PLATELET RICH PLASMA (PRP)

Giving patients more options without surgery or steroid injections for painful damaged  tissue injuries of ligaments, tendons, joints, heel pain and wounds.

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PRP (Platelet-Rich-Plasma)

Platelet-rich plasma (PRP) is a non-surgical option for the management of many conditions as noted in much of the literature today. In podiatric conditions including sport injuries of the lower extremity, PRP has also been incorporated into conditions such as plantar fasciitis, chronic tendinitis as well as wound healing. 

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Platelets are key factors in hard and soft tissue repair mechanisms. They provide the essential growth factors FGF, PDGF, TGF-ß, EGF, VEGF, IGF that are involved in cell migration, differentiation and proliferation. The stimulation of fibroblasts and endothelial cells induces new extracellular matrix deposition and neo-vascularization.

Plasma is essential for cell survival as it contains nutrients, vitamins, hormones, electrolytes and proteins. Proteins are key molecules for the coagulation process and the formation of the fibrin polymer that will serve as a scaffold for cell migration, differentiation and proliferation. (Info from Regenlab USA website).

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In surgery it is utilized for fractures that have not healed and/or to incorporate healing at the surgical site of fusions and grafting with great success in the literature. PRP has been studied since the mid-1970's and has become the forefront in the advancement for non-surgical options for regenerative medicine.

Blood is mainly composed of RBC (red blood cells), WBC (white blood cells), plasma, and platelets.  Platelets are small discoid blood cells within the blood cell containing clotting and growth factors which are released during the body's healing process after an injury. On activation, the platelets accelerate the inflammatory cascade as well as healing by the release of many potent growth factors.

A normal blood specimen contains only 6% platelets whereas platelet rich plasma (PRP) contains a much higher concentration of platelets around 80% after the centrifuge process we use and ready within 5 minutes.  Click here to make an appointment.

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The Regen™ BCT (Blood Cell Therapy) tube prepares 4 to 5ml of autologous platelet rich plasma with a platelet recovery superior to 80% and a concentration factor of 1.6-fold. Although the system is technically capable of producing significantly higher platelet concentrations, it is not what research shows to be beneficial for clinical use. More and more studies demonstrate that concentrations of platelets 1 to 3 times over the baseline show more robust healing rates than those with concentrations of 3 to 8 times the baseline1.

Some studies even showed that too high platelet concentrations may actually have negative effects. In a in vivo study2 it was shown that highly concentrated platelet preparations had an inhibitory influence on osteoblast activity, probably due to unwanted inhibitory and cytotoxic effects of growth factors at such high concentrations. Similarly an in vitro study3, demonstrated that platelet concentration over 2.5-fold, resulted in a reduction in proliferation and a suboptimal effect on osteoblast function. (Info from Regenlab USA website).

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Indications

A PRP injection is generally recommended in dense connective tissue injuries of ligaments, fascia (plantar fasciitis) tendon or muscle injuries. 

Precautions

The main precaution are for patients with a low platelet counts. Although PRP is relatively safe, precautions are required in individuals with bleeding disorders, those on blood thinning medications or anti-inflammatory medications, individuals allergic to local anesthetic agents, pregnancy or breast feeding and those with active infections.

Procedure

The blood drawn will be centrifuged (spun) to separate the platelets from other blood components. The platelet rich portion of the blood is then extracted into a syringe.

Then, PRP injection of platelets drawn from the patients blood (which contains a high concentration of growth factors) is injected under a local anesthetic into a muscle, tendon or ligament tear to help the body start its process of  the healing cascade.

Foot Pain and PRP

The Use of Platelet Rich Plasma in the Management of Foot and Ankle Conditions (2011).
This article discussed the results of treating 634 patients with PRP for various foot and ankle conditions. Platelet Rich Plasma (PRP) was used alone or in conjunction with surgical procedures with favorable outcomes.