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Posts for: February, 2014

        Exercise is important to maintaining a healthy lifestyle and will almost never be discouraged by your doctor. But, like for most things, following a plan and becoming acclimated will be far more beneficial than jumping in too far, too soon! By building up your body’s tolerance to the rigors of your chosen exercise you can be sure that injury will occur less frequently. This is especially true regarding stress fractures of the lower extremity!

        Your legs and feet are at the bottom of your body and they suffer the abuse of running and jumping associated with exercise first-hand. Repetitive motions and the subsequent impacts cause the parts of the bones that are absorbing the most shock to wear down or weaken. If you’ve ever changed up your exercise habits suddenly or increased the intensity of your runs you may have noticed your shins or feet began to hurt during exercise. These may be signs of a stress fracture, usually a small break in one of the metatarsals of the foot. 

(Picture of the foot from emoryhealthcare.org)

        If you think you might have a stress fracture, the best thing to do is to rest the foot! (Stop running.) There may be some light bruising, swelling or redness around the area that is hurting. Of course, elevating your affected limb and utilizing ice packs will help decrease pain and swelling!

        Depending on the severity of your stress fracture, you may need a special shoe or boot that takes the weight off of your fracture site. In worst-case scenarios, a cast and crutches will be what are required to get you back to 100 percent.

        In situations where bone is the healing tissue there are many factors that can affect the speed of recovery. Patients who are diabetic or smokers will find themselves with a stress fracture for significantly longer than their counterparts who do not have compromised vascularity. Proper nutrition that includes a lot of Calcium and adequate rest will ensure the right environment for bone healing. 

(Radiograph from newyorkfootexperts.com)

**** Runners that take a break for winter should use caution when returning to their exercise regimen and begin at a lower level to protect their bones! ****

        Exercise, however, is not always the culprit when a stress fracture is suspected. In patients with Osteoporosis or a general decreased bone density, fractures can occur from normal activity. (Walking, Standing or Using the stairs.)

        Women athletes, especially very slim ones, have been found to be at an increased risk for stress fractures due to hormonal imbalances and their subsequent disposition to Osteoporosis.   

     Whether you are very active or only take the occasional stroll, it is important to maintain a balance between the many factors related to bone and foot health.

           Be safe and keep those feet happy! 


        With all the activity happening in the world of sports, both domestically and abroad, there are bound to be an increasing number of injuries to tendons. Since your tendons connect your muscles to your bones they often take a significant amount of abuse and often show signs of wear and tear. Plantar fasciitis and even problems with the Achille’s Tendon are some issues involving your tendons that Podiatrists commonly diagnose and treat.

        When an injury occurs, the human body mounts a response to begin healing it immediately. In a case in which a tendon is torn, ruptured or strained, your platelets and other blood cells begin to work together to fix the damage.

        Although the platelets do cling together to form a platelet-plug and stop bleeding, they have been found to also secrete growth factors that promote wound healing and attract beneficial cells to the damaged area. 

      (Platelets in their active form in the blood. Picture from www.thrombosisadviser.com)

        Given the healing power of these tiny particles in our blood, doctors began performing Platelet-rich Plasma (PRP) injections in the late 1980’s to help patients in critical condition. The procedure is very simple and is explained below.

Step One: Blood is drawn from the patient. Not very much!

Step Two: The collected blood is placed in a centrifuge that concentrates the platelets and growth factors into a smaller amount of plasma.

Step Three: The Platelet-Rich Plasma is then carefully injected into the site around your injured tendon! 

(Picture from www.stemcellorthopedic.com)

After the injections, you may experience some discomfort, but do not despair! Your body is reacting in the normal and desired way to the sudden influx of platelets and healing factors. You may want to ice and elevate your injury, perhaps even use Tylenol for pain relief. But ibuprofen, Advil and other NSAIDs will produce the opposite reaction that the procedure is trying to create.  

This treatment should be just a part of a rehabilitation planned by your doctors in order to get you back to your best. Finally, the PRP injection process may seem to be over-simplified, but it really is a very easy and effective way to treat tendonitis in all its forms.

****PRP injections routinely speed up the rate of healing in tendon-related injuries and are ever-increasing in their popularity amongst Sports Medicine physicians!****

Another impressive use for PRP injections is in the field of wound care. Patients with chronic wounds, diabetic or otherwise, often find that their physicians struggle with treating these persistent wounds and the subsequent infections and other issues. The processes that help with the tendonitis are the same ones that assist in the closing and healing of chronic wounds. The growth factors abundant in PRP are the perfect assistant to the struggling wound bed!

Much like the PRP injections, blood is taken from the patient and centrifuged into its components. The difference is that in the case of chronic wounds there is an open area that is not closing. The PRP is combined with an enzyme present in your body that works as a blood-clotting factor. This newly formed PRP gel can then be applied to the pesky wound and begin the task of laying down new collagens for healthy skin to grow over and promote new vasculature to feed the healing wound. 

(Picture of a PRP gel being prepared from www.plateltex.com)

            Researchers are working around the clock to try to find new ways to heal the human body. From wound healing to cancer treatments, we as physicians are also working to facilitate the use of these new discoveries in the safest and most beneficial way possible for our patients. In the case of PRP treatments, it is the marriage of our human biology and physiology to the latest trends in medicine that allow us to provide excellent care to you and yours.

References:

(1)Sampson S, Gerhardt M, Mandelbaum B. Platelet rich plasma injection grafts for musculoskeletal injuries: a review. Curr Rev Musculoskelet Med. 2008 Dec;1(3-4):165-74.

(2)Smith R, Gassman C, Campbell M. Platelet Rich Plasma: Properties and Clinical Applications. The Journal of Lancaster General Hospital. Summer 2007. Vol 2. No 2. 73-78.

(3)Lacci K, Dardik A. Platelet-Rich Plasma: Support for Its Use in Wound Healing.  Yale Journal of Biology and Medicine 83 (2010), pp.1-9.