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Platelet rich plasma for plantar plate injuries

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Craig Payne, Mar 1, 2013.

  1. Craig Payne

    Craig Payne Moderator

    Articles:
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    I have seen no evidence or scientific publications on this, but this YT video turned up in my alerts this AM:

     
    Last edited by a moderator: Sep 22, 2016
  2. Admin2

    Admin2 Administrator Staff Member

  3. Paul Bowles

    Paul Bowles Well-Known Member

    Not speaking for how the above video displays technique but with the latest "spurge" of research on PRP and tendon tear repair I see no reason why theoretically this would not "help". At our clinic we are very close to getting the last few signatures on all the paperwork that will allow us to start a trial with PRP in intrasubstance tears of the plantar fascia.
     
  4. cpoc103

    cpoc103 Active Member

    Paul are you aware of the work Dr Tom Cross has been doing at the stadium and sports medicine centre?
    They did some work using PRP on both the PF and Achilles. At one of their education/ conference nights last year, Dr Cross advised there was no significant improvement in either structure. And there are several clinics in the US showing the same.

    Maybe one of the reasons behind this is due to the poor blood supply both of these structures have. At our clinic we hear a lot of pts say they have had this done, with very little success.

    Col.
     
  5. Paul Bowles

    Paul Bowles Well-Known Member

    Hi Col,

    Yes I have heard and read similar reports however recently I have also seen some encouraging data from colleagues on intrasubstance tears in the achilles tendon. I find the correlation between patient reports of improvement versus radiological reports of improvement inconsistent at best! I had a very high profile athlete have PRP done on their patellar tendonosis a while back and on US it showed no difference - functionally he was leaps and bounds ahead with no pain - and has been appraching twleve months now - go figure! I have also been spurred on by recent articles looking at cartilage loss in the knee. There is also a new technique out similar to PRP called "orthokine" where they separate the blood then incubate it - we are discussing this new treatment as well. I have three peer reviewed research papers on my desk about orthokine but haven't got around to reading them thoroughly yet, in saying that the resuts do look encouraging. This (PRP, autologous, orthokine) is one treatment area I think needs more investigation - we are at a point with technology now where thorough investigation is possible and should be considered. With the amount of intrasubstance tears we identify daily in our clinic there must be something more we can do to manage these, let alone prevent them! But my thoughts on prevention later based on some data we have just collected!

    Lets not forget - I was one of the first people to call this "witch-craft" several years ago - maybe the data can help change my mind! ;)

    Lets just say if you "don't" pre-emptively US your patients investigating for tears prior to managing their fasciosis I think you may be treading on very thin ice!

    Col how do you manage your intrasubstance tears in the plantar fascia?
     
  6. docbourke

    docbourke Active Member

    PRP has not been shown on any level 1 study to do any good anywhere in the body. There is a plethora of case reports and such but this proves a fad and nothing more. There are several level 1 studies showing no difference between PRP and control in Chronic non insertional Achilles tendinosis (see JBJS and FAI) including an as yet unpublished study with 50 patients we conducted ourselves. I believe it should only be performed as an experimental procedure under strict trial conditions until it's efficacy can be proven. It is certainly a big money spinner to those doing it. This includes radiology practices and sports medicine physicians amongst others. If you are the unlucky one to get an infection then God help you in court justifying an invasive procedure with little or no scientific merit.
    Gerardhttp://www.podiatry-arena.com/podiatry-forum/gfx_v3BrownGold/icons/icon13.gif
     
  7. cpoc103

    cpoc103 Active Member

    Hi Paul sorry for late reply, I have been interstate and organising my wedding lol.

    Paul when you say how do I treat my intrasubstance tears, do you mean partial or full thickness tears or do you mean micro tears??

    Research has shown micro tears to be a normal occurrence in certain soft tissue groups. If I suspect a partial or even full thickness tears I will send for imaging start with US and maybe even MRI, if this comes back +ve I will suggest some sort of cam walker. But usually I will only send for imaging if a pt has had some sort of injury or impact!
    Docbourke I agree the research so far for prp use in muscle and tendon has shown no scientific evidence of any improvement in these structures.. I will disagree with you however, about no research showing any benefit in the body, we have used prp to treat foot and leg ulceration with good results..

    Col.
     
  8. PORTAL Education

    PORTAL Education Active Member

  9. Paul Bowles

    Paul Bowles Well-Known Member

    Congratulations!

    Fair enough - but where is your same evidence that CAMWALKERS benefit partial thickness intrasubstance tears of the plantar fascia? What are the detriments to having the patient in a camwalker for 8+ weeks and where is the evidence which shows tears such as these heal in that time frame?

    Sure we all know immobilization helps but so does time, good supportive footwear, orthoses, pain relief etc....

    What I am getting at is that every management strategy carries its risks. I have seen far to many patients improve with PRP in the last 12 months to blindly dismiss it, and even though the evidence may suggest otherwise, I am quite happy to inquire as to whether we are asking the correct questions from that evidence.





    ..and where is the "evidence" for that? Surely you would agree the published data on that field is almost as wishy washy as the published data on PRP for intrasubstance tears? Im off to DFCON in Los Angeles next week and will talk to those gentleman about their thoughts - I am sure I will get an earful for that entire week on PRP for wounds! I'll keep you updated!
     
  10. cpoc103

    cpoc103 Active Member

    Hi Paul

    Sorry cant seem to use the quote on my iPad lol, cheers looking forward to it.

    Yes true there are serious detriments in cam boot for pro longed use, but there are lots of research to show these modalities can and do work. Now I must admit here that in the last few years I have probably only used a boot a couple of times, the tear would have to be pretty large, I too would use good shoes and orths. I'm not saying I wouldn't use prp but rather the current research is inconclusive!!

    Yes the data published for wound management is as wishy washy as for intrasubstance tears, however it has been used for a long time within wound care practice for a long time. I have personally obviously never used it, but while working in the NHS I got to see its results first hand. I did see a couple of published papers from the uk some years back but for the life of me can't remember the names of them, I will try and email one of my colleagues to see if I can get some copies..

    I'm going to do the logged in version of dfcon, would love to go to LA but yeh can't afford that and a wedding lol. Would be great to hear your feedback on the latest trends Paul.
    Safe travels

    Col.
     
  11. cpoc103

    cpoc103 Active Member

    Paul can I ask a question?
    With the PRP injections who is it that actually carries the procedure out, is it a podiatrist or a doc?

    Col.
     
  12. Paul Bowles

    Paul Bowles Well-Known Member

    Currently we refer to two different practitioners - one is a sports physician the other is a radiologist. The sports physician does tradional PRP whilst the radiologist prefer autologous injections i.e. immediate withdrawel and injection no centrifuge separation.
     
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