate the healing process at the site administered allowing damaged tissue to gradually regenerate and heal.  It is a non invasive, officed based procedure which requires no anesthesia and has a proven success rate that is equal to traditional treatment methods, including surgery.