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Searching file 26

Message Number 261782
Re: has anyone had APC injection ot autologous platelet injection? View Thread
Posted by Laurie C. on 11/06/09 at 12:32

I have had APC injections multiple times not due to PF issues into my joint, but have had them injected as any other injection - no meds needed to relax and done in the procedure room under xray.

Result number: 1

Message Number 261781

Re: has anyone had APC injection ot autologous platelet injection? View Thread
Posted by Carole on 11/06/09 at 11:48

I am sched to have APC injection (1st out of 2) to help with horrific PF pain. Dr. did PF surgery 7 mos ago but pain worse than B$ surgery. Dr. says APC inject should disolve any scar tissue & rebuild proper healing. I am going to 'day surgery ctr' - I'm told I will get something to relax me for injection. Is this injection painful and were you sedated in any way?

Result number: 2

Message Number 261482

Re: Heel Spur View Thread
Posted by Dr. DSW on 10/23/09 at 19:16

I have been in practice for over 23 years and have treated thousands of patients with heel pain/plantar fasciitis/'heel spurs'. I have published papers in very well respected journals regarding this topic, so I can assure you that I am very 'up to date' on all the newest treatment options.

I can assure you that there is NO procedure where there is an injection that 'dissolves' your heel spur. I am 100% sure of this FACT.

There are many procedures that treat the SYMPTOMS of a 'heel spur' via injections of cortisone, autologous platelets or other medications, but none of these 'dissolve' the heel spur.

There are are other methods focused on treating the actual fascia such as ESWT or Topaz, but once again, these methods do not
'dissolve' the heel spur. There is cryosurgery, radiofrequency ablation, etc., and once again none of these procedures 'dissolve' the heel spur.

The ONLY way to remove the heel spur (the heel spur is rarely removed in cases of plantar fasciitis/heel pain), is to actually surgically remove the bony prominence better known as a 'heel spur' with a surgical instrument. There is no other way to 'dissolve' this bony growth.

Therefore, if you 'think' you are about to undergo a procedure in a couple of months involving an 'injection to remove a heel spur', I believe you'd better call your doctor for a better explanation, because obviously you misunderstood the procedure that's actually going to be performed. Because I can assure you that there is no injection that is going to 'dissolve' your spur. That's probably why you couldn't find any information about it on the internet!!

Result number: 3

Message Number 261354

Re: has anyone had APC injection ot autologous platelet injection? View Thread
Posted by david g on 10/18/09 at 03:54

as I probably have one of the largest series in uk/europe--your experience is unfortunate for you,but with the technique I employ I have never had that technique failure & even use APC clots in the treatment of resistant ulcers.Again sorry for ur mishap.

Result number: 4

Message Number 261353

Re: has anyone had APC injection ot autologous platelet injection? View Thread
Posted by david g on 10/18/09 at 03:54

as I probably have one of the largest series in uk/europe--your experience is unfortunate for you,but with the technique I employ I have never had that technique failure & even use APC clots in the treatment of resistant ulcers.Again sorry for ur mishap.

Result number: 5

Message Number 261321

Re: has anyone had APC injection ot autologous platelet injection? View Thread
Posted by physiosteo on 10/16/09 at 05:51

yes I have had them. First was fantastic. I ruptured my achilles after the second. You might want to stop at one!! (and David G: I don't know whether you are in the UK or the USA but most physicians around London seem to know about my case and are limiting their injections because of me..........)

Result number: 6

Message Number 261320

Re: has anyone had APC injection ot autologous platelet injection? View Thread
Posted by david g on 10/16/09 at 04:43

have done APC injs for four yrs.used effectively for acute or chronic tendonopathies eg PF,tennis elbow,t.achilles,infra-patellar ligament.They are safe & I have never come across the ulcerated skin problemdiscussed elsewhere.They are also very effective in children eg Sindig Larsen in place of steroids>
We do not use any supports at all but specific Phyiotherapy is important. Success rates are in the region of 85-90%even in chronic (2-3yr) conditions.On occasions 2or even 3 injs may be needed.

Result number: 7

Message Number 261300

Re: Haglund's Deformity View Thread
Posted by Gillian on 10/14/09 at 21:01

hi john and brian I was just injected with cortison in my achilles heal for the same thing. my doctor told me that there was some new procedure where they inject platelets taken from your arm and put it in your heel to accelerate healing. He also told me i would need surgery and that he would need to surgically remove my achilles heal and put it back on. From everything i'm reading on this sight however, the recovery time and the possibilty of it making the condition worse really scare me.

My goal is to run a marathon but every time i get back into shape i feel that i'm thrown baac again by pain that returns. This is the second cortisone injection i have had and i am an extremely active person. i suffer from depression and running and exercise are my main source of relief.
I dont want to give up the running but amd wondering what i can do now to prevent having to resort to the removal of the tendon and the potential risks involved.

Is the idea of running a marathon a complete fantasy. or is there hope for this condition t be resolved without surgery. my doctor mentioned something about the achilles tendon growing into the deformity or running right through it now. Thata didn't sound right to me.
Anybody have any luck with cortisone injections. Did i do the wrong thing?

Result number: 8

Message Number 261165

Re: Heel Pain View Thread
Posted by Dr. DSW on 10/08/09 at 20:25

Justin,

I'm not sure I would have the shockwave, since your condition does not sound like 'typical' plantar fasciitis.

The fact that your pain gets worse as the day progresses, and that you don't have 'morning' pain makes me wonder if there is something else going on other than plantar fasciitis. Additionally, the fact that the steroid provided you with relief when nothing else helped also throws up a flag.

Have you had an MRI? Have you had any blood work? Have you been tested for tarsal tunnel syndrome? Have you considered an evaluation by a rheumatologist? I would highly recommend these courses of action prior to considering shockwave therapy or platelet injections.

Result number: 9

Message Number 260613

partial tear plantar fascia View Thread
Posted by mb1234 on 9/16/09 at 10:17

I have a partial tear plantar fascia at the dorsal aspect of the proximal attachment of the medial band of the plantar fascia.

Did physical therapy (whirlpool bath, electric stimulation for 6 weeks) My doctor recommended a walking boot. after 2 weeks in the boot, I completely threw out my back and was on bed rest for 1 1/2 weeks. After a second MRI- and minimal healing of the tear (1.0 cm from 1.6) I am unsure of what to do next? can anyone suggest?

platelet therapy?
ice and tape?
deep tissue massage?

Result number: 10

Message Number 260200

Re: taking 2 1/2 months off to heal, or should I? View Thread
Posted by Dr. DSW on 8/30/09 at 09:43

You do not have 'typical' plantar fasciitis. There are literally dozens of other treatment options in addition to those you were offered. In my 23+ years of experience, I have actually rarely if ever seen my patients experience any benefit from the heel cups you described.

You are correct, injections do not heal plantar fasciitis, but if there is an inflammatory component an injection can often provide significant relief in addition to other treatment options including, taping, OTC orthoses such as PowerSteps, custom orthoses, ice massage, non weight bearing stretching such as the plantar fascia stretch, proper foot wear, oral anti-inflammatory medications, night splints, Dyna-Splint, physical therapy, weight loss when appropriate, and many other options.

Of course there are other options when patients have not obtained relief with conservative care such as Medrol dose packs, removable casts, casting, ESWT, Topaz, dry needling, platelet injections, etc.

However, if you have 'atypical' plantar fasciitis, other diagnoses must be considered such as a calcaneal stress fracture or nerve entrapment. Additional diagnostic testing may be indicated such as an MRI and or nerve studies.

Result number: 11
Searching file 25

Message Number 259848

Re: Making a decision between ESWT, Topaz, or dry needling View Thread
Posted by Dr. Ed on 8/18/09 at 21:11

Bob:

Lets look at things another way. Say I offered you $2000 and three months to completely resolve the problem. You now have to pick one treatment. The first thing I would want to do is to refine the diagnosis. Is it truly recalcitrant plantar fasciitis or is it fasciosis? If it is indeed fasciosis, then I would opt for the treatments targeted toward fasciosis. Use of autologous platelet concentrates is not a specific treatment for plantar fasciosis/fasciitis. It is a means of encouraging healing.

I,again, need to invoke the treatment triad. The treatment need be tailored as precisely as possible to the pathology.

Dr. Ed

Result number: 12

Message Number 259834

Re: Making a decision between ESWT, Topaz, or dry needling View Thread
Posted by Dr. DSW on 8/18/09 at 16:42

There have been some recent foreign literature studies that have shown little efficacy for APC/autololous platelet injection therapy for plantar fasciitis. However, it's ironic that last night on the news they were discussing this as an 'amazing new' alternative being performed by doctors at University of Pennsylvania and Jefferson for some bone pathology and tendon/sports injuries.

In actuality, this technology has already been around for a few years. I really don't agree with Dr. Z on this one regarding the real potential for infection, etc. Every time you have a blood test, the blood is drawn with a 16 or 18 gauge needle, and I don't see much chance of infection re-injecting the blood after it's been spun down in a centrifuge.

I'm just not sold on it's success rates/efficacy at this point in time.

It's funny, because I speak with a lot of podiatrists, and many of them are less than thrilled with their success rates with ESWT. I have to 'assume' that many of them may be performing the procedure on patients that aren't really fulfilling the REAL criteria, since Dr. Z reports a much higher success rate. They may not be screening their patients properly prior to scheduling for ESWT.

Result number: 13

Message Number 259816

Re: Making a decision between ESWT, Topaz, or dry needling View Thread
Posted by RickH on 8/18/09 at 12:03

It has been known for about 10 years that platelettes have all kinds of healing and growth factors. We use these growth factors to help heal diabetics. More recently them have been found to be helpful in healing chronic inflammation. We simple have people come into the office, draw about 10 cc of your own blood, spin it down to obtain about 3 cc on concentrated platelettes and inject it back into the area of inflammation. It takes about 15 minutes. There are some recent studies that show it is helpful in healing in vascular surgery. It is however not FDA approved for PF or achilles tendonitis

Result number: 14

Message Number 259806

Re: Making a decision between ESWT, Topaz, or dry needling View Thread
Posted by RickH on 8/18/09 at 08:59

I have been a podiatrist for 27 years and have used ESWT and Topaz for chronic PF and Achilles tendonitis. Recently I have been using concentrated autologous platelette gel injections. It is a simple office procedure and I charge the same as a I would for a cortisone injection. Results are similar ie 80-90% range. No downtime from regular activities.

Result number: 15

Message Number 259386

Re: ultrasound guided prp,prolotherapy View Thread
Posted by Dr. DSW on 8/04/09 at 19:18

Autologous platelet rich plasma injections have been discussed on this board many times, and some recent studies have actually shown evidence that these injections may not be very effective.

Prolotherapy is also controversial in it's effectiveness for plantar fasciitis, with no real studies that I know of published reporting it's success rate.

Naturally, any doctor providing those services will tell you that he/she has 'great results'.

Our resident ESWT 'guru' is Dr. Z, and he has stated many times that the greatest results with ESWT are when two treatments are given, with the understanding that the diagnosis must be correct.

Therefore, I would strongly consider ESWT since it's completely non invasive, if you meet the requirements.

Result number: 16

Message Number 258996

Re: has anyone had APC injection ot autologous platelet injection? View Thread
Posted by Mary H on 7/21/09 at 20:37

I had procedure done 3 years ago for PF. It was somewhat painful procedure,HOWEVER I would do it again. I had both feet done at same time. I was off my feet for about 4-5 days(rolling around in computer chair). After about 2 weeks I could tell a difference in the PF pain--it was much better! I still was a little sore from procedure but it was nothing compared to what PF pain had been. It did take about 4-6 months for full treatment healing. Now I can walk long & far without PF pain.

Result number: 17

Message Number 258922

Re: Plantar Fasciitis & Topaz View Thread
Posted by Dr. Ed on 7/17/09 at 21:24

Debra:

Is the 70 percent success rate you speak of specifically for plantar fasciitis or plantar fasciosis? Crutches? The Topaz procedure does not require one to be on crutches. Platelet rich plasma injections appear to have promise but have been popularized as a 'magic bullet' for a large number of musculoskeletal conditions. The downside appears to be small. Is your insurance carrier willing to pay for the PRP? If not, what is the cost? Do you have plantar fasciosis?

Perhaps Drs. DSW and Z will comment here. We have focused on treatments more specifically targeted for fasciosis/fasciitis on this site to date.

Dr. Ed

Result number: 18

Message Number 258919

Re: Plantar Fasciitis & Topaz View Thread
Posted by debra on 7/17/09 at 18:26

I haven't heard anyone write about the platelet rich plasma injection
(prp) which I recently had after trying all other avenues (p.t., cortisone, etc.) My doctor told me that this is a step to try and less invasive than, topaz. It's a procedure where they draw a patients own blood, spin it to enrich the platelets (healing part of blood) and inject it into the fascia while observing with ultra-sound. Takes only a few minutes. In a walking boot and crutches for two weeks so that the foot rests/heals. I hope it works. I have heard the success rate is about 70% and is not very expensive. There is alot of info on web.

Result number: 19

Message Number 258712

G-8 Meeting View Thread
Posted by john h on 7/08/09 at 09:35

China will prevent any changes to reduce emissions at the current meeting of the G-8 in Europe. A goal of a 2 degree reduction in the earths temperature in 50 years has been a goal voiced by some including the U.S. Apparently China will not be part of this. What all this may mean is that the Cap and Trade bill recently passed by the House may have trouble in the Senate. If other nations, in particular the largest polluter in the world, are not going to get behind a strong reduction in carbon gases then why should we put our selves in a weakened economic position by passing the bill just passed in the House. India is also in disagreement with the U.S. as to how much the U.S. should reduce emissions. They think we should have much stronger reductions than even passed in the recent Cap & Trade bill before they will agree to any further efforts on their part. The fact is the U.S. cannot go this road by itself and have any significant effect on global warming. That is if we or the world can really have any effect at all on global warming. That is still up for debate.

I think that we overstate just what powers we as humans have over the earths temperature. The sun, ocean currents, explosions of super novas, sun spots, platelet movements are far beyond our comprehension as to their effect on the earth. Humans have been on this earth a very small time in the big scheme of things. Could we prevent an ice age, a volcanic eruption, a tsunami, etc. Humans are no more than a grain of sand on the worlds beach in or powers to effect things that could destroy our planet. In any event we will ultimately become space dust. We are slapping at mosquitoes while the tiger is carrying us away. These are of course my opinions on global warming. Many will disagree. The G-8 conference info are facts according to the morning news.

Result number: 20

Message Number 258706

APC injection View Thread
Posted by Cathy W on 7/07/09 at 22:26

has anyone had APC injection ot autologous platelet injection?
Posted by Cathy W on 7/07/09 at 22:22
I posted the comment on 5/10 indicating that I had 3 injections done 2 weeks ago. Since then I had an area on my heel about a half inch above the top injection site that appeared that was numb to the touch, discolored, and developed a large blister. The blister then burst and the site progressively worsened. I developed a lot of sharp stabbing pain and throbbing pain in the site, ozzing, and then the skin began deadening. At first the doctor had told me to keep a dry sock over it. But when it got to the point of actually becoming a hole in the back of my heel in which you could slightly see my achilles tendon, he decided I needed an outpatient surgery for debredement of the area (2 days before my son's wedding!) that is now being called an ulcer. That was mid-June. I was then placed on a wound vac for 2 weeks. Then more dead skin began to develop and I had to have a minor debredement done in the office and am now wearing a aqua ng bandage (silver nitrate with antiobiotic) for a few days with plans to return to the wound vac for a few more months and then possible skin grafting to the area. All of this and I still don't know if my actual issue with the achilles tendonitis was corrected by the injections because of the pain I am now experiencing from the complication of the ulcer that developed. So instead of a few minor injections and 4 weeks of healing, I am now looking at 7 months of healing for an issue that I didn't previously have, if I am lucky. Has anyone heard of anything like this happening????? If I would have had the regular surgery for my achilles tendonitis I would have only experienced 6 weeks of healing and be fine now.

Result number: 21

Message Number 258705

Re: has anyone had APC injection ot autologous platelet injection? View Thread
Posted by Cathy W on 7/07/09 at 22:22

I posted the comment on 5/10 indicating that I had 3 injections done 2 weeks ago. Since then I had an area on my heel about a half inch above the top injection site that appeared that was numb to the touch, discolored, and developed a large blister. The blister then burst and the site progressively worsened. I developed a lot of sharp stabbing pain and throbbing pain in the site, ozzing, and then the skin began deadening. At first the doctor had told me to keep a dry sock over it. But when it got to the point of actually becoming a hole in the back of my heel in which you could slightly see my achilles tendon, he decided I needed an outpatient surgery for debredement of the area (2 days before my son's wedding!) that is now being called an ulcer. That was mid-June. I was then placed on a wound vac for 2 weeks. Then more dead skin began to develop and I had to have a minor debredement done in the office and am now wearing a aqua ng bandage (silver nitrate with antiobiotic) for a few days with plans to return to the wound vac for a few more months and then possible skin grafting to the area. All of this and I still don't know if my actual issue with the achilles tendonitis was corrected by the injections because of the pain I am now experiencing from the complication of the ulcer that developed. So instead of a few minor injections and 4 weeks of healing, I am now looking at 7 months of healing for an issue that I didn't previously have, if I am lucky. Has anyone heard of anything like this happening????? If I would have had the regular surgery for my achilles tendonitis I would have only experienced 6 weeks of healing and be fine now.

Result number: 22

Message Number 258704

Re: has anyone had APC injection ot autologous platelet injection? View Thread
Posted by Cathy W on 7/07/09 at 22:19

I posted the comment on 5/10 indicating that I had 3 injections done 2 weeks ago. Since then I had an area on my heel about a half inch above the top injection site that appeared that was numb to the touch, discolored, and developed a large blister. The blister then burst and the site progressively worsened. I developed a lot of sharp stabbing pain and throbbing pain in the site, ozzing, and then the skin began deadening. At first the doctor had told me to keep a dry sock over it. But when it got to the point of actually becoming a hole in the back of my heel in which you could slightly see my achilles tendon, he decided I needed an outpatient surgery for debredement of the area (2 days before my son's wedding!) that is now being called an ulcer. That was mid-June. I was then placed on a wound vac for 2 weeks. Then more dead skin began to develop and I had to have a minor debredement done in the office and am now wearing a aqua ng bandage (silver nitrate with antiobiotic) for a few days with plans to return to the wound vac for a few more months and then possible skin grafting to the area. All of this and I still don't know if my actual issue with the achilles tendonitis was corrected by the injections because of the pain I am now experiencing from the complication of the ulcer that developed. So instead of a few minor injections and 4 weeks of healing, I am now looking at 7 months of healing for an issue that I didn't previously have, if I am lucky. Has anyone heard of anything like this happening????? If I would have had the regular surgery for my achilles tendonitis I would have only experienced 6 weeks of healing and be fine now.

Result number: 23

Message Number 258557

Re: Earth cooling or heating? View Thread
Posted by john h on 7/02/09 at 11:46

When looking at weather phenomena one cannot make any assumptions based on what happens in one year or even ten years. The earth's weather is so intertwined with many things way beyond mans control that we are very presumptuous to think we can stop warming,cooling, ice ages, or what ever. Much of our weather has to do with the sun and ocean currents, platelet movements over which we have no control. We could be entering an ice age and not even know it. We have had several ice ages and there is not reason to think we will not have another. Those big rocks in Central Park in NYC were put there by ice. The Grand Canyon was created by ice. The earth's plates are constantly on the move and they create earth quakes, volcanoes and who knows what else. New islands are being created daily under the water to eventually rise up and become an island volcanoe. Once the earth had only one giant continent which broke away to eventually form what we have now. The earths plates are still moving and could very easily create a gigantic volcanoes explosion that could hide the earth's sunlight for many years leading to extinction of much of life on earth. The earth has had so many hits from objects from outer space any of which could destroy most of humanity that is hard not to believe it is only a matter of time until another giant meteorite hits us again. When talking of time in reference to the earth we might be talking about 50,000 years or next year. The sun will eventually burn up and expand enveloping earth. It will then blow up likely becoming a Super Nova. In the big scheme of things I seriously doubt man can prevent global warming anymore than he can stop an ice age or the death of our sun. Even if America cuts back on carbon emissions we still have the really giant polluters of China, India, Russia and all the third world countries pumping out more emissions each year at a growing rate. In fact they will pump out more emissions than we can conserve as they add more factories and cars. I am much more concerned about a total economic collapse of our nation than about our feeble attempts to control the earths weather. The economy is here and now and is something we can do something about be it right or wrong.

Result number: 24

Message Number 258398

Re: Traditional Plantar Fascia Release or Platelet Injection View Thread
Posted by bevM on 6/26/09 at 10:40

After months of pain/steroid inj, etc, I found Dr. Maria Buitrago, Houston, Barrett Foot and Ankle, who performed the platelet injection during outpatient. After 1 month + a few days, my heel feels back to normal and I am able to walk without the outrageous 'limp'. I heartily recommend this procedure and understand that Dr. B is having excellent results (from nurses at outpatient). Good luck!

Result number: 25

Message Number 258371

Re: Anyone hear of this method of spinning and injecting your blood in the site? View Thread
Posted by Laurie C. on 6/25/09 at 13:25

It's called APC (Autologous Platelet Concentrate). They spin out your platelets and re-inject those. I've had this done four times on my foot (not related to PF).

It worked very well for me.

Result number: 26

Message Number 257748

PF Won't Go Away! View Thread
Posted by DDorin on 5/26/09 at 18:18

I have PF in both feet - I've had Therapy, Cortisone Shot, Boot, Night Splint, Shock Wave Therapy, now I'm schedule for the Platelet Injection. The pain is unbearable especially by the end of the day. Nothing has helped - stretching, icing, etc. Has anyone had the Platelet Injection? What successs?

Thank You,
Debbie

Result number: 27

Message Number 257585

For the DR's - New European Treatment- Is this valid? View Thread
Posted by donnan on 5/18/09 at 09:17

My daughter sent me a clipping from Women's Health magazine May 2009 issue. It says the following:

FOOT RELIEF
European researchers have developed a successful treatment for plantar fasciitus, an injury that causes heel pain. In the 15 minute procedure, a doctor numbs the heel and inserts needles into the problem area. Bleeding inside the foot results, bringing to the area platelets whose proteins stimulate tissue repair.

Does this sound valid to you Dr.'s? Is this something I should pursue and if so where do I start? This has never been suggested to me by anyone but then I gave up on Dr's here and haven't seen anyone in the last few months.

Result number: 28

Message Number 257398

Re: has anyone had APC injection ot autologous platelet injection? View Thread
Posted by physiosteo on 5/10/09 at 12:12

Yes.
I had two injections.
My tendon ruptured about three weeks after the second. I slipped on some rice on a supermarket floor and shredded the achilles. Who's to know whether it would have occurred anyway, but since that incident I believe that British physicians have a rule to stick to one injection only.
I had a reconstruction using my hamstring tendon.
That failed and I had a second reconstruction using my flexor hallucis longus. Successful, thank God!
Altogether I had to take almost a year off work

Take care until you have been able to strengthen the musculotendinous complex!

Result number: 29

Message Number 257397

Re: has anyone had APC injection ot autologous platelet injection? View Thread
Posted by Cathy on 5/10/09 at 12:03

I had these injections done 2 weeks ago for chronic acute inflamation in my achilles tendon. I had 3 injections as an outpatient procedure in the back on my heel through my achilles tendon. I am in a boot and have been on crutches. The first few days I experienced quite a bit of pain in the injection sites. I am still having some throbbing pain in the heel and go to the doctor for a follow up tomorrow. I was initially told to be off my feet and in a boot for 4 weeks.

Result number: 30

Message Number 256673

PRP for severe archilles tendonitis View Thread
Posted by KarzieK on 4/06/09 at 18:26

Had first PRP injection in Feb 2009. Wearing a ankle brace that loops over foot and ties ASO brand per doctors orders all day long.
Still feeling burning and pain. Doctor says that it will take more time and has patients that are pain free that had injection before me. I am beginning to wonder if this injection of my platelets will ever work? Does it take more than one injection which I am willing to do. Up on my feet alot at work, can't take any anti inflamatory medication just tylenol. I use ice occasionally is their a light at the end of this tunnel? I could use any advice, I see the doctor again in a few weeks.

Thank-you Much

Result number: 31

Message Number 256316

Re: has anyone had APC injection ot autologous platelet injection? View Thread
Posted by linda on 3/23/09 at 19:19

should you wear a boot after you have the APC?

Result number: 32

Message Number 255310

Plantar fasciosis - considering EPF View Thread
Posted by Lauren on 2/20/09 at 11:15

Hi,

I've had chronic PF for almost 2 years now and I am seriously considering having an endoscopic plantar fasciotomy done. I've read the horror stories and it's definitely given me pause, but I'm not sure if I have any options left and the pf has reached the point where it's interfered with me being able to even to things like grocery shopping or stand in a line.

I have had the following conservative treatments: custom orthotics, cortisone shot, night splints, Graston, and walking boot. A couple weeks ago I had cryosurgery which was unsuccessful.

I have had diagnostic ultrasound which my doctors read and said that it indicated I had plantar fasciosis.

I think the only things left for me other than a fasciotomy is the Topaz procedure or platelet injections. I am wary of the platelet injections because it is experimental and I may be hit with a huge bill if the insurance doesn't cover it, and I don't think my doctor does the Topaz procedure. I don't believe I'm a candidate for ESWT because I don't have morning pain or pain at the insertion point (pain is along the arch and occurs while walking or standing).

My doctor said that there shouldn't be much of a risk because he'd only cut 1/3-1/2 of the plantar fascia, and that he's had a very high success rate. Is it true that the risk of the lateral column syndrome has been minimized with only a partial cut of the fascia? If there is still a significant risk of severe complications I might consider platelet injections even though I could incur thousands of dollars of expenses in the process or finding a doctor who performs Topaz. Thanks.

Result number: 33

Message Number 255207

Re: Feedback please on radiofrequency therapy. Good and bad View Thread
Posted by Jen R on 2/18/09 at 13:04

That makes perfect sense...just like many doctors wouldn't want (or couldn't afford) to purchase the ESWT machines. About two years ago, I made about 6 calls to local podiatrists looking for one who could perform a diagnostic ultrasound on me to confirm my PF. Not one of them had an ultrasound machine. Now THAT surprised me.

But anyway...I didn't realize a machine was needed for this treatment.

And by the way...there was a report on our local news last night about platelet injections and how it's promoting quick healing. It was just recently that we talked about this on here.

Jen

Result number: 34

Message Number 254887

Re: Archilles tendonitis / autologous blood injections View Thread
Posted by Dr. DSW on 2/08/09 at 07:56

In addition to autologous platelet injections, there have been several studies showing promising results with the use of ESWT for insertional Achilles tendinitis. This is another conservative treatment option that you may want to discuss with your doctor.

Result number: 35

Message Number 254885

Re: Archilles tendonitis View Thread
Posted by Dr. DJP on 2/08/09 at 01:20

To address both of your posts, make sure you are talking about the same thing. Doctor's will generally NOT inject steroid into the achilles tendon for fear of rupture. That is very different than injecting autologous platelet gel. APC injections use your own blood and spin down the growth factors thought to induce healing. The idea is that by concentrating these cells and injecting that concentration into the damaged tissue, we can more effectively recruit the cells that repair tissue. It is not accepted as standard care in tendon repair at this time although the same mechanism is shown to help bone healing. I have experience in 3 patients where we tried the APC injection as the procedure between exhausted conservative therapy such as rest, immobilization, medications, physical therapy etc. and open surgery. My feeling is that the risk is low compared to the potential benefit, including avoiding open surgery. If it doesn't work you are back to surgery anyway. Consequently, all 3 of my patients have done well, but that is too small of a group to draw any conclusion about. The early medical literature tends to support the procedure. Lastly, I have no financial interest in the treatment. Again, if you have tried everything else except surgery the greatest risk is that it simply doesn't work.

Dr. DJP

Result number: 36

Message Number 254879

Archilles tendonitis View Thread
Posted by KarzieK on 2/07/09 at 15:18

How effective are platelet injections for severe archilles tendonitis with some fluid present? Had another MRI no rips or tears so far but the archilles bump is there with inflammation. Doctor wants me to have this injection and told me it would help me out alot. Been doing some research and seems to work. Although have read it may be more than one injection. Have had this pain for over a year with 2 mri's. Have orthodics and doing exercises but the pain and burning stabbing pain is always there, even at night. Would really appreciate some advice before I run into a bigger problem.

Thank-you Much!

Result number: 37

Message Number 254556

Re: Stem Cells for PF View Thread
Posted by Dr. DSW on 1/29/09 at 20:43

Jen,

See my response under 'ask the doctors'. Stem cells and platelet rich injections, aka autologous platelet injections are NOT the same. As far as I know, no one is utilizing stem cells for PF.

Result number: 38

Message Number 254555

Re: stem cells for PF View Thread
Posted by Dr. DSW on 1/29/09 at 20:41

Jen,

No one that I know of is utilizing stem cells for PF. Some doctors ARE utilizing autologous platelet injections, which are NOT stem cells and I think that the two methods are being confused. It is simply a proprietary method of taking the patient's own blood, spinning it down in a centrifuge via a special proprietary method, and re-injecting it into the painful area to help the area heal. The proposed mechanism is that it contains the growth/healing factors to kickstart the healing process needed to decrease the inflammation, etc.

Once again, this has NOTHING to do with stem cells.

If you want to learn more about this method, just 'google' autologous platelet injections for plantar fasciitis, and you should find plenty of information.

Result number: 39

Message Number 254486

Re: Stem Cells for PF View Thread
Posted by MarkL on 1/28/09 at 13:41

Hi Hillary,

If you are referring to platelet rich plasma injections (PRP), I have tried them ... and it was unsuccessful after two injections. I have waited the six weeks since the second shot... the time that my doctor told me I needed to wait for results. Not to say it won't work for you, but it was a complete waste of time and money for me. Furthermore, it was painful. I could not walk for almost three days without crutches. I was really annoyed with my doctor for not having forewarned about that and even the need for crutches, which I was fortunate borrow after I got home.

Mark

Result number: 40

Message Number 253812

Re: has anyone had APC injection ot autologous platelet injection? View Thread
Posted by Ryan on 1/08/09 at 20:14

Thanks. I'll do a search and read about it. I wonder if any of the doctors that post here have done or do this treatment? I guess they would have written about it if they did. I'd still like their opinion on it. Maybe some of their colleagues use the treatment and they would speak to the issue.

Result number: 41

Message Number 253811

Re: has anyone had APC injection ot autologous platelet injection? View Thread
Posted by Laurie C. on 1/08/09 at 19:59

It stands for Autologous Platelet concentrate. I had it injected for another problem in my ankle unrelated to PF.

Result number: 42

Message Number 253810

Re: has anyone had APC injection ot autologous platelet injection? View Thread
Posted by Ryan on 1/08/09 at 19:43

Would you explain APC injections. What does APC stand for and what and where do they inject?

Result number: 43

Message Number 253808

Re: has anyone had APC injection ot autologous platelet injection? View Thread
Posted by judi on 1/08/09 at 18:30

Hi.

I had the apc injections and did not have to wear a boot.

I had to have the procedure done twice. I have never had pain again.

Previous to the APC I had several cortisone injections.

I hightly recommend the treatment.

Kim Foot and Ankle Center
Dr. James Jung
Dr. Raymond Bautists
Dr. S. Don Kim

Result number: 44

Message Number 253805

What to do Now for chronic plantar fasciitis View Thread
Posted by MarkL on 1/08/09 at 14:17

I was evaluated with plantar fasciitis in May 2007 and have tried several conservative treatment options including two different pairs of orthotics, stretching for weeks on end, taping, and icing -- all to no avail. In August 2008, I received trigger point injections, then 3 dextrose prolotherapy injections, and then finally 2 platelet rich plasma (Pry) injections in the past month. While the jury may still may be out on the PRP injections as it may take 4 to 6 weeks to see results, I am already looking for my next options for this because I do not feel the least bit better as of now. I am seeking recommendations as to what I might pursue next. I have not tried night splints nor casting as of yet, and wonder if they could help at this late date? A podiatrist I saw recently suggested that ESWT may not have long lasting effects. Do you agree, or what other options can you recommend?

Result number: 45

Message Number 253419

Re: Prolotherapy Healed Me! View Thread
Posted by Dr. DSW on 12/22/08 at 18:37

No,the article you've posted a link to is not prolotherapy. As per Ryan's answer, prolotherapy does not utilize autologous platelet injections to promote neovascularization, etc., but uses an irritant to help build up the collagen.

Result number: 46

Message Number 253391

Re: Prolotherapy Healed Me! View Thread
Posted by Jane on 12/22/08 at 08:39

I'm curious: when you guys are talking about prolotherapy, are you referring to the injection of platelet rich plasma, as described in this article?

http://www.podiatrytoday.com/article/3151

Result number: 47

Message Number 252883

Re: "dry-needling" and steroid injections View Thread
Posted by Dr. DSW on 12/08/08 at 14:25

Dr. Z is correct. 'Needling' is various forms has existed for years, and there was actually a needling technique to actually perform a fasciotomy described many years ago.

It's interesting that someone 'tweaks' a long standing procedure, calls it a 'new' technique and all of a sudden it gains media attention. Although the abstract seems promising, as per Dr. Z, there are too many variables missing from the equation. And as someone that's treated this condition for a long time, I would like to be optimistic but do not believe that 95% will be a realistic cure rate.

Ironically, needling, ESWT, autologous platelet injections and Topaz are all methods that are being utilized or theorized to kick-start the body's own healing process. Needling actually seems to be the less expensive form of Topaz, since Topaz treatment actually is forming a grid of punctures in the fascia.

Result number: 48
Searching file 24

Message Number 249128

Re: Traditional Plantar Fascia Release or Platelet Injection View Thread
Posted by Leslie on 8/11/08 at 17:27

I'm also considering the autologous platelet injection and am wondering if you had any success??

Result number: 49

Message Number 248014

Re: has anyone had APC injection ot autologous platelet injection? View Thread
Posted by Sue K on 6/26/08 at 06:52

I am considering injections- I don't know much about it either. I have tried every other conservative treatments for PF- platelet growth injections are the last stop before having Plantar Fascia Release Surgery. I would also welcome any input, or stories from people who have had this sort of treatment.

Result number: 50

Message Number 247441

Re: HTP Heel Seats? View Thread
Posted by JenR on 6/07/08 at 09:05

Dr. Wander,

Can you please elaborate on autologous platelet injections and how they differ from traditional cortisone injections?

Thanks,

Jen R

Result number: 51

Message Number 247438

Re: HTP Heel Seats? View Thread
Posted by Dr. DSW on 6/07/08 at 06:59

Tammy,

I'm sorry, but there is quite a bit of research and there are quite a few treatment options for plantar fasciitis. If you don't think there's a lot of research or literature regarding plantar fasciitis, simply perform a google search and find out.

It may not be taught in nursing school, but I can assure you that it is constantly being studied and written about, and new methods are being developed constantly. Over the past few years, ESWT, Topaz treatments, cryosurgery, autologous platelet injections are just a few of the treatments that have developed.

No drug will ever be developed for PF, since it's an inflammatory tissue problem that then can become a degenerative problem from chronic inflammation, and is often caused by mechanical issues. No pill will 'cure' all those components.

Result number: 52

Message Number 247178

Foot pain View Thread
Posted by Kayte on 5/29/08 at 11:51

Hello

For the past month I have had intense pain in the back of my right heel- it has gotten worse, when i first get up in the morning I cannot put weight on it, and for a couple hours of being up. I can feel some swelling in the spot where it hurts- it feels like there is something there too-

I have pf in the left foot- but this is a different pain- not the same pain.

I go to the doc June 10th for a different reason I am going to bring this up- but until then what can i do to alivate the pain- i cannot take ibprofen due to low platelets-

thanks

Result number: 53

Message Number 247161

Re: Traditional Plantar Fascia Release or Platelet Injection View Thread
Posted by Anna E on 5/28/08 at 20:46

Thanks for your reply Dr. DSW. Following Autologous Platelet Injection Therapy there will be a minimum of 3 sessions of ESWT (every week). My husband agrees with you that the Autologous Platelet Injection Therapy will do little if any harm and if it doesn't work then I always have the other option of Traditional Plantar Fascia Release. My final decision is to try the Autologous Platelet Injection Therapy w/ESWT first before going to a more drastic measure.

Result number: 54

Message Number 247152

Re: Traditional Plantar Fascia Release or Platelet Injection View Thread
Posted by Dr. DSW on 5/28/08 at 14:54

Although I personally have not performed this procedure, I would consider any procedure PRIOR to having a plantar fascia release. And if you do have a plantar fascia release, please make sure that you only have a PARTIAL plantar fascia release and that your doctor describes all the potential post operative risks/complications.

The autologous platelet injection therapy may not provide relief, but it will do little if any 'harm'. Additionally treatments to consider are ESWT and Topaz, prior to fascial release.

Result number: 55

Message Number 247142

Traditional Plantar Fascia Release or Platelet Injection View Thread
Posted by Anna E on 5/27/08 at 23:49

I've been dealing with heal pain for over 2 years and have tried numerous treatments that have not worked. I am currently scheduled for the Traditional Plantar Fascia Release procedure on June 2 but have recently seen another doctor about Platelet Injection. I'm terrified of being cut on and am thinking about doing the Platelet Injection but can't find enough statistical information on it. Has anyone had success with Platelet Injection?

Result number: 56

Message Number 245561

Re: endoscopic fascial release View Thread
Posted by Dr. DSW on 4/07/08 at 13:00

As per Dr. DJC's comments, there are a plethora of options prior to considering EPF. Most doctors today have a significant amount of choices in their armamentarium to offer their patients, and as I previously stated, EPF should realistically be the very last choice since it is basically a non reversible procedure, that compromises the integrity of a very vital structure of the foot......the plantar fascia.

Although I do perform EPF, it is a procedure I rarely recommend. Radiofrequency ablation is a procedure that many doctors I know and some patients I know have spoken very highly of, though I do not have any personal experience with this procedure. Autologous platelet injections have been utilized for several years for other applications in addition to plantar fasciitis, and act in a similar way to ESWT in the sense that it helps 'kick start' the healing process, but it does this via growth factors,etc. Topaz also works in similar manner to ESWT since it also stimulates angiogenesis and the body begins to repair itself.

Additionally, there are other completely non-invasive techniques that many amateur and professional sports teams are utilizing for soft tissue injuries, including ART and GRASTON, which can be used for plantar fasciitis.

The bottom line is that if the only choice your doctor is now offering you is EPF, you may want to explore other opinions. For an excellent resource of causes of heel pain and treatment options, you may want to read Scott's 'heel pain book' on this site by clicking on the blue highlighted link.

And Dr. DJC, I welcome you to this site and would also welcome you to be a regular contributor.

Result number: 57

Message Number 245413

Re: questioning surgery on heel spurs on both feet- View Thread
Posted by dr g on 4/02/08 at 02:53

New xrays would probably not be that beneficial. More helpful may be an ultrasound to see how thick the fascia is and if there is actually any inflammation. That being said, good orthotics and supportive shoes are necessary. There are now many alternatives to fascia cutting type of surgery. There is shock wave , topaz, cryoanalgesia, and autogenous platelet growth factor injections. I have used shock wave and cryoanalgesia for years now and have not needed to 'open' any heels.

Result number: 58

Message Number 242493

Re: After Plantar Fasciaitis View Thread
Posted by Kathy H on 1/28/08 at 18:47

Rick, What was the name of the procedure they did to increase blood flow to the area? Was it an APC injection(blood platelets), ESWT, or what? thanks

Result number: 59

Message Number 242175

Re: "All my ex's live in Texas...thats why I hang my hat in Tennessee" -George Strait View Thread
Posted by Kathy H. on 1/19/08 at 14:16

Dr. Ed, Yes, I know that George Strait song. I believe I have fasciosis now, not fasciitis after 1.7 years. I am having graston technique done in Dallas. It is not available in the state of Tennessee. I have had it done for 2 months and will probaly give it another month or so. I have had some improvement, but don't know if it is possible to see complete healing with graston or not. Does anybody know if complete healing of
fasciosis has occurred with graston?

If graston doesn't totally work, I am thinking about either an autologous blood platelet injection( APC) or ESWT with the Dornier Epos Ultra. After reading messages on this board, I believe this is the machine I want.

I posted once on this board asking the doctors if anyone knew of the results of APC injections and no one answered so I don't know if they know that much about it. There is a long article about it on the podiatry today.com website.

Through the Dornier website, I contacted them and asked them if they knew anyone in Nashville who used the Dornier Epos Ultra and they gave me the phone no. of the technician who actually does it. I talked briefly with him yesterday and he gave me the name of a podiatrist in the Nashville area who let him use his office to do it in.

I would love to know the questions to ask this gentleman( that's the Southern in me). Should I ask him how many he has performed? What questions should I ask the podiatrist himself? At this time I am trying to have my MRI read by a musculoskeletal radiologist to confirm fasciosis. If I do ESWT, I want this to be as successful as possible, so insight on what to ask would be so... helpful.

Also, this may be a crazy question...but since the board advocates heat after ESWT, would it be wiser it have it performed when it is a little warmer, say April or May, because it is cold..in Tennessee right now.

Result number: 60

Message Number 241918

Re: has anyone had APC injection ot autologous platelet injection? View Thread
Posted by Laurie C. on 1/13/08 at 17:20

It was a year ago.

Result number: 61

Message Number 241915

Re: has anyone had APC injection ot autologous platelet injection? View Thread
Posted by Kathy H. on 1/13/08 at 15:50

Laurie, Thanks. I don't quite understand when your APC injection was, though. Was it just very recent, because I had heard that the protocol for how you had to be in the boot had recently been shortened.

Result number: 62

Message Number 241877

Re: has anyone had APC injection ot autologous platelet injection? View Thread
Posted by Laurie C. on 1/11/08 at 23:37

Yes, I had my joint capsule had prolapsed and I had the injection into my joint. Six weeks? Not so bad. I actually have been in a cast for almost 4 weeks now and I have another 6 weeks in a walking boot. It's good to do it now becuase it's winter and you can hide the hideous boot with jeans.

Result number: 63

Message Number 241873

Re: has anyone had APC injection ot autologous platelet injection? View Thread
Posted by Kathy H. on 1/11/08 at 23:16

Laurie, Thanks so much for answering. How long ago was that and was it a condition where they were trying to heal your ankle. Were you told that APC helps tissue to heal? And was it hard to wear the boot for 6 weeks?

Result number: 64

Message Number 241857

Re: has anyone had APC injection ot autologous platelet injection? View Thread
Posted by Laurie C. on 1/11/08 at 17:37

I didn't do it for PF, but I did it for another problem in my ankle. I wore the boot for 6 weeks and it resolved that particular problem.

Result number: 65

Message Number 241848

has anyone had APC injection ot autologous platelet injection? View Thread
Posted by Kathy H. on 1/11/08 at 16:56

Hi, I would like to know the results of anyone who has had the autologous platelet injection injected into their heel for PF. I am possibly considering doing this in the near future if in case my other treatments don't work. Has the time that you're supposed to wear the boot(possibly 6 weeks)changed? thanks everyone

Result number: 66

Message Number 240173

GPS platelet gel or autologous platelet injections View Thread
Posted by Kathy H on 12/02/07 at 23:19

Hello doctors, What do you think about the effectiveness of autologous platelet gel injections for the treatment of planar fasciitis? Does the concentration of platelets and white blood cells help you heal quicker? Would you have to be in a non weight bearing boot for 2 days or can you walk out of the office? And should the injection be ultrasound guided? thanks

Result number: 67
Searching file 23

Message Number 239606

Re: PF - considering surgery - but first a few questions please View Thread
Posted by Dr. DSW on 11/19/07 at 06:38

Tom,
Prior to exploring autologous platelet injections, ESWT, EPF, etc., I really believe you need to rule out an arthritic condition, that's why I mentioned it in my original post. My original post recommended a consultation with a rheumatologist, not simply a rheumatoid profile, since there are many conditions in addition to ankylosing spondylitis, and I firmly believe in utilizing experts in their fields. Many conditions need more than blood tests to be diagnosed, and I still feel that a rheumatologist is the best source, since he/she will combine his/her thorough history/examination and knowledge to determine which specific blood tests may be the best to order for your particular case. There are MANY specialized blood tests for varying arthritic/rheumatoid disorders in addition to a 'rheumatoid' panel, and a rheumatologist is the true expert in the field.

Result number: 68

Message Number 239602

Re: PF - considering surgery - but first a few questions please View Thread
Posted by Tom B. on 11/18/07 at 21:13

Dr Z,

Thanks for your replies.

I have not had an Arthritic blood work profile. I will have this done.

I do have first step morning pain as well as pain after any extended period of sitting. I have seen 3 doctors regarding this condition and they all tell me I do not have a gait problem ( maybe a slight pronation). They all agree I have flat feet. I have been suffering with this for nearly three years and my pain used to be more localized and acute in the beginning. I would say it was more concentrated in my arch in the beginning and more 'identifiable'. Now, after 3 years the pain is more distributed (arch, balls of feet, and heels) and is better categorized as ' all over'. There is also a numbness/swelling sensation, although there are no noticeable signs of swelling. The pain is not acute when I press on it, it typically feels good when I press/massage the areas, although at certain angles, the pain can be intense/uncomfortable.

I have not explored ESWT although I have read a little about it. I did not see the URL to the web site you mentioned. I will consider this prior to electing the surgery.

I am still seeking answers to some of my original questions and would very much appreciate your opinion on the following:

1) Since I have a great deal of tightness in my ankle and calfs, I am contemplating night splints. Are night splints effective? At this point I do not mind a long recovery period (up to a year as long as I am making progress), but can stretching and wearing the night splints ultimately stretch my ligaments enough to eliminate most (80%) of my pain?

2) Regarding the endoscopic plantar fasciotomy procedure, what is the success rate and is this considered a cure? Also, I cannot find any literature which talks about the cut to the ligament in my calf area that my doctor described. Is this a commpn practice? Generally speaking are there risk concerns with these techniques? How long of a recovery can I expect? Are there doctors or certain hospitals that are considered specialists in this procedure? I am in the New York City area.

3) I do not mind some maintenance exercises, even daily, to keep the pain under control but, the way I am now, I can't stretch often enough to keep my pain level manageable. I am stretching all the time. If I elect surgery, can I expect to have to continue to do the stretching exercises? Will I be able to return to any sports activity?

4) Are there other non-invasive things I should try? Have dietary or homeopathic approaches shown to be of any benefit?

5)What do you think about the relatively recent autologous platelet concentrate (APC+) appraoch to PF? This sounds attractive and low risk. Am I missing something?

Thank you for your help.

best regards,
Tom

Result number: 69

Message Number 239542

Re: Platelet inject treatment View Thread
Posted by DR. Z on 11/16/07 at 08:30

Thanks. I will research this one. This is very interesting

Result number: 70

Message Number 239529

Re: Platelet inject treatment View Thread
Posted by Laurie c. on 11/15/07 at 22:22

Maybe it created new tissue growth that sealed the prolapse? I don't know it worked. The remarkable indication on my arthrogram was proof positive for me. I'm not pain free though as I still have some other issues within my ankle joint which I will having arthroscopy in a few weeks - but it is definitely better than open ankle surgery (at least I think so).

Result number: 71

Message Number 239524

Re: Platelet inject treatment View Thread
Posted by Dr. Z on 11/15/07 at 20:38

That's is a new indication. I not sure how this would seal a prolapse up nicely. I can see where it were stimulate new tissue growth. Glad you are pain free.

Result number: 72

Message Number 239522

Re: Platelet inject treatment View Thread
Posted by Laurie c. on 11/15/07 at 19:58

Actually, I had this procedure done for a posterior ankle prolapse and it sealed the prolapse up nicely. It cost me $300 and I was in a boot for 6 weeks, but I avoided open ankle surgery.

Result number: 73

Message Number 239519

Re: Platelet inject treatment View Thread
Posted by Dr. Z on 11/15/07 at 19:34

HAving done four APC's procedures without ANY success I would avoid this procedure at this time for the following reasons.
- its experimental/investigational
- Blood is removed from your body,growth factors are removed and then injected back. Think about this . Removed and then re-injected. There is the risk of infection
Why would you not consider ESWT instead of an experimental procedure that this is.
For those who think insurance is going to cover this . No experimental procedures are covered.
There are just too many other options that are safe and effective.
Wait until long term results are out in large numbers. Again who wants blood removed and then replaced back into your body.

Result number: 74

Message Number 239517

Re: Platelet inject treatment View Thread
Posted by Denisea on 11/15/07 at 18:44

Dr. Alan Mishra was one of the pioneers of APC injections having had great success with injection of the lateral epicondyle. He has done several PF's and had really good success, and is currently doing a study. The only reason I have balked at it when he says I should do it is because he wants me Non WB for 48 hours and then in a walking boot for six weeks. I can't do that given I am standing in the OR 2-3 days a week. But I just read some literature now and it looks like the recovery time is changing.

I would give it a shot if I were you, can't hurt. I'm thinking of taking a week vacation to get it done if I can ambulate more quickly without a boot.

Result number: 75

Message Number 239477

Re: Platelet inject treatment View Thread
Posted by Dr. DSW on 11/14/07 at 18:30

This subject has been discussed on this board. You may also want to perform a 'google' search using the medical terminology 'autologous' platelet injections for plantar fasciitis for a more specific search.

Result number: 76

Message Number 239474

Re: Platelet inject treatment View Thread
Posted by HIlaryG on 11/14/07 at 16:21

Actually they said they separate your platelets from the rest of your blood cells and inject just the platelets.
Go to google.com and do a search using the words 'platelets' and 'plantar fasciitis'. I came up with a few interesting articles.

Result number: 77

Message Number 239471

Platelet inject treatment View Thread
Posted by Lakemom on 11/14/07 at 14:22

I was watching Fox news last nite and they talked about a new treatment of injecting your own platlet enriched blood into the plantar fascia as a effective treatment.

I am unable to get the server here to post the site, it keeps hanging up but if you search Platelet treatment plantar fasciitis you will find some links.

Result number: 78

Message Number 239380

Re: Vitamin E. View Thread
Posted by Denisea on 11/12/07 at 21:30

1600mg of Vit E? Why are you taking so much?

As long as you stopped on Friday you should be fine. It has a very mild platelet affect and it is short acting, you may have more swelling/bruising. Do they use a torniquet for this surgery? I don't know.

But seriously, 1600mg of Vit E is overboard. 400IU max.

Denise

Result number: 79

Message Number 235831

Re: Can someone with a low platelet count consider estw? View Thread
Posted by Caroline109 on 9/09/07 at 17:49

Sure will do some more consultations. Thank you.

Result number: 80

Message Number 235772

Re: Can someone with a low platelet count consider estw? View Thread
Posted by Dr. Z ( vacation) on 9/08/07 at 18:56

Hi
Any type of auto immune disorder can reduce the positive outcome of ESWT procedures and may in fact be the cause of your heel pain. I have treated patients on low doses of steriods due to IBS and they have done very well but this is very rare to treat. So the best and next step is to order additional testing and consultation with Hematologist and orthopedic doctor.

Result number: 81

Message Number 235766

Re: Can someone with a low platelet count consider estw? View Thread
Posted by Caroline109 on 9/08/07 at 16:29

I never have taken coumadin or plavix so I don't have to worry about that. My clotting issue is autoimmune. I'll probably end up calling my orthopedist (the foot specialist) after I speak to my hematologist about the treatment. When I do see him, I'll ask about an mri or ultrasound to confirm that PF is what I actually have. I appreciate you answering the questions.
Thanks!

Result number: 82

Message Number 235756

Re: Can someone with a low platelet count consider estw? View Thread
Posted by Dr. Z ( vacation) on 9/08/07 at 14:29

Hi
I really don't see any problem with you having any type of bleeding issue with ESWT. Good idea to pass this by your hematologist doctor
I would like for you to have an ultrasound and or mri to confirm that the fascia is degenerative and that this isn't a local nerve entrapement issue or systemic. Classic indication for ESWT is first step morning pain. It does sound like there is pain at or near your pf insertion. So in summary making sure that you have pf is more of the issue then the bleeding . I have NEVER seen any serious bleeding problems with ESWT used for pf and this includes cases where doctor have kept the patient on coumadin or plavix. I am not suggesting that you stay on either coumadin or plavix but its not the end of the world if you do ESWT while on these medications

Result number: 83

Message Number 235755

Re: Can someone with a low platelet count consider estw? View Thread
Posted by Dr. Z ( vacation) on 9/08/07 at 14:29

Hi
I really don't see any problem with you having any type of bleeding issue with ESWT. Good idea to pass this by your hematologist doctor
I would like for you to have an ultrasound and or mri to confirm that the fascia is degenerative and that this isn't a local nerve entrapement issue or systemic. Classic indication for ESWT is first step morning pain. It does sound like there is pain at or near your pf insertion. So in summary making sure that you have pf is more of the issue then the bleeding . I have NEVER seen any serious bleeding problems with ESWT used for pf and this includes cases where doctor have kept the patient on coumadin or plavix. I am not suggesting that you stay on either coumadin or plavix but its not the end of the world if you do ESWT while on these medications

Result number: 84

Message Number 235751

Re: Can someone with a low platelet count consider estw? View Thread
Posted by Caroline109 on 9/08/07 at 13:08

My doctor called it atypical because my feet rarely hurt when I get up in the morning. They hurt more as the day progresses and when I go to bed and lie there with pressure on the heels from the mattress, they hurt, a lot! The doctor has in the past pushed on the area just past the arch of the foot, by thestart of the heel and it hurts a lot.

My low platelet count is idiopathic---no known reason for it. Discovered the day my oldest son was born while in labor, almost 27 years ago. I do take Celebrex for knee and shoulder arhtritis (which I could discontinue, at least temporarily, if necessary) and during the summer, I take Zyrtec for summer and early fall allergies. As far as surgeries go, I've had 3 csections and 2 partial menisectomies (one on each knee)as well as wisdom teeth removal back when I was in college. I never had bleeding issues during the surgeries (had prednisone for the last weeks of 2nd and 3rd pregnancies, a common practice back then if you had a low platelet count during pregnancy---now there are other treatments as well).
I may ask my hematologist about the whole thing when I see him in a couple of weeks but I would like to provide him with some information from a foot professional on the subject as well.
I appreciate any opinion you may have. Thanks!

Result number: 85

Message Number 235725

Re: Can someone with a low platelet count consider estw? View Thread
Posted by Dr. Z ( vacation) on 9/07/07 at 22:01

Hi
The first thing that strikes me with your post is the word atypical plantar fasciitis. I have a few questions. Do you have pain and or limp when you sit for any period of time or first get up in the morning? Is there pain at or near the insertion of your plantar fascia? Can your doctor press on this area and cause lots of pain and is it one area or all over the bottom of the foot? These some of the inclusion criteria for ESWT treatments
As for the platelet low count. If you have problems with clotting or any blood thinner such as coumadin or plavix you need to be off these medications before ESWT is undertaken. If you only have a low platelet count. I would need to know the reason and what medications you are taking. I would need to know lists of operations you have undergone. What is your healing ability.? How that for a start

Result number: 86

Message Number 235719

Can someone with a low platelet count consider estw? View Thread
Posted by Caroline109 on 9/07/07 at 21:28

I've had PF on and off for a few years, bilaterally. I've had a cortisone shot in each foot which did nothing and some PT, which included both stretching exercises and the treatment the ultrasonic therapy (ionepheresis??) which helped for a while. My doctor, an orthopedic surgeon who specializes in feet, mentioned something about trying estw a few years ago but at the time, I said no because 1) it was quite new then and 2) not covered by our insurance (which I'm not sure if it is now) and 3) I wasn't sure if I could have it with a chronic low platelet count. My feet have been getting very painful lately, especially at night in bed (my doctor says I have atypical PF)and have been considering this possible treatment, although I have yet to go back to see the ortho. about it. At this point, because I see that the literature advises against people with bleeding/bruising issues having estw, I was wondering what your personal opinion on this subject might be. My count averages around 75,000 (a regular count is between 150,000 and 300,000 generally).
Thank you for any information.
Caroline

Result number: 87

Message Number 230194

Re: heel spur View Thread
Posted by Laurie C. on 5/20/07 at 12:34

I think you may mean APC (autologous platelet concentrate). I had this procedure done.

Result number: 88
Searching file 22

Message Number 221963

Re: question for Dr.goldstein on non union View Thread
Posted by Dr. J. Rocco on 2/09/07 at 11:14

Casting and bone stimulator are unlikely to work without stable fixation. Revision surgery, Bone graft (autograft-your own cells), platelet gel, and stable fixation with multiple screws. Don't wait any longer.

Result number: 89

Message Number 221466

Possible Diagnosis of TTS with other contributing factors View Thread
Posted by Amanda on 2/03/07 at 10:46

Hi. I just found your group and I have a bit a complicated scenario. I have been trying to find an answer to my ankle problem since July. I have been to 4 podiatrists with the last one seeming to give me the answer of what has been giving me pain in my ankle. I completed 9 weeks of PT and the symptoms were getting worse including numbness of my feet, numbness of my lower leg and an inability to move my toes up or down. The doctor did an arthogram and found that I had prolapsed joint capsule that was causing pressure on my tibial nerve and my flexor tendon. He did an experimental procedure that I felt had relatively low risk versus an open ankle surgery. He used something called autologous platelet concentrate in which your platelets are seperated from your blood and injected into the capsule in hopes of it healing. I was in a orthoboot for 6 weeks. I recently had a repeat arthogram which showed the prolapse was gone. However, I still have burning, tingling and extreme sensitivity to cold and heat in my foot. He has mentioned I could also have TTS as part of my problem. I have previously had a pressure sensitive neuro testing done and it showed I had complete loss of two point perception in my tibial nerve. How does a doctor know when the nerve pain you are feeling is because the compression still exists or because the nerves are regenerating? I'm concerned as if I do have TTS, I understand that at some point there can be permanent nerve damage that is unable to heal. I had taken Lyrica for 4 weeks with no noticeable improvement and I'm on Neurontin now. However, since being out of my walking boot for a few days now, I now have the ankle pain again (not just the nerve pain). As far as the tibial nerve, if a Dr. said you had complete loss of two point perception of the tibial nerve, where would it most likely begin on the tibial nerve? I have a ton of quetsions and want to avoid permanent damage.

Result number: 90

Message Number 220596

Re: burse View Thread
Posted by Dr. Z on 1/24/07 at 18:18

Hi
This is a fairly new procedure in podiatry. It is suppose to stimulate tissue growth and thus the healing of your plantar fascia. I am not aware of autologous platelet therapy being used for a bursitis
I personally like ESWT for patients that have had failed conserative therapy still in pain for at least six months and have plantar fasciitis. At this point in time it is important to make sure that you have plantar fasciitis.
Dr. Wander has posted many time about studies showing that there is no such thing as a bursitis on the bottom of the foot
The reason I talk about Pf or plantar fasciitis is that you mentioned EPF and that is a surgical procedure for cutting the fascia
I hope that answered your questions.

Result number: 91

Message Number 220591

burse View Thread
Posted by Dale C on 1/24/07 at 17:45

seen doc today said i didn't have bone spur but had burse(not sure of the spelling)on left heel give me the choice of autologous platelet concentrate injections or EPF what do you sugest.read message board on injections and i must say a little turned off with this procedure.
doc said it was a new procedure not a whole lot of info.I know I'm the one making choice but I value other appendions.
thanks

Result number: 92
Searching file 21
Searching file 20

Message Number 208298

Re: Is TTS pain a sign you should listen to? View Thread
Posted by Bryan W. on 8/24/06 at 17:52

I agree with the above comments. The pain meds will allow you to go further but there is a reason the pain exists..to tell your brain enough now rest. When the nerve is agitated it feeds back via the pain message. so if you cover it with meds...well now you are going to really make things worse in the long run. Will you cause more damage to the nerve that is not reversable??? maybe I do not think even a Pod or Dr. will advise it is a good thing. But sometimes you want to go the extra yard so you use the meds...for me it is Ibuprofen since it works pretty well and I have a good tummy for it! I agree with Bambi the strong meds are good in the begining but one should ween off ASAP since the longterm is as she said not a good outcome typically. Some might argue about Lycra but so far I have resisted going on it since i am able to tollerate my pain levels with just Ibuprofen. From Wikipedia I copy/paste.....
_____________________________________________________________________
Pregabalin (INN) (IPA: [prɪˈgæbələn]) is an anticonvulsant drug used for neuropathic pain, as an adjunct therapy for partial seizures, and in generalized anxiety disorder. It was designed as a more potent successor to gabapentin. Pregabalin is marketed by Pfizer under the trade name Lyrica.

In the U.S., it is considered to have dependence liability if misused, and is classified as a Schedule V drug.[1]

History

Pregabalin was initially developed by biochemist Richard Silverman at Northwestern University in the United States. The drug was approved in the European Union in 2004. Pregabalin received U.S. Food and Drug Administration (FDA) approval for use in treating epilepsy, diabetic neuropathy pain and post-herpetic neuralgia pain in June 2005, and appeared on the U.S. market in fall 2005.

Pharmacology

Like gabapentin, pregabalin binds to the α2δ subunit of the voltage-dependent calcium channel in the central nervous system, blocking channel action and thus calcium influx. However, the exact mechanism of action is unknown.

Clinical use

Indications

Pregabalin is indicated for:

* Treatment of neuropathic pain in adults
* Adjunctive therapy in adults with partial seizures with or without secondary generalization

In the European Union, it has also been approved for the treatment of generalized anxiety disorder (GAD).[2]

Adverse effects

Adverse drug reactions associated with the use of pregabalin include:[3][4]

* Very common (>10% of patients): dizziness, drowsiness
* Common (1–10% of patients): visual disturbance (including blurred vision, diplopia), ataxia, dysarthria, tremor, lethargy, memory impairment, euphoria, weight gain, constipation, dry mouth, peripheral edema
* Infrequent (0.1–1% of patients): depression, confusion, agitation, hallucinations, myoclonus, hypoaesthesia, hyperaesthesia, tachycardia, excessive salivation, sweating, flushing, rash, muscle cramp, myalgia, arthralgia, urinary incontinence, dysuria, thrombocytopenia
* Rare (<0.1% of patients): neutropenia, first degree heart block, hypotension, hypertension, pancreatitis, dysphagia, oliguria, rhabdomyolysis

Drug interactions

No pharmacokinetic interactions have been demonstrated in vivo. The manufacturer notes some potential pharmacological interactions with oxycodone, lorazepam and ethanol (alcohol). Concurrent use may increase the central nervous system effects of these medications (e.g. drowsiness, effects on concentration).[3]

References

1. ^ Drug Enforcement Administration, Department of Justice. Schedules of controlled substances: placement of pregabalin into schedule V. Final rule. Fed Regist 2005;70(144):43633-5. PMID 16050051
2. ^ Pfizer (2006-03-27). Pfizer's Lyrica Approved for the Treatment of Generalized Anxiety Disorder (GAD) in Europe. Press release. Retrieved on 2006-06-02.
3. ^ a b Pfizer Australia Pty Ltd. Lyrica (Australian Approved Product Information). West Ryde: Pfizer; 2006.
4. ^ Rossi S, editor. Australian Medicines Handbook 2006. Adelaide: Australian Medicines Handbook; 2006. ISBN 0-9757919-2-3
___________________________________________________________________

Ibuprofen (INN) (IPA: [ˈaɪbjuprofɛn]) is a non-steroidal anti-inflammatory drug (NSAID) widely marketed under various trademarks including Act-3, Advil, Brufen, Motrin, Nuprin, and Nurofen. It is used for relief of symptoms of arthritis, primary dysmenorrhoea, fever, and as an analgesic, especially where there is an inflammatory component. Ibuprofen was developed by the research arm of Boots Group.

Clinical use

Low doses of ibuprofen (200 mg., and sometimes 400 mg.) are available over the counter (OTC) in most countries. Ibuprofen has a dose-dependent duration of action of approximately 4–8 hours, which is longer than suggested by its short half-life. The recommended dose varies with body mass and indication. Generally, the oral dose is 200–400 mg (5–10 mg/kg in children) every 4–6 hours, up to a usual maximum daily dose of 800–1200 mg. Under medical direction, a maximum daily dose of 3200 mg may sometimes be used.

Off-Label and investigational use

* As with other NSAIDs, ibuprofen may be useful in the treatment of severe orthostatic hypotension.[1]
* In some studies, ibuprofen showed superior results compared to placebo in the prophylaxis of Alzheimer's disease, when given in low doses over a long time.[2] Further studies are needed to confirm the results before ibuprofen can be recommended for this indication.
* Ibuprofen has been associated with a lower risk of Parkinson's disease, and may delay or prevent Parkinson's disease. Aspirin, other NSAIDs, and paracetamol had no effect on the risk for Parkinson's.[3] Further research is warranted before recommending ibuprofen for this use.

Ibuprofen lysine

In Europe, Australia, and New Zealand ibuprofen lysine (ibuprofenlysinat, the lysine salt of ibuprofen) is licensed for treatment of the same conditions as ibuprofen. Ibuprofen lysine has been shown to have a more rapid onset of action compared to base ibuprofen.[4]

Mechanism of action

Ibuprofen is an NSAID which is believed to work through inhibition of cyclooxygenase (COX), thus inhibiting prostaglandin synthesis. There are at least 2 variations of cyclooxygenase (COX-1 and COX-2 ), ibuprofen inhibits both COX-1 and COX-2. It appears that its analgesic, antipyretic, and anti-inflammatory activity are achieved principally through COX-2 inhibition; whereas COX-1 inhibition is responsible for its unwanted effects on platelet aggregation and the GI mucosa.

Main article: Non-steroidal anti-inflammatory drug

Adverse effects

Ibuprofen appears to have the lowest incidence of gastrointestinal adverse drug reactions (ADRs) of all the non-selective NSAIDs. However, this only holds true at lower doses of ibuprofen, so over-the-counter preparations of ibuprofen are generally labelled to advise a maximum daily dose of 1,200 mg.

Main article: Non-steroidal anti-inflammatory drug

Reported adverse drug reactions

In low single doses (200 to 400 mg) and daily doses of up to 1,200 mg the incidence of side effects is low. However, in patients treated on a long-term basis with more than 1,200 mg daily discontinuation rates are as high as 10 to 15%.

Common adverse effects include: nausea, dyspepsia, gastrointestinal ulceration/bleeding, raised liver enzymes, diarrhoea, headache, dizziness, salt and fluid retention, hypertension.[5]

Infrequent adverse effects include: oesophageal ulceration, heart failure, hyperkalaemia, renal impairment, confusion, bronchospasm, rash.[5]

Photosensitivity

As with other NSAIDs, ibuprofen has been reported to be a photosensitising agent.[6][7] However, this only rarely occurs with ibuprofen and it considered to be a very weak photosensitising agent when compared with other members of the 2-arylpropionic acids. This is because the ibuprofen molecule contains only a single phenyl moiety and no bond conjugation, resulting in a very weak chromophore system and a very weak absorption spectrum which does not reach into the solar spectrum.

Cardiovascular risk

Along with several other NSAIDs, ibuprofen has been implicated in elevating the risk of myocardial infarction, particularly among those chronically using high doses.[8]

Stereochemistry
3D model of (R)-ibuprofen
Enlarge
3D model of (R)-ibuprofen

Ibuprofen, like other 2-arylpropionate derivatives (including ketoprofen, flurbiprofen, naproxen, etc) contains a chiral carbon in the α-position of the propionate moiety. As such there are two possible enantiomers of ibuprofen with the potential for different biological effects and metabolism for each enantiomer.

Indeed it was found that (S)-(+)-ibuprofen (dexibuprofen) was the active form both in vitro and in vivo.

It was logical, then, that there was the potential for improving the selectivity and potency of ibuprofen formulations by marketing ibuprofen as a single-enantiomer product (as occurs with naproxen, another NSAID).

Further in vivo testing, however, revealed the existence of an isomerase which converted (R)-ibuprofen to the active (S)-enantiomer. Thus, due to the expense and futility that might be involved in marketing the single-enantiomer, most ibuprofen formulations currently marketed are racemic mixtures. A notable exception to this is Seractiv (Nordic Drugs).

Human toxicology

Ibuprofen overdose has become common since it was licensed for over-the-counter use. There are many overdose experiences reported in the medical literature.[9] Human response in cases of overdose ranges from absence of symptoms to fatal outcome in spite of intensive care treatment. Most symptoms are an excess of the pharmacological action of ibuprofen and include abdominal pain, nausea, vomiting, drowsiness, dizziness, headache, tinnitus, and nystagmus. Rarely more severe symptoms such as gastrointestinal bleeding, seizures, metabolic acidosis, hyperkalaemia, hypotension, bradycardia, tachycardia, atrial fibrillation, coma, hepatic dysfunction, acute renal failure, cyanosis, respiratory depression, and cardiac arrest have been reported.[10]. The severity of symptoms varies with the ingested dose and the time elapsed, however, individual sensitivity also plays an important role. Generally, the symptoms observed with an overdose of ibuprofen are similar to the symptoms caused by overdoses of other NSAIDs.

There is little correlation between severity of symptoms and measured ibuprofen plasma levels. Toxic effects are unlikely at doses below 100 mg/kg but can be severe above 400 mg/kg;[11] however, large doses do not indicate that the clinical course is likely to be lethal.[12] It is not possible to determine a precise lethal dose, as this may vary with age, weight, and concomitant diseases of the individual patient.

Therapy is largely symptomatic. In cases presenting early, gastric decontamination is recommended. This is achieved using activated charcoal; charcoal absorbs the drug before it can enter the systemic circulation. Gastric lavage is now rarely used, but can be considered if the amount ingested is potentially life threatening and it can be performed within 60 minutes of ingestion. Emesis is not recommended.[13] The majority of ibuprofen ingestions produce only mild effects and the management of overdose is straightforward. Standard measures to maintain normal urine output should be instituted and renal function monitored.[11] Since ibuprofen has acidic properties and is also excreted in the urine, forced alkaline diuresis is theoretically beneficial. However, due to the fact ibuprofen is highly protein bound in the blood, there is minimal renal excretion of unchanged drug. Forced alkaline diuresis is therefore of limited benefit.[14] Symptomatic therapy for hypotension, GI bleeding, acidosis, and renal toxicity may be indicated. Occasionally, close monitoring in an intensive care unit for several days is necessary. If a patient survives the acute intoxication, he/she will usually experience no late sequelae.

Availability

Ibuprofen was made available under prescription in the United Kingdom in 1969. In the years since, the good tolerability profile along with extensive experience in the community (otherwise known as Phase IV trials), has resulted in the rescheduling of small packs of ibuprofen to allow availability over-the-counter in pharmacies worldwide. Indeed there has been an increasing trend towards descheduling ibuprofen such that it is now available in supermarkets and other general retailers. The wider availability has meant that ibuprofen is now almost as commonly used as aspirin and paracetamol.

Slang names
This section does not cite its references or sources.
You can help Wikipedia by introducing appropriate citations.

A standing joke about some athletes' regular use has produced "Vitamin I"[1] as a slang term for ibuprofen.

In the military, "Grunt Candy" is used as a generic name for ibuprofen, paracetamol, or naproxen.
[edit]

See also

* Paracetamol

References

1. ^ Zawada E (1982). "Renal consequences of nonsteroidal antiinflammatory drugs.". Postgrad Med 71 (5): 223-30. PMID 7041104.
2. ^ Townsend K, Praticò D (2005). "Novel therapeutic opportunities for Alzheimer's disease: focus on nonsteroidal anti-inflammatory drugs.". FASEB J 19 (12): 1592-601. PMID 16195368.
3. ^ Chen H, Jacobs E, Schwarzschild M, McCullough M, Calle E, Thun M, Ascherio A (2005). "Nonsteroidal antiinflammatory drug use and the risk for Parkinson's disease.". Ann Neurol 58 (6): 963-7. PMID 16240369.
4. ^ Geisslinger G, Dietzel K, Bezler H, Nuernberg B, Brune K (1989). "Therapeutically relevant differences in the pharmacokinetical and pharmaceutical behavior of ibuprofen lysinate as compared to ibuprofen acid.". Int J Clin Pharmacol Ther Toxicol 27 (7): 324-8. PMID 2777420.
5. ^ a b (2004) Rossi S Australian Medicines Handbook, 2004, Australian Medicines Handbook. ISBN 0-9578521-4-2.
6. ^ Bergner T, Przybilla B. Photosensitization caused by ibuprofen. J Am Acad Dermatol 1992;26(1):114-6. PMID 1531054
7. ^ Thomson Healthcare. USP DI Advice for the Patient: Anti-inflammatory Drugs, Nonsteroidal (Systemic) [monograph on the internet]. Bethesda (MD): U.S. National Library of Medicine; c2006 [updated 2006 Jul 28; cited 2006 Aug 5]. Available from: http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202743.html
8. ^ Hippisley-Cox J, Coupland C (2005). "Risk of myocardial infarction in patients taking cyclo-oxygenase-2 inhibitors or conventional non-steroidal anti-inflammatory drugs: population based nested case-control analysis.". BMJ 330 (7504): 1366. PMID 15947398.
9. ^ McElwee NE, Veltri JC, Bradford DC, Rollins DE. (1990). "A prospective, population-based study of acute ibuprofen overdose: complications are rare and routine serum levels not warranted.". Ann Emerg Med 19 (6): 657-62. PMID 2188537.
10. ^ Vale JA, Meredith TJ. (1986). "Acute poisoning due to non-steroidal anti-inflammatory drugs. Clinical features and management.". Med Toxicol 1 (1): 12-31. PMID 3537613.
11. ^ a b Volans G, Hartley V, McCrea S, Monaghan J. (2003). "Non-opioid analgesic poisoning". Clinical Medicine 3 (2): 119-23. PMID 12737366.
12. ^ Seifert SA, Bronstein AC, McGuire T. (2000). "Massive ibuprofen ingestion with survival.". J Toxicol Clin Toxicol 38 (1): 55-7. PMID 10696926.
13. ^ (2004). "Position paper: Ipecac syrup.". J Toxicol Clin Toxicol 42 (2): 133-43. PMID 15214617.
14. ^ Hall AH, Smolinske SC, Conrad FL, Wruk KM, Kulig KW, Dwelle TL, Rumack BH. (1986). "Ibuprofen overdose: 126 cases.". Ann Emerg Med 15 (11): 1308-13. PMID 3777588.

Result number: 93

Message Number 201346

To John h View Thread
Posted by Ralph on 6/17/06 at 13:46

John,
Here is a trial study that might interest you.

Low Back Pain Study

IRB #106-03 A Pilot Trial of IV Pamidronate for Low Back Pain

Principal Investigators: Marco Pappagallo, MD
Contact: Janet Auger, Research Coordinator, (212) 844-1501
Status: Open for Enrollment

Design: This is a single center, randomized, double-blind, placebo-controlled dose escalation pilot study. The primary objective is to determine which pamidronate treatment protocol is optimal for the Phase III trial.

Pamidronate belongs to a class of drugs used to treat weak or brittle bones. The purpose of this research study is to evaluate the effect of pamidronate on chronic low back pain. While preliminary results with pamidronate for low back pain are promising, well-designed trials are needed to determine the true effectiveness of this drug for low back pain.

Study subjects will receive intravenously (injection into a vein) administered placebo or pamidronate. There will be very close monitoring via blood tests, physical examinations, and telephone contact with subjects.

Eligible participants include males and females over age 21, with non-cancer-related low back pain that has been present for at least 3 months.

Risks associated with pamidronate include flu-like symptoms within 3 days of the treatment. The development of local inflammation of a vein, increased bleeding from low platelets, and low blood calcium or magnesium levels is rare.

Result number: 94

Message Number 201289

Re: Toe amputation question View Thread
Posted by Ralph on 6/16/06 at 16:27

Have you taken your mother to a Wound Clinic. Many major hospitals have them.

A neighbor of ours is a diabetic. He developed an sore on his heel which of couse he didn't feel because of neuropathy in his feet.

To make a long story short. The wound which was about the size of a quarter, infected and open down to exposing his heel bone.

The wound clinic worked wonders on him. It took several months of treatment with a daily routine done by his wife at home.

One of the treatments involved taking his own blood, separating out the platelets which were used to make a liquid that was put into the opening. The wound closed slowly from the inside out.

I remember we all cheered when it got down to the size of a dime, slowly but surely it healed.

I'm not a doctor but if you've not seen a doctor at a wound clinic you might want to see one prior to having an amputation.

Wound Clinics are heaven sent in many cases. Without one our neighbor would have lost his foot.

Something you may want to check into by calling hospitals in your area.

Result number: 95
Searching file 19

Message Number 198206

Re: platelet injection treatment View Thread
Posted by Kay on 4/28/06 at 12:37

okay thanks

Result number: 96

Message Number 198042

Re: platelet injection treatment View Thread
Posted by Dr. Zuckerman on 4/25/06 at 16:35

I used it for one patient. Didn't help that much. There is an excellent artilce in Podiatry Today. Search this site or use google to find the article

Result number: 97

Message Number 198034

platelet injection treatment View Thread
Posted by Kay on 4/25/06 at 14:01

has anyone tried autologous platelet-rich plasma injections? Did it help?

Result number: 98
Searching file 18

Message Number 186565

Re: San diego Update - for Ralph View Thread
Posted by Dr. David S. Wander on 11/02/05 at 13:23

Elvis,
The blood platelet injection is a newer, not new technology. It has been written about for a while and I believe that a study was being performed by Dr. Steve Barrett. Ironically, Dr. Barrett is the doctor that invented the endoscopic plantar fasciotomy (EPF) procedure. In the preliminary studies that I've read, the success rates with the new "injection" procedure were tremendous with virtually no side effects or negative effects. If the studies prove that it's successful, it will drastically improve treatment considering that it will eliminate the complications that many other treatments are associated with. If you're still having pain, why don't you volunteer to be in the study group! You can then change the name you post with from Elvis to "guinea pig"!

Result number: 99

Message Number 186478

ART Update View Thread
Posted by elvis on 11/01/05 at 20:35

Ralph - to honor your request I'm reporting on a visit I made today to my DPM. first he was gald to see me. He doesn't get to talk technical stuff with many patients so he's very chatty with me. Here goes:

1. He was thrilled that I got relief from AST. He said he questions a lot of things out there that are claimed to "cure" PF but ART is one things that he said makes sense. His feeling was that the ART treatment "released the pressure on my PF" ( i think those were his words). He said he knew about ART but then wanted to know exactly what the ART provider did. I told him that I was just a dumb patient and realy incompetent to really talk about this subject with him but he wanted me to talk to him anyway!! LOL He must be a dumb doctor, huh? Wanting to liste to a testimaonial!! I note that he didn't ask for any FDA testing or double blind clinical peer reviewed article!! LOL

2. I went over the best I could about the movements that I was asked to do during the ART treatment. he then asked, "Well, how long did it take? 5 minutes? 10 minutes?" Interesting but this guy was willing to LISTEN!!!!! To a dumb patient no less!! LOL

3. He took a look at my foot and we talked about the recent pain. He explained again that we're trying to balance the pronation/supination thing. I said "yeah I know." I told him that for whatever it's worht that the guy at the running store who is the SD Running Club coach said that his analysis of my giat indicated that both feet supinated a little bit. He said that wasn;t surprising in that my pains in the ankle, metatarsals, cuboid are all "supinating" pains. We, er I mean, HE decide to adjust my orthotic to allow for more pronation to try and get rid of my non-PF pains. He even gave me a sticky tape insert to put on the underside of my orthotic if his adjustment doesn;t work. He sadi to give his adjustment a week to see if it works.

4. My doctor then asked if I ever heard of prolo-therapy and I said "of course." And he said "Of course you HAVE!!" I told him that a DPM in Hill Crest (a very strange and demented place) charged $40/treatment for 3 treatments spaced out every 1 or 2 weeks. He said that PROLO-THERAPY actually works. It's been reported in the literature to stimulate growth factors. He has tried it using 50% dextrose. He said he never would've thought that Polotherapy would work! Imagine that a health care professional being wrong!!

5. He then told me that he had been accepted to do an FDA study on APC for PF. Those that don't know what APC is then look it up!! No, I wouldn't be so arrogant!! But wait a minute I am not a HEALTH CARE PRACTITIONER!! Screw it!! LOL APC is Autologous Platelet Concentrate. They take a blood sample, spin it, concentrate the platelet fraction and then re-inject it back into your heel. The growth factors stimulate healing. He opined that ESWT, prolotherapy and APC probably all had the same mechanism of action, ie, stimulate growth factors to cause healing. But that's OK he is a HEALTH CARE PRACTITIONER and so it's OK for him to give us his opinion! LOL He said the "problem" with all of these procedures is that you can't cut the heel open and observe the changes in the tissues. I said, "Wait a minute!! What about the treatment TRIAD and the 3rd leg --- TISSUE QUALITY!!!" He said "Didn't you hear what I just said?? You can't tell because you will never open up the heel to take a look!" I said well what about a fancy ultrasound? He said that he wasn't sure that they was a 100% correlation between fascia thickness and PF. As an example he said that if you took 10 people without PF and 10 with PF and did MRIs and ultrsounds he didn't think a radiologist could correctly pick with 100 degree certainty who had PF and who didn't. I think that's a very good point but WTFDIK??

Result number: 100

Message Number 186477

San diego Update - for Ralph View Thread
Posted by elvis on 11/01/05 at 20:34

To honor your request I'm reporting on a visit I made today to my DPM. first he was gald to see me. He doesn;t get to talk technical stuff with many patients so he's very chatty with me. Here goes:

1. He was thrilled that I got relief from AST. He said he questions a lot of things out there that are claimed to "cure" PF but ART is one things that he said makes sense. His feeling was that the ART treatment "released the pressure on my PF" ( i think those were his words). He said he knew about ART but then wanted to know exactly what the ART provider did. I told him that I was just a dumb patient and realy incompetent to really talk about this subject with him but he wanted me to talk to him anyway!! LOL He must be a dumb doctor, huh? Wanting to liste to a testimaonial!! I note that he didn't ask for any FDA testing or double blind clinical peer reviewed article!! LOL

2. I went over the best I could about the movements that I was asked to do during the ART treatment. he then asked, "Well, how long did it take? 5 minutes? 10 minutes?" Interesting but this guy was willing to LISTEN!!!!! To a dumb patient no less!! LOL

3. He took a look at my foot and we talked about the recent pain. He explained again that we're trying to balance the pronation/supination thing. I said "yeah I know." I told him that for whatever it's worht that the guy at the running store who is the SD Running Club coach said that his analysis of my giat indicated that both feet supinated a little bit. He said that wasn;t surprising in that my pains in the ankle, metatarsals, cuboid are all "supinating" pains. We, er I mean, HE decide to adjust my orthotic to allow for more pronation to try and get rid of my non-PF pains. He even gave me a sticky tape insert to put on the underside of my orthotic if his adjustment doesn;t work. He sadi to give his adjustment a week to see if it works.

4. My doctor then asked if I ever heard of prolo-therapy and I said "of course." And he said "Of course you HAVE!!" I told him that a DPM in Hill Crest (a very strange and demented place) charged $40/treatment for 3 treatments spaced out every 1 or 2 weeks. He said that PROLO-THERAPY actually works. It's been reported in the literature to stimulate growth factors. He has tried it using 50% dextrose. He said he never would've thought that Polotherapy would work! Imagine that a health care professional being wrong!!

5. He then told me that he had been accepted to do an FDA study on APC for PF. Those that don't know what APC is then look it up!! No, I wouldn't be so arrogant!! But wait a minute I am not a HEALTH CARE PRACTITIONER!! Screw it!! LOL APC is Autologous Platelet Concentrate. They take a blood sample, spin it, concentrate the platelet fraction and then re-inject it back into your heel. The growth factors stimulate healing. He opined that ESWT, prolotherapy and APC probably all had the same mechanism of action, ie, stimulate growth factors to cause healing. But that's OK he is a HEALTH CARE PRACTITIONER and so it's OK for him to give us his opinion! LOL He said the "problem" with all of these procedures is that you can't cut the heel open and observe the changes in the tissues. I said, "Wait a minute!! What about the treatment TRIAD and the 3rd leg --- TISSUE QUALITY!!!" He said "Didn't you hear what I just said?? You can't tell because you will never open up the heel to take a look!" I said well what about a fancy ultrasound? He said that he wasn't sure that they was a 100% correlation between fascia thickness and PF. As an example he said that if you took 10 people without PF and 10 with PF and did MRIs and ultrsounds he didn't think a radiologist could correctly pick with 100 degree certainty who had PF and who didn't. I think that's a very good point but WTFDIK??

Result number: 101

Message Number 186476

Ralph View Thread
Posted by elvis on 11/01/05 at 20:33

To honor your request I'm reporting on a visit I made today to my DPM. first he was gald to see me. He doesn;t get to talk technical stuff with many patients so he's very chatty with me. Here goes:

1. He was thrilled that I got relief from AST. He said he questions a lot of things out there that are claimed to "cure" PF but ART is one things that he said makes sense. His feeling was that the ART treatment "released the pressure on my PF" ( i think those were his words). He said he knew about ART but then wanted to know exactly what the ART provider did. I told him that I was just a dumb patient and realy incompetent to really talk about this subject with him but he wanted me to talk to him anyway!! LOL He must be a dumb doctor, huh? Wanting to liste to a testimaonial!! I note that he didn't ask for any FDA testing or double blind clinical peer reviewed article!! LOL

2. I went over the best I could about the movements that I was asked to do during the ART treatment. he then asked, "Well, how long did it take? 5 minutes? 10 minutes?" Interesting but this guy was willing to LISTEN!!!!! To a dumb patient no less!! LOL

3. He took a look at my foot and we talked about the recent pain. He explained again that we're trying to balance the pronation/supination thing. I said "yeah I know." I told him that for whatever it's worht that the guy at the running store who is the SD Running Club coach said that his analysis of my giat indicated that both feet supinated a little bit. He said that wasn;t surprising in that my pains in the ankle, metatarsals, cuboid are all "supinating" pains. We, er I mean, HE decide to adjust my orthotic to allow for more pronation to try and get rid of my non-PF pains. He even gave me a sticky tape insert to put on the underside of my orthotic if his adjustment doesn;t work. He sadi to give his adjustment a week to see if it works.

4. My doctor then asked if I ever heard of prolo-therapy and I said "of course." And he said "Of course you HAVE!!" I told him that a DPM in Hill Crest (a very strange and demented place) charged $40/treatment for 3 treatments spaced out every 1 or 2 weeks. He said that PROLO-THERAPY actually works. It's been reported in the literature to stimulate growth factors. He has tried it using 50% dextrose. He said he never would've thought that Polotherapy would work! Imagine that a health care professional being wrong!!

5. He then told me that he had been accepted to do an FDA study on APC for PF. Those that don't know what APC is then look it up!! No, I wouldn't be so arrogant!! But wait a minute I am not a HEALTH CARE PRACTITIONER!! Screw it!! LOL APC is Autologous Platelet Concentrate. They take a blood sample, spin it, concentrate the platelet fraction and then re-inject it back into your heel. The growth factors stimulate healing. He opined that ESWT, prolotherapy and APC probably all had the same mechanism of action, ie, stimulate growth factors to cause healing. But that's OK he is a HEALTH CARE PRACTITIONER and so it's OK for him to give us his opinion! LOL He said the "problem" with all of these procedures is that you can't cut the heel open and observe the changes in the tissues. I said, "Wait a minute!! What about the treatment TRIAD and the 3rd leg --- TISSUE QUALITY!!!" He said "Didn't you hear what I just said?? You can't tell because you will never open up the heel to take a look!" I said well what about a fancy ultrasound? He said that he wasn't sure that they was a 100% correlation between fascia thickness and PF. As an example he said that if you took 10 people without PF and 10 with PF and did MRIs and ultrsounds he didn't think a radiologist could correctly pick with 100 degree certainty who had PF and who didn't. I think that's a very good point but WTFDIK??

Result number: 102
Searching file 17

Message Number 178199

Orthotic Update View Thread
Posted by elvis on 7/11/05 at 18:22

I went back to my podiatrist today and he took some more stuff off the bottom of my rigid orthotic. He said I probably needed a litte bit more room for pronation. The past couple of weeks I was experiencing ankle pain and pain around the ankle bone going up into the lower portion of my leg. This pain started almost immediately after putting on my Asics with the orthotics in them. Actually my feet feel the best with my Ecco sandals on. I have also been getting pains in my metatarsal area radiating from underneath the ankle on the lateral side and going up onto the top of my foot in the 3rd metatrasal region. Actaully the pain in the metarsal area has been getting much worse lately and masking the pain in the heel. The heel pain seems to be subsiding but it is still slightly sensitive to a finger probe of the heel. He still has hopes of getting me back on my feet with just the orthotics so that I can do the things that I normally do......which for me is running marathons. He asked be to take naproxyn twice a day (444mg) for a week to see if it helps with the metatarsal pain.

We talked about ESWT but I'm gonna try the new setting on the orthotic, weight loss and naproxyn first. As much as the orthotic hurt after putting it on lately my foot imediately felt "relieved" by the new orthotic setting. I'm still doing stretching and electric messager. For what it's worth I asked him what his success rate was on the ESWT and he said about 80%. He uses an off-label protocol with the Sonocur machine and gradually sets the dial up increasing the energy whihc by the edn of the procedure administers as much or more than the Ossatron.....all without anesthesia of any sort. I asked him what success meant to him and he said that it is when people can resume pre-PF activities and stop having to see him. I don't know how well, or even if, he follows up with his ESWT patients.

He also said that he helped develop a protocol for a new FDA trial on APC (autologous platelet concentrate) that he thinks will be done in San Diego soon. He said that that was a possibility down the road too. He said that APC is more apt to be used in the areas of the foot that have more blood vessls, nerves and other structures that you normally wouldn't want to hit with ESWT, ie, like the arch area.

So far so good. I'll do a 1.5 mile walk tonight and see what happens.

Result number: 103

Message Number 174949

Re: Sonorex in San Diego View Thread
Posted by elvis on 5/13/05 at 16:20

Thanx for all of the replies.
1. No, I expect the treatment to be at least $1,000 not $500. He said I would most likely need 2 treatments and possibly 3. He was upfront about that. What I'm looking to get out of this is no more pain and be able to get back running. And yes I WILL run more marahtons (i hope!! LOL) Those are my goals. Dr Z, the thing that looks attractive to me is to at least get one treatment of ESWT and see how I handle it.....all for $500 with no traveling anywhere. Since it's my left foot I could even drive myself to the office. The United Shockwave podiatrist (also local) offered the Dornier for $800 where United would assume fighting it out with Blue Cross PPO. My orthopedic surgeon in LaJolla has offered me an Ossatron treatment with no general anesthesia for $3,100. Since I am a cheap ba&*rd I'm going with the new guy! LOL No, but really I think the Sonorex is definitely better than the Ossatron option and the Dornier is a close 2nd to my pick. See discussion below of my office visit.
2. He said he would give total energy at least equal to the Ossatron protocol for one high energy treatment. He threw around numbers by I didn't write them down.
3. The group is Oasis Sports Medical Group. The podiatrist I saw was Dr. Kent Feldman. Here's a link to their phone and address. I couldn't find a website:

http://www.google.com/local?q=oasis+sports+medicine&hl=en&lr=&rls=GGLD,GGLD:2003-52,GGLD:en&sa=X&near=San+Diego,+CA&radius=0&latlng=32715278,-117156389,5432694950141040328

4. Ed....that's exactly what he does. He starts low and progessively ratchets up the dose as the numbing of nerves starts. End result - he doesn't use any anesthesia.

I went and saw him today. I was quite impressed and feel comfortable in his care. You doctors have always said that that is an important factor. The outfit is a Sports Medicne only office. It is huge....the whole 2nd floor of a good sized building. Lots of patients hobbling around in the office! LOL Here's what he did/said:

5. We chatted. I brought (1) a timeline documenting my running and treatments so far and (2) a list of supplements that I take. He looked those over.
6. He examined my foot...prodded the heel, range of motion, strength of foot, etc.
7. Lately, my symptoms have changed. I am getting much more pain in my lateral metatrsals and stiffness in the foot below my ankle. Because that pain was getting much worse in the metatarsal area it seemed that the heel pain was subsiding a little. In fact I'm sure it has been at least with respect to the mornings and early afternoons. The bad pain is definitley appearing later on in the day. Here's a typical day. Get out of bed and it hurts like a female dog (in deference to the word police !! :-). Afer one or 2 minutes the pain subsides substantially and then within 10 minutes it feels pretty darned good but not totally void of pain. It feels this way up until the early afternoon and then it gets tender on the first few steps when I stand up from my desk. In the evening if I sit down to watch a program it hurts quite badly on the first several steps. Repeat the following day. You get the idea.
8. He looked over all of the stuff I brought in (Velcro boot cast, night splint, orthotics).
9. He had me stand up and told me to relax. He then lifted my big toe on the effected foot. He muttered a "a hah... little bit". He then made me stand in my orthotics and he did the same thing and said "little better". He didn't elaborate.
10. He told me that he was pretty darn sure he could easily get rid of the pain in my metatarsals with a cortisone injection. He thought that it was highly likely that that pain was due to limping and putting undue pressure on the outside of my foot. He said he wanted to tape my heel and see how it feels after 3 or 4 days. He thinks it may subside with this (i assume) because it's already seemed to subside recently. Anyway he thought there was chance that the taping may help and then we could avoid the ESWT.
11. He then injected my metatrasals with a combo of 2 steroids one short or intermediate acting and the other long acting (i think they were dexamethasone and methylprednisolone but I can't remember for sure). There also was some local anasthetic in there to. It hurt like a female dog....much worse than the heel shots I've gotten - i think because the heel shot goes in quick and this one took a minute or 2. It seemed like about a half hour! Yikes But it does feel better now.
12. He then taped my foot and said to wait for Monday to see how it is. On Monday we'll talk about ESWT in more detail.
13. I asked about his experince in ESWT and he said that 10-15% of people don't respond well. He has done only 2 plantar fasciotomies in the last 18 months so he is really happy with the ESWT.
14. He is trying to get chosen to do an FDA study on growh factor injections (APC autologous platelet concentrate). He said he would soon know if he will participate.
15. Overall I was very happy with the visit. I'll report back next week.

Result number: 104

Message Number 172067

Re: Insurance type question View Thread
Posted by CarolineH on 3/28/05 at 15:05

Have your business join the local Chamber of Commerce. When my husband had a consulting company with him as the only employee, we were unable to get health insurance for us because of a preexisting medical condition of mine (low platelet count). Companies were willing to insure my husband and sons but wouldn't insure me. Therefore he had his business join the local Chamber of Commerce and we were able to get it at a group rate. It wasn't terribly affordable but we got excellent coverage until he closed the business due to 9/11. We kept the business going in name only so we would have health insurace. We kept this insurance until he became employed again 15 months later when we could get much cheaper benefits through his employer. Ironically, now that my husband is back at work, and this is his second job since he went back to work, he works as a computer person at a major health insurance company in Hartford, CT.

Result number: 105

Message Number 170165

PF View Thread
Posted by Darlene on 2/28/05 at 16:24

I found some interesting information on the www.myfootshop.com website. This is something I haven't heard of before.

I will paste below:

On The Horizon....

Drs. Barrett and Erredge in Texas have taken a novel approach to treating plantar fasciitis. They have put forth a hypothesis that plantar fasciitis is not the result of repetitive loading and inflammation but rather the result of degenerative change in the fascia unrelated to mechanical load. Their study, published in the November 2004 edition of Podiatry Today advocates the use of autologous platelet concentrate (APC+) injected directly into the portion of the fascia that is painful. This technique stimulates healing.

Autologous (meaning derived from the patient) platelets are obtained by drawing the patients blood and processing it to obtain a concentrated mix of platelets. Platelets are known to have 4-6 times the normal level of human growth factor. Introduction of growth factor into a wound stimulates the influx of fibrocytes and new vascular ingrowth. This technique has been used for some time in the treatment of chronic wounds but is a new way of addressing chronic inflammatory problems such as fasciitis and tendonitis.

We applaud these doctors for their innovative thinking and look forward to more studies using this technique.

Result number: 106
Searching file 16

Message Number 169412

Re: Seeing xrays on CD - Amazing! View Thread
Posted by CarolineH on 2/19/05 at 10:06

I love Thermacare heat wraps. I get a lot of referred pain from my shoulder arthritis at the top of my ribs and find sticking a Thermacare wrap there when I go to bed makes the ache sort of melt away. I get the neck/shoulder ones to do that. I sometimes wish there were ones for feet!
I take Celebrex for my arthritis (200 MG) and am glad it will be staying on the market too. TYlenol just doesn't work well enough. I also have a low platelet count so I really have to watch what medicines I put in my body (hematologist okayed the Celebrex), especially anything anti-inflammatory.

Result number: 107

Message Number 165564

Re: Strong supporting muscles View Thread
Posted by Ed Davis, DPM on 12/13/04 at 15:04

Julie:

She is doing better -- thanks. The thing that seems to help her the most during occasional flare ups is our inversion table.

The one thing about muscle tissue we sometimes forget is that muscle tissue is not just there for support but the fact that muscle tissue is highly vascular so it brings a good blood supply to the area.

There is only so much we can do to "cheat" the aging process. That is where the new field of "anti-aging" medicine comes into play. That often involves use of adjusting hormone levels; something we are just learning more about. Many of the "anti-aging" clinics rely fairly heavily on use of growth hormone (practically used via injections only) and testosterone which often works well in a cream form due to the gradual delivery of the substances. The substance 1-testosterone (or one-testetherone) is a small portion of our natural testosterone and is reportedly 7 times as anabolic as testosterone and does not metabolize into estrogen (aromatization). It, for now, is available in cream form (online) and would consider application to an injured area in an attempt to speed healing ( the FDA is looking hard at the stuff and will proably have it off the market in a few months). Beyond this, we are looking at "local" growth factors (apparently Dr. Z is doing a study on a platelet derived growth factor for use in the plantar fascia). The issue with aging is declining levels of the various hormonal "support" that we had when younger and "anti-aging" medicine is looking at replacing or augmenting the hormones the level of which are in decline.
Ed

Result number: 108

Message Number 164533

Re: how is everyone, post eswt? View Thread
Posted by Tina H on 11/22/04 at 08:19

Hi Lori- I was doing pretty well however the past few days I've started having morning pain again, not sure why. My load bearing activity level has actually decreased as my field hockey coaching season is over. The only thing that I can think of is that I've stopped taking anti-inflammatories. I was taking Bextra for three years and decided it was enough with all the hoopla. Maybe I'll have to go back to alleve because the Bextra may have been keeping the moring pain in check.
As far as the swelling, that seems to be almost gone, unless I'm on my feet all day. My ankle still seems stiff. I'm too scared to have another treatment of ESWT at this point. It will be intresting to see if the autologous platelet injections work in larger scale trials. I think I will wait for that. Hope you will be doing better soon. So far for me the most improvement occurred between week 12 - 16. Tina

Result number: 109

Message Number 164496

A new treatment "ouch" View Thread
Posted by Dieter Fellner on 11/21/04 at 16:03

Discussing the intense capital investment necessary for ESWT, a colleague wrote the following:

"I worked with a podiatrist who spent some years in Asia, she said some TCM practitioners will wack the medial tubercle area with a hammer.....this stimulates a healing response for very little capital investment."

This was not a joke, but underlines the fact the profession is leaning towards a new model of understanding to explain why patients get heel pain and how this can be treated.

Encouraging a healing response through the formation of new blood vessels is one of the factors proposed as important in explaining ESWT. Other methods used include:

Injecting Autologous Platelet Concentrate
Prolotherpay
Cryosurgery

The precise mechanisms to explain how these treatments might work remains uncertain. But like ESWT there are an increasing number of patients who have been helped by such alternative treatments.

Once science has identified the underlying cause of this complaint, especially in the chronic cases, who do not respond well to the usual treatments, perhaps we can hope for a predictable, cost effective treatment. I think we are getting closer!

Result number: 110

Message Number 163870

Re: Autologous platelet concentrate injections View Thread
Posted by Dian V on 11/13/04 at 22:27

Wow, just doing research on this myself. I have PF with heel stress fracture and my doc is recommending this procedure. He said the same thing.......20cc blood taken and then 2cc injected into my foot. Sounds Franstein-ish, but he said it would help heal (heel, ha) alot faster. He said he's had great success with it.........

Result number: 111

Message Number 163774

Re: Autologous platelet concentrate injections View Thread
Posted by Dr. Z on 11/12/04 at 21:51

I will keep you posted on the procedure I perform. I will be doing a few in combination with ESWT. My goal is too reduce overall pain reduction time

Result number: 112

Message Number 163773

Re: Autologous platelet concentrate injections View Thread
Posted by Dr. David S. Wander on 11/12/04 at 21:31

Thanks Dave, I did read that article. I find it interesting that although Dr. Barrett inveneted the EPF, he makes no mention of the procedure as a treatment option for plantar fasciitis in the article!

Result number: 113

Message Number 163659

Re: New treatment discussed View Thread
Posted by Ed Davis, DPM on 11/12/04 at 00:02

Steve:
The view of the problem as fasciosis is logical. They are using growth factors that are platelet derived. A corrollary to this would be to ask questions as to the influence of other hormones involved in the grwoth and maintainance of tissue: testosterone and growth hormone.
Ed

Result number: 114

Message Number 163593

Re: Autologous platelet concentrate injections View Thread
Posted by Dr. Z on 11/11/04 at 16:22

Dr. Wander,
There is an article in Podiatry Today written by Dr. Barrett.

Result number: 115

Message Number 163484

Re: Autologous platelet concentrate injections View Thread
Posted by Dr. David S. Wander on 11/10/04 at 18:14

I don't know where you are located, but I believe that Dr. Barrett is performing this procedure in Texas. This is the same Dr. Barrett that "invented" the EPF procedure.

Result number: 116

Message Number 163446

Re: Autologous platelet concentrate injections View Thread
Posted by Dr. Z on 11/10/04 at 11:27

Hi
I got your e-mail and sent you a reply

Result number: 117

Message Number 163435

Re: Autologous platelet concentrate injections View Thread
Posted by scott tompkins on 11/10/04 at 10:50

dr z, i emailed you directly and it bounced back a standard reply.

I am interested in the study you may be doing with the platlet technique. My doctor stated i would be a good candidate.

Thank you
scott tompkins
va beach, va

Result number: 118

Message Number 163375

Re: Autologous platelet concentrate injections View Thread
Posted by Dr. Z on 11/09/04 at 17:52

Hi

Glad you asked. I will be evaluating this procedure in Dec. Please e-mail
Dr. Z at footcare@comcast.net. Once I am 100% sure of the date and how many cases the company is allowing Dr. Z to do I will do announing this to the heelspurs.com board. Yes this sounds very promising alone and in conjunction with ESWT.

Result number: 119

Message Number 163369

Autologous platelet concentrate injections View Thread
Posted by scott tompkins on 11/09/04 at 16:14

hello. I have had PF in the arch area for almost 3 years. I have tried everything non-surgical method there is out thereacupncture, eswt, prolotherapy, art, anti-inflamatories, orthotics, cortisone shots, stretching, strengthing, night splint, physical therapy, anodyne, rest, ice.

Is there anyone in the us practicing the autologous platelet concentrate injections. This is where you own blood is taken (20cc) and then prepared and you get about 3cc of apc+, then this is injected into the problematic area.

It sounds like a great thing to try, but i do not know who may be doing this?

Result number: 120
Searching file 15

Message Number 153366

In response to Dr. Sandell View Thread
Posted by Elyse B on 6/18/04 at 07:40

I took the libery of doing some research, let me know what you think:

What is mobilization?
Mobilization is a hands-on manual therapy designed to restore joint movement, power, and range of motion. The therapist gently coaxes joint motion by passive movement within or to the limit of a joint's normal range of motion. The therapist's movement of the joint is very precise and is limited by the amount of joint play, which may be less than 1/8th of an inch.
The overall goal of mobilization is to restore normal joint function including the surrounding soft tissue (e.g. muscle, ligaments, fascia). Physical Therapists, Osteopaths, and Chiropractors perform mobilization.
What part of the spine is treated?
In the spine, any of the facet joints and/or the costovertebral articulations (thoracic spine and ribs) may become stiff causing joint dysfunction. When a joint is unable to move freely, a cycle of muscle spasm, pain, and fatigue may begin.
What causes joint dysfunction?
Joint dysfunction can be caused by poor posture, trauma, spinal disease, or congenital problems. Left untreated, joint dysfunction can affect the surrounding soft tissue and may lead to a loss of strength and flexibility.
Are other treatments involved in mobilization?
Myofascial release, or soft tissue mobilization, is a therapy used to release tension stored in the fascia. Fascia are sheets of fibrous tissue that encase and support muscles separating them into groups and layers. Fascia also covers joints capsules and ligaments. Following trauma, the fascia and muscles may shorten restricting joint movement and blood flow. The techniques used in myofascial release break up fascial adhesions and relaxes muscle tension helping to normalize physical motion within the joint capsule.
Rehabilitation of Soft Tissue Injuries in the 1990s

The days of prolonged immobilization are a part of the past for the treatment of soft tissue injuries. The increased attention toward sports medicine throughout the late 1970s and 1980s has led to research and many clinical studies that will outline the course of rehabilitation throughout the years to come. A review of the current literature on acute soft tissue injuries classifies different types of soft tissue lesions as well various phases of healing.1 Current literature redefines the aims and objectives of rehabilitation pointing out the many benefits of the use of modalities, early mobilization, and the importance of a full rehabilitation program.
Over the past two decades, soft tissue injuries have hit the spotlight. Almost all traumatic injuries, automobile accidents, athletic or other injuries result in some degree of soft tissue damage. It's now recognized that many soft tissue injuries result in a degree of permanent impairment and leave their host with some permanent pain, restrictions, and loss of function.2 To combat the debilitating (aftermath) of soft tissue injury, new technology and rehabilitation protocols have been developed.
Etiology of Soft Tissue Injuries, Direct and Indirect Trauma
Many soft tissue injuries come from direct trauma such as being struck by a moving object or a fall; other injuries may be classified as indirect trauma and result from overloading or chronic overuse, thus giving us the classification of direct and indirect etiology.3 Indirect can be further divided into three sub-classes: acute -- which occurs from sudden overloading as seen in many lifting injuries; chronic or overuse -- which are often seen in many assembly line or factory workers who must perform repetitive movements hundreds of times daily; acute on chronic -- occurs when a chronic conditions hits an acute phase. This third sub-class is also very common in the work environment where the same job is performed day in and day out. By first defining the etiology of a condition, we are on the proper course toward treatment and the prevention of further injury.
Phases of Healing -- Phase I
The current literature describes three main phases of soft tissue healing. An initial reaction phase which lasts up to 72 hours post-injury.4 This phase is also referred to as the acute inflammation phase.3 The reaction phase displays with the classic signs of inflammation with pain, swelling, redness and warmth. In the cases of indirect etiology, these classic signs may not be readily visible but are proceeding at the microscopic level.5
The long-used application of cryotherapy (ice) is still supported by numerous studies as very effective treatment in this initial phase.6,7,8,9 Cryotherapy slows the inflammatory process as well as provides an analgesic effect. Ultrasound may also be used to decrease swelling in this inflammatory phase, but must be used for short periods to prevent hyperemia.10 Transcutaneous nerve stimulation (TNS) and electric muscle stimulation (EMS) have also been shown to be effective.
The use of continuous passive motion (CPM) has been shown to clear hemoarthrosis (blood present in the synovial joints post-trauma) during the initial reaction phase. In the 24 hours following trauma, the synovial fluid in joints treated with CPM displayed less blood than immobilized joints. At 48 hours the joints treated by CPM demonstrated the synovial fluid was clear where as the immobilized joint remained grossly bloody.11
The use of manipulation can also be employed in the reaction phase and is suggested in the areas of fixation that have resulted from the injury. This will expedite the removal of hemoarthrosis, reduce spasms, edema and pain as well as reduce nerve root irritation when present.12 Cyriax states, "When free mobility was encouraged from the onset, the fibers in the scar were arranged lengthwise as in a normal ligament. Gentle passive movements do not detach fibrils from their proper formation at the healing breach, but prevent their continued adherence at abnormal sites."13
In the initial reaction phase, the use of CPM and manipulations (which are both mobilization techniques) must be used in a controlled protective manner to prevent any further damage to the healing ligaments.11
The initial reaction phase can be treated effectively using classic cryotherapy, specific modalities, as well as a controlled program of CPM and manipulations.
Phase of Healing -- Phases II and III
The second stage of healing, the repair phase, may last from 48 up to 6 weeks. This phase is characterized by the production and laying down of new collagen.4 During this phase, the collagen is not fully oriented in the direction of tensile strength.5
The third phase, the remodeling phase, which lasts from 3 weeks to 12 months or more, is the phase in which the collagen is remodeled and along with with phase II determines the functional capabilities of the soft tissue after the healing process is completed.14 True rehabilitation must focus on maintaining these functional capabilities. Oakes3 describes the aims of rehabilitation as regaining pain-free movement with full strength, power and range of motion, thus describing the functional capabilities of the soft tissue.
To regain the functional capabilities, stresses of function must be put on the healing tissue. As described by Roy:15 "If a limb is completely immobilized during the recovery process, the tissues may emerge fully healed but poorly adapted functionally with little chance for change, particularly if the immobilization has been prolonged." Mobilization techniques must take place throughout the repair and remodeling phases to insure proper tissue adaptation. Several benefits of mobilization have been defined which include increased strength3,16 and flexibility of healed tissue, less scar formation and adhesions,14 increased cartilage nutrition,17 and lesser incidence of recurrence of injury.18
Rehabilitation Protocol
Rehabilitation protocol following soft tissue injury must include mobilization techniques to insure good functional adaptation. A program combining manipulations, the use of modalities, mobilization technique, and a strengthening program will insure optimal rehabilitation.
Manipulations and modalities should be used during all three phases of healing to limit fixations, control pain and spasms as well as maintain neurologic integrity. Mobilization should be carried out within the limits of pain on the patient, starting with controlled passive motion. Controlled passive motion should be employed until a maximum range of motion is reached. At this point, active assistive motion should be employed. As the injury heals and the tissue adapts, the patient can be graduated to active resistive motion. Active resistive motion should be followed by a strengthening program of kinetic resistive exercise. This will insure a return to maximum strength for the patient. Keep in mind all rehabilitation should be performed within the patient's limits of pain and periodic re-evaluation and testing such as muscle testing and surface EMG should be performed to evaluate the patient's progress. Also remember that the final remodeling phase can last over a year post injury; rehabilitation should be directed accordingly.
By following this rehabilitation protocol and progression, a return to maximum functional capabilities can be insured, returning the patient to maximum pain free range of motion and strength.
Rehabilitation in the 1990's focuses on regaining function. After all, function does determine what we can do with our lives.
J. Scott Brown, D.C.

Soft Tissue Injuries










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SOFT TISSUE INJURIES
Defined as an injury to muscle tissue, tendons, ligaments, fascia, and innervating nerve supply. It is common for soft tissue injuries to be coupled with joint pain, offering a worsening of pain upon initial movements (waking, sit to stand) or lessen with mild activity
History may reveal the following:
~ Blunt trauma
~ Rapid deceleration or acceleration (Such as injuries sustained in a motor vehicle accident)
~ Overstretching a tissue beyond its normal anatomical limits (Such as with over exertion or sports injuries)
Evaluation:
~ Range of motion-restricted due to pain- sensation of 'pulling"
~ Motor and sensory- possible decrease in sensory perception
~ Orthopedic testing- may not be positive for adjacent joints
~ Palpation-may elicit warmth and throbbing sensation. Edema and myospasm evident.
Treatment may include:
~ Cryotherapy (acute stages)
~ Interferential muscle stimulation
~ Hot fomentation
~ Ultrasound
~ Manual therapies including deep friction massage and joint mobilization
~ Passive and active stretching
~ Gentle, progressive resistance exercises both in office and at home
Due to the fact that there are three phases of soft tissue healing there are specific treatment objectives for each.
• Acute Phase- reduce inflammation, edema, and pain with physical therapy modalities
• Remodeling Phase- Scar tissue must be mobilized and tissue elasticity must be restored through manual techniques and passive and active stretching
• Rehabilitative Phase- It is important to strengthen all tissues in and around injured region. Education may be necessary for long-term prevention in the areas of posture, lifting techniques, and maintenance of exercise and overall health.
Physical therapy may be necessary to break the pain/myospasm cycle and to restore tissue to a normal pain free function. Additionally, there may be a need for gradual, supervised return to daily activity to avoid relapses.
Adverse affects of untreated injury could include:
Chronic pain or functional limitations due to:
~ Tissue shortening
~ Range of motion restrictions
~ Joint degeneration
~ Accumulation of adhesions along muscular fibers



Immobilization or Early Mobilization After an Acute Soft-Tissue Injury?
Pekka Kannus, MD, PhD
THE PHYSICIAN AND SPORTSMEDICINE - VOL 28 - NO. 3 - MARCH 2000

In Brief: Experimental and clinical studies demonstrate that early, controlled mobilization is superior to immobilization for primary treatment of acute musculoskeletal soft-tissue injuries and postoperative management. Optimal treatment and rehabilitation follow four steps that address response to trauma. First is treating the damaged area with PRICES: protection, rest, ice, compression, elevation, and support. Second, during the first 1 to 3 weeks after the injury, immobilization of the injured tissue areas allows healing without extensive scarring. Third, when soft-tissue regeneration begins, controlled mobilization and stretching of muscle and tendons stimulate healing. Fourth, at 6 to 8 weeks postinjury, the rehabilitative goal is full return to preinjury level of activity.
Acute soft-tissue injuries such as muscle-tendon strains, ligament sprains, and ligament or tendon ruptures occur frequently in sports and exercise. Without correct diagnosis and proper treatment, they may result in long-term breaks in training and competition. Far too often, injuries become chronic and end careers of competitive athletes or force recreational athletes to abandon their favorite activity. For these reasons, an increased focus has been on finding ways to ensure optimal healing. In this regard, the question has centered on immobilization or early mobilization in treatment.
Soft-Tissue Response to Trauma
Musculoskeletal soft tissue responds to trauma in three phases: the acute inflammatory phase (0 to 7 days), the proliferative phase (about 7 to 21 days), and the maturation and remodeling phase (21 days and thereafter; table 1). (1)

TABLE 1. Phases of Healing After an Acute Soft-Tissue Injury
Phase Approximate Days After Injury

Inflammation 0-7
Proliferation 7-21
Maturation and remodeling >21

Acute inflammatory phase. In this phase, ischemia, metabolic disturbance, and cell membrane damage lead to inflammation, which, in turn, is characterized by infiltration of inflammatory cells, tissue edema, fibrin exudation, capillary wall thickening, capillary occlusions, and plasma leakage. Clinically, inflammation manifests as swelling, erythema, increased temperature, pain, and loss of function. The process is time dependent and mediated by vascular, cellular, and chemical events culminating in tissue repair and sometimes scar (adhesion) formation.
Proliferative phase. These changes include fibrin clotting and a proliferation of fibroblasts, synovial cells, and capillaries. The inflammatory cells eliminate the damaged tissue fragments by phagocytosis, and fibroblasts extensively and markedly elevate production of collagen (initially, the weaker, type 3 collagen, later type 1) and other extracellular matrix components.
Maturation and remodeling phase. In this phase, the proteoglycan-water content of the healing tissue decreases and type 1 collagen fibers start to assume a normal orientation. Approximately 6 to 8 weeks postinjury, the new collagen fibers can withstand near-normal stress, although final maturation of tendon and ligament tissue may take as long as 6 to 12 months.
Injury and Four-Step Treatment
After an injury, the ideal treatment and rehabilitation program should include four steps.
PRICES. Immediately after injury, the damaged area should be treated with PRICES: protection, rest, ice (cold), compression, elevation, and support (table 2) (1,2). The aim is to minimize hemorrhage, swelling, inflammation, cellular metabolism, and pain, and to provide optimal conditions for healing (2). Since prolonged inflammation may lead to excessive scarring, early, effective treatment seeks to prevent it. On the other hand, one must remember that inflammation is not only the body's response to insult, but also the initial step in healing.

TABLE 2. Basic Treatment Plan for Acute Musculoskeletal Injury ('PRICES' Mnemonic)

P = Protection from further damage
R = Rest to avoid prolonging irritation
I = Ice (cold) for controlling pain, bleeding, and edema
C = Compression for support and controlling swelling
E = Elevation for decreasing bleeding and edema
S = Support for stabilizing the injured part

Immobilization and protection. The second step is immobilization and protection of the injured tissue area during the first 1 to 3 weeks. In the early phase of healing, immobilization allows undisturbed fibroblast invasion of the injured area that leads to unrestricted cell proliferation and collagen fiber production. Premature and intensive mobilization at this time leads to enhanced type 3 collagen production and weaker tissue than that produced during an optimal immobilization period (2). Protection (such as with a cast or brace) prevents secondary injuries and early distension and lengthening of injured collagenous structures such as a torn anterior cruciate ligament (ACL) (3).
Maturation. About 3 weeks after injury, collagen maturation and final scar tissue formation begins (1,2,4). In this phase, injured soft tissues need controlled mobilization. Less injured portions of the tissue or joint, however, can be mobilized earlier, sometimes even during the proliferative phase. Prolonged immobilization, though, must be avoided to prevent atrophy of cartilage, bone, muscle, tendons, and ligaments (5-12). Controlled muscle stretching and joint movement enhance new collagen fiber orientation parallel to the stress lines of the normal collagen fibers; these activities also serve to prevent tissue atrophy from immobilization. Treatment can be supported with physical therapy to improve local circulation and proprioception, inhibit pain, and strengthen muscle-tendon units.
Resumption of activity. Approximately 6 to 8 weeks after the injury, new collagen fibers can withstand near-normal stress, and the goal for rehabilitation is rapid and full recovery to activity. If the previous steps were followed, protection is no longer needed, and each component of the damaged soft tissue is ready for a progressive mobilization and rehabilitation program (2).
Soft-Tissue Healing: Experimental Studies
The current literature on experimental acute soft-tissue injury speaks strongly for the use of early, controlled mobilization rather than immobilization for optimal healing.
Knee joint. Studies by Woo and colleagues (reviewed in Woo and Hildebrand [13]) have shown that an experimentally induced tear of the medial collateral ligament (MCL) in animals heals much better with early, controlled mobilization than with immobilization. Early mobilization influenced healing even more than did surgical repair performed on the rupture. Exercise had an adverse effect on ligament healing and knee stability only when the animals' joints had been rendered unstable by transection of both the ACL and the MCL. These results probably reflect the poor regeneration potential of the ACL after rupture or transection (3,13).
Muscle. Much of the experimental data about the effects of early mobilization versus immobilization on muscle injury repair have come from studies in Tampere and Turku, Finland, and have been reviewed in Järvinen and Lehto (2). In experimentally injured rat gastrocnemius muscle, fiber regeneration is often inhibited by dense scar-tissue formation. Immobilization immediately after injury limits the size of the connective tissue area formed within the injury site. Penetration of muscle fibers into the connective tissue is prominent, but their orientation is complex and fibers are not parallel to the uninjured muscle fibers. In addition, immobilization for longer than 1 week resulted in marked atrophy of the injured gastrocnemius. Mobilization instituted immediately after injury resulted in dense scar formation and interfered with muscle regeneration.
In the rat model, the best results were achieved when mobilization was started after 3 to 5 days of immobilization. In the gastrocnemius, muscle fiber penetration through the immature connective tissue appeared optimal, and orientation of regenerated muscle fibers aligned with the uninjured muscle fibers. The gain in strength and capacity for energy absorption has been similar and as good as that of muscles treated by early immediate mobilization alone (2).
Tendons. Using a rat model, Enwemeka et al (14) demonstrated a significant increase in Achilles tendon strength after repair and early mobilization compared with repair and immobilization. In divided, unrepaired rat Achilles tendons, Murrell et al (15,16) obtained similar results. Gelberman at al (17) reported that mobilization of an animal extremity enhanced the orientation and organization of tendon collagen. Thus, after the inflammatory phase, a controlled stretching and strengthening of the regenerating, repaired tendon is likely to increase the final tensile properties of the tendon. However, suspicion remains that even with optimal therapy after repair, the collagen fibers in the tendon may be deficient in content, quality, and orientation (10). If so, this deficiency may present increased risk of inflammatory reaction, tendon degeneration, and tendon reruptures during later activities.
Soft-Tissue Healing: Clinical Trials
Early controlled mobilization. Controlled clinical trials of acute soft-tissue injuries support the results of experimental studies and have shown that early controlled mobilization is superior to immobilization, not only in primary treatment, but also in postoperative management. The superiority of early controlled mobilization has been especially clear in terms of quicker recovery and return to full activity without jeopardizing the subjective or objective long-term outcome. Evidence has been systematic and convincing for many injuries (table 3): acute ankle ligament rupture (18-20); after surgery for ankle ligament rupture (21); after surgery for chronic ankle ligament instability (22); knee ligament injury (6,23); articular cartilage injury (24); minimally displaced distal radius fracture (25); and complete Achilles tendon rupture (26-28). In addition, in many other injuries such as elbow or shoulder dislocation and many nondisplaced fractures, early mobilization yielded good results, although not all studies used a control group (10,29).

TABLE 3. Soft-Tissue Injuries That Have Been Shown to Have Better Outcomes With Early Mobilization Than With Immobilization

Acute ankle ligament tears
Postsurgery acute or chronic ankle ligament tears
Knee ligament injuries
Complete Achilles tendon ruptures

Randomized studies. The importance of results from prospective, randomized trials cannot be overemphasized; they may dramatically change our thinking and conventional treatment protocols. For example, 2-year results from a prospective, randomized study (27) from Hannover, Germany, (conservative functional treatment alone vs surgery plus similar functional treatment) support the use of early functional rehabilitation alone in complete Achilles tear. This finding is supported by an experimental observation in rats that surgical repair of a surgically divided Achilles tendon did not improve the outcome obtained by functional treatment (free-cage activity) alone (30).
Other examples come from investigations of patellar dislocation: Two randomized studies (31,32) from Finland indicate that after a 2-year follow-up, conservative treatment of acute patellar dislocation gives results at least as good as surgical treatment followed by similar conservative treatment. Comparable observations have been made in acute, complete rupture of the ankle ligaments: Early controlled mobilization alone gives results at least as good as surgery plus early controlled mobilization (18,21,33).
Practical Applications
Avoiding atrophy. Obviously, the best method for preventing immobilization atrophy is usage. Complete immobilization should be minimal and often is not needed at all. During the last 10 to 15 years, many postoperative protocols, especially those involving knee and ankle ligament injuries, have undergone a major change from long, complete immobilization to early, controlled mobilization using elastic or other bandages, rehabilitative braces, continuous passive devices, or a combination immediately after the trauma. Also, active joint motion and weight bearing is allowed earlier than before, and training during immobilization is becoming more and more effective (10). Even modern fracture treatment has considerably reduced the degree and duration of cast immobilization (10,25).
Early mobilization. Early mobilization is the best method to avoid joint contracture and its harmful consequences on articular cartilage. The technique also serves to maintain and return joint proprioception, which, in turn, may be important in preventing reinjury and in hastening recovery to full fitness. In addition, Frank et al (34) have suggested that joint motion may help reduce postinjury and postoperative pain, swelling, and thromboembolic complications.
The efficacy of early motion in preventing immobilization atrophy depends on how well it controls pain, inflammation, and swelling. Inflammation and pain result in voluntary inhibition of muscle activity across the affected joint. Spencer et al (35) have even reported that pain is not required to cause muscle inhibition; swelling alone is sufficient (so-called reflex inhibition). Therefore, primary treatment should control all three factors using early controlled motion in combination with other treatment modalities such as cold, anti-inflammatory analgesics, and transcutaneous neural stimulation.
Rehabilitation programs. For each joint and each type of injury, rehabilitation programs must be individualized, taking into account the injured structures that should be protected from premature and intensive mobilization, as well as the uninjured structures that should be mobilized as soon as possible. To prevent muscle dysfunction when immobilization must be used, diverse stimuli are needed throughout the entire period; these include strength, power, and endurance exercises. The modern operational principle in the treatment of acute soft-tissue injuries and during immobilization is that "within the limits of pain, everything that is not explicitly forbidden is allowed." (10) This, of course, requires good cooperation between the patient and the attending physician and physical therapist.
Take-Home Message
Controlled experimental and clinical trials have yielded convincing evidence that early, controlled mobilization is superior to immobilization for musculoskeletal soft-tissue injuries. This holds true not only in primary treatment of acute injuries, but also in their postoperative management. The superiority of early controlled mobilization is especially apparent in terms of producing quicker recovery and return to full activity, without jeopardizing the long-term rehabilitative outcome. Therefore, the technique can be recommended as the method of choice for acute soft-tissue injury.
MEDICO LEGAL NEWS
ALAN M. IMMERMAN, D.C.
DECEMBER 10, 1998
Copyright 1998

ACUTE SOFT TISSUE INJURIES: DO THEY HEAL PARTIALLY OR COMPLETELY?
As described by Kellett, there are three stages in the healing of soft tissue (referring to ligament and tendon):
1. Acute Inflammatory Phase: Marked by swelling, redness, warmth and pain, the acute inflammatory phase lasts about 72 hours. During this period of time, the body minimizes blood loss by activating the blood coagulation system; dilates (widens) the blood vessels so that healing elements may be more quickly delivered to the damaged tissues; and removes debris which results from the damage to soft tissue cells.
2. Repair Phase: This phase lasts from 48 hours to 6 weeks. Early in the repair phase the body finishes the job of cleansing the entire area of the soft tissue injury. Next the body synthesizes new fibers (collagen) to replace the damaged fibers. The new collagen is not, however, fully orientated in the direction of tensile strength.
3. Remodeling Phase: This phase lasts from 3 weeks to 12 months or more. During this phase, the body remodels the newly synthesized collagen in order to increase the functional capabilities of the tendon or ligament to withstand the stresses imposed on it. (Kellett, 1986)
It is important to note that normal ligaments are composed of type I collagen whereas damaged and healed ligaments contain a large proportion of type III collagen. Type III collagen is considered an "immature" form of collagen because it is deficient in the number of cross-linkages between and within the collagen subunits. Experiments which have studied ligament healing in rabbits have found that 40 weeks after injury the collagen is still deficient in content and quality. (Kellett, 1986) The cross-linkages are of critical importance in determining the strength of the newly synthesized collagen. (Loitz and Frank, 1993)
What do other authors say about the final extent of healing? Woo and Buckwalter in 1987 stated: "It became apparent that most injuries to the Musculoskeletal soft tissues do not result in repair that restores normal tissue structure and function and that the long-term results vary. Unlike bone, regeneration of normal tissue and complete restoration of normal function rarely occurs in the musculoskeletal soft tissues." (Woo and Buckwalter, 1987)
In 1993, Loitz and Frank stated: "Cellular changes indicative of scar maturation are present by 12 months and continue to approach normality for up to 30 months, but to date, no study has documented an end to scar remodeling and a return of the ligament to ‘normal.’" (Loitz and Frank, 1993)
CONCLUSIONS
The only reasonable conclusion that can be drawn from the existing research and literature is that acute soft tissue injuries never heal completely. Normal ligament and tendon is replaced by an inferior type of tissue.
Tissue Response to Injury
THE INFLAMMATORY REPSONSE
Acute Inflammation
Phase 1; Acute phase
- Redness
- Heat
- Swelling
- Pain
- Loss of function

- Cellular death continues after initial injury because of the following;
o Lack of oxygen caused by disruption of circulation
o Digestive enzymes of the engulfing phagocytes that spill over to kill normal cells
- Vascular response
o First hour; Vasoconstriction; Decrease in the diameter of a blood vessel
o Second hour; Vasodilation; Increase in the diameter of a blood vessel.
§ Exudate; Fluid with a high protein content and containing cellular debris that comes from blood vessels
and accumulates in the area of the injury
§ Permeable; Permitting the passage of a substance through a vessel wall
§ The vadodilator theory of autoregulation suggests that metabolic byproducts increase blood flow by
causing vasodilation in localized area
- Cellular response
o Mast cells; Connective tissue cells contain heparin (blood anticoagulant) and histamine
o Leukocytes; Consist of two types – granulocytes (e.g., basophils and neutrophils) and agranulocytes
(e.g., monocytes and lymphocytes)
o Phagocytosis; Process of ingesting microorganisms, other cells, or foreign particles, commonly performed
by monocytes (white blood cells)
o Macrophages engulf large quantities of bacteria
o Diapedesis is the process by which leukocytes squeeze through pores in the capillary wall
- Chemical mediators
o Histamine (Released by mast cells and platelets); Increased capillary permeability
o Serotonin (Released by mast cells and platelets)
o Bradykinin
o Prostaglandins
o Leukotrienes
- Complement system
o Leukocyte chemotaxis
o Phagocytosis
- Bleeding and exudate
o Blood coagulation; Thromboplastin + Calcium = Prothrombin = Thrombin = Fibrinogen
= Insoluble fibrin clot (+ Vitamin K)

Phase 2; Repair Phase (Fibroplasis phase); Scar formation
- Tissue repairs;
o By resolution
o By granulation tissue
o By regeneration
- Tissue repair depends on
o Elimination of debris
o Regeneration of endothelial cells
o Production of fibroblasts
- Fibroblasts become active during regeneration phase of the inflammatory response to begin building collagen

Phase 3; Remodeling phase (up to 1 ~2 years)
- Remodeling depends on the amount and type of scar tissue present
- Synthesis; Process of forming or building up
- Lysis; Process of breaking down

Chronic Inflammation
- Chronic inflammation can stem from repeated acute microtraumas and overuse.
Tissue Response to injury


Acute inflammation has a short onset and a short duration. It consists of hemodynamic changes, production of an exudate, and the presence of granular leukocytes. Chronic inflammation has a long onset and a long duration. It displays a presence of nongranular leukocytes and a more extensive formation of scar tissue.
Acute inflammation: vascular and cellular events

- 5 cardinal signs of inflammation (4) originally by Roman physician Celsius in 1st Century AD; Galen, a Greek physician added functio laesa in the second century.
- serve as reminder to athlete of injury and to prevent the athlete from exceeding safe limits and reinjuring area
Five signs
- redness (rubor)
- swelling (tumor)
- heat (calor)
- pain (dolor)
- loss of function (functio laesa)

Three phases: acute, reactive, or substrate inflammatory phase; the repair and regeneration phase; and the remodeling phase.

Acute inflammation

Phase I: Acute phase
The acute phase of inflammation is the initial reaction of body tissue to an irritant or injury and is characteristic of the first 3 or 4 days after injury. Acute inflammation is the fundamental reaction designed to protect, localize, and rid the body of some injurious agent in preparation for healing and repair. The main causes of inflammation are trauma, chemical agents, thermal extremes, and pathogenic organisms.

Vascular response
First hour. At the time of trauma, before the usual signs of inflammation appear, a transitory vasoconstriction occurs, causing decreased blood flow. At the moment of vasoconstriction, coagulation begins to seal broken blood vessels, followed by the activation of chemical influences. Vasoconstriction is replaced by dilation of venules, arterioles, and capillaries in the immediate area of the injury.
Second hour. Vasodilation brings with it a slowing of blood flow, increased blood viscosity, and stasis, which leads to swelling (edema). With dilation also comes exudation of plasma and concentration of red blood cells (hemoconcentration). Much of the plasma exudate results from fluid seepage through the intact vessel lining, which becomes more permeable, and from higher pressure within the vessel. Permeability is relatively transient in mild injuries, lasting only a few minutes, with restoration to a pre-injury state in 15 to 30 minutes. In slightly more severe situations there may be a delayed response with a late onset of permeability. In such cases, permeability may not appear for hours and then appears with some additional irritation and a display of rapid swelling lasting for an extended period.
A redistribution of leukocytes occurs within the intact vessels, caused in part by a slowing of circulation. These leukocytes move from the center of the blood flow to become concentrated and then line up and adhere to the endothelial walls. This process is known as margination, or pavementing, and occurs mainly in venules. The leukocytes pass through the wall of the blood vessel by ameboid action, known as diapedesis, and are directed to the injury site by chemotaxis (a chemical attraction to the injury). It should be noted that ameboid motion is a slow process, taking about 6 hours. With an injury there is also an increase in lymph flow because of a high interstitial tissue pressure.

Cellular response
In phase I of acute inflammation, mast cells and leukocytes are in abundance. Mast cells are connective tissue cells that contain heparin (a blood anticoagulant) and histamine. Basophils, monocytes, and neutrophils are the major leukocytes. Basophils leukocytes are believed to bring anticoagulant substances to tissues that are inflamed and are present during both acute and chronic inflammatory healing phases. The neutrophils representing about 60% to 70% of the leukocytes arrive at the injury site before the larger monocytes. They immigrate from the bloodstream. Neutrophils emigrate from the bloodstream through diapedesis and phagocytosis to ingest smaller debris than do monocytes. Phagocytosis is the process of ingesting material such as bacteria, dead cells, and other debris associated with disease, infection, or injury. Opsonin is a protein substance in the blood serum that coats microorganisms and other cells, making them more amenable to phagocytosis. The phagocyte commonly accomplishes this process by projecting cytoplasmic pseudopods, which engulf the object and ingest the particle through enzymes. When the neutrophils disintegrates, it gives off enzymes called lysozomes, which digest engulfed material. These enzymes act as irritants and continue the inflammatory process. Neutrophils also have chemotactic properties, attracting other leukocytes to the injured area. The monocyte, which is a nongranular leukocyte, arrives on the scene into large macrophages that have the ability to ingest large particles of bacteria or cellular debris.

Chemical mediators
Chemical mediators for the inflammatory process are stored and given off by various cells. Histamine, the first chemical to appear in inflammation, is given off by blood platelets, basophils leukocytes, and mast cells. It is a major producer of arterial dilation, venule, and capillary permeability. Serotonin is a powerful vasoconstrictor found in platelets and mast cells. With an increase in blood there is an increase in local metabolism. Permeability is produced by the contraction of the endothelial cells of the capillary wall, producing a gap between cells. Gaps allow plasma to leak proteins, platelets, and leukocytes. Plasma proteases, with their ability to produce polypeptides, act as chemical mediators. A major plasma protease in inflammation is bradykinin, which increases permeability and causes pain.
Heparin is also given off by mast cells and basophils and temporarily prevents blood coagulation. In addition, in the early stages of acute injury, prostaglandins and leukotrienes are produced. Both of these substances stem from arachidoic acid; however, prostaglandins are produced in almost all body tissues. They are stored in the cell membranes phospholipids. Leukotrienes alter capillary permeability and, it is believed, play a significant role, along with prostaglandin, in all aspects of the inflammatory process. Prostaglandins apparently encourage, as well as inhibit, inflammation depending on the conditions that are prevalent at the time.

Inflammation response Mediators
vasoconstriction serotonin from platelets and mast cells
vasodilation histamine from platelets, basophils, and mast cells
prostaglandin from arachidonic acid
leukotrienes from arachidonic acid
bradykinin from body fluids
margination and pavementing loss of micro-circulation, increase in blood viscosity
emigration of leukocytes leukocytes pass through capillary walls (diapedesis)
chemotaxis leukocytes attract other leukocytes
phagocytosis leukocytes, debris, complement, opsonization

Bleeding and exudate
The extent of fluid in the injured area is highly dependent on the extent of damaged vessels and the permeability of the intact vessel. Blood coagulates in three stages. In the initial stage thromboplastin is formed. In the second stage prothrombin is converted into thrombin under the influence of thromboplastin with calcium. In the third stage, thrombin changes from soluble fibrinogen into soluble fibrin. The plasma exudate then coagulates into a network of fibrin and localizes the injured area.

Phase II: Repair phase
The term repair is synonymous with healing, whereas regeneration refers to restoration of destroyed or lost tissue. Healing, which extends from the inflammatory phase (48 to 72 hours to approximately 6 weeks), occurs when the area has become clean through the removal of cellular debris, erythrocytes, and the fibrin clot. Tissue repair is accomplished through three processes: by resolution, in which there is little tissue damage and normal restoration; by the formation of granulation tissue, occurring if resolution is delayed, and by regeneration the replacement of tissue by the same tissue. The formation of scar tissue after trauma is a common occurrence; however, because scar tissue is less viable than normal tissue, the less scarring the better. When mature, scar tissue represents tissue that is firm, fibrous, inelastic, and devoid of capillary circulation. The type of scar tissue known as adhesion can complicate the recovery of joint or organ disabilities. Healing by scar tissue begins with an exudate, a fluid with a large content of protein and cellular debris that collects in the area of the injury site. From the exudate, a highly vascular mass develops known as granulation tissue. Infiltrating this mass is a proliferation of immature connective tissue (fibroblasts) and endothelial cells. Gradually the collagen protein substance, stemming from fibroblasts, forms a dense, fibrous scar. Collagenous fibers have the capacity to contract approximately 3 to 14 weeks after an injury and even as long as 6 months afterward in more severe cases.
During this stage, two types of healing occur. Primary healing, healing by first intention, takes place in an injury that has even and closely opposed edges, such as a cut or incision. With this type of injury, if the edges are held in very close approximation, a minimum of granulation tissue is produced. Secondary healing, healing by secondary intention, results when there is a gaping lesion and large tissue loss leading to replacement by scar tissue. External wounds such as lacerations and internal musculoskeletal injuries commonly heal by secondary intention.

Phase III: Remodeling Phase
Remodeling of the traumatized area overlaps that of repair and regeneration. Normally in acute injuries the first 3 to 6 weeks are characterized by increased production of scar tissue and increased strength fibers. Strength of scar tissue continues to increase from 3 months to 2 years after injury. Ligamentous tissue takes as long a 1 year to become completely remodeled. To avoid a rigid, non-yielding scar, there must be a physiological balance between synthesis and lysis. There is simultaneous synthesis of collagen by fibroblasts and lysis by collagenase enzymes. The tensile strength of collagen apparently is specific to the mechanical forces imposed during the remodeling phase. Forces applied to the ligament during rehabilitative exercise will develop strength specifically in the direction that force is applied. If too early or excessive strain is placed on the injury, the healing process is extended. For proper healing of muscles and tendons, there must be careful consideration to mobilize the site. Early mobilization can assist in producing a more viable injury site; on the other hand, too long a period of immobilization can delay healing. The ideal of collagen remodeling is to have the healed area contain a preponderance of mature collagenous fibers that have a number of cross-linkages. As stated, collagen content and quality may be deficient for months after injury.

Chronic inflammation
If acute inflammation reaction fails to be resolves in 1 month, it is termed a sub-acute inflammation. If it lasts for months or even years, the condition is termed chronic. Major chemicals found during chronic inflammation are the kinins (especially bradykinin), which also cause vasodilation, increased permeability, and pain. Prostaglandin, also seen in chronic conditions, causes vasodilation. Prostaglandin can be inhibited by aspirin.

Soft tissue healing
All tissues of the body can be defined as soft tissue except for bone. The human body has four types of soft tissue: epithelial tissue, which consists of the skin and the lining of vessels and many organs; connective tissue, which consists of tendons, ligaments, cartilage, fat, blood vessels, and bone; muscle, which can be skeletal, cardia, or visceral and nervous tissue, which consists of the brain, spinal cord, and nerves.

Cartilage healing
Articular cartilage has limited capacity to heal. Cartilage has little or no direct blood supply. When chondrocytes are destroyed and the matrix is disrupted, healing is variable. Articular cartilage that fails to clot and as no perichondrium heals and repairs slowly. On the other hand, if the affected area includes the subchondral bone, which has a greater blood supply, granulation tissue is formed and the healing process proceeds normally.

Ligament healing
Ligament healing follows the same course of healing as other vascular tissue. If proper immediate and follow-up management is done, a sprained ligament will undergo the acute, repair, and remodeling phases in approximately the same time period as other vascular tissues.
During the repair phase, collagen fibers realign in reaction to joint stress and strains. Full ligament healing with scar maturation may take as long as twelve months.

Skeletal muscle healing
Skeletal muscles cannot undergo the mitotic activity required to replace cells that have been injured. In other words, regeneration of new myofibers is minimal. Skeletal muscle healing and repair follow the same process as other soft tissue developing tensile strength according the Wolffs law.

Wolffs Law
Wolffs law states that after injury both bone and soft tissue will respond to the physical demands placed on them, causing them to remodel or realign along lines of tensile force. Therefore it is critical that injured structures be exposed to progressively increasing loads throughout the rehabilitation process.

Nerve healing
Because of the nature of nerve cells, they cannot regenerate after they have died. Regeneration can take place within a nerve fiber. The closer the injury is to the nerve cell, the more difficult regeneration becomes.
For nerve regeneration to occur, an optimal environment must be present. If peripheral nerve regeneration occurs, it is at a rate of only 3 to 4 mm per day. Injured nerves within the central nervous system do not regenerate as well as peripheral nerves do.

Modifying Soft-Tissue healing
The healing process is unique in each athlete. Age and general nutrition can play a role in healing. The older athlete may be more delayed in healing than younger athletes are. The injuries of an athlete with poor nutritional status may heal more slowly than normal. Athletes with certain organic disorders may heal slowly. For example, blood conditions such as anemia and diabetes often inhibit the healing process.

Management Concepts

1. Drugs to treat the inflammation. There is a current trend toward the use of antiprostaglandin medications, or nonsteroidal anti-inflammatory drugs (NSAIDs). The intent of this practice is to decrease vasodilation and capillary permeability.

2. Therapeutic modalities. Both cold and heat are used for different conditions. In general, heat stimulates acute inflammation and cold acts as an inhibitor. Conversely, in chronic conditions, heat may severe as a depressant. A number of electrical modalities are used for the treatment of inflammation stemming from sports injuries.

3. Therapeutic exercise. A major aim of soft-tissue rehabilitation through exercise is pain-free movement, full-strength power, and full extensibility of associated muscles. The ligamentous tissue, if related to the injury, should become pain free and have full tensile strength and full range of motion. The dynamic joint stabilizers should regain full strength and power. Immobilization of a part after injury or surgery is not always good for all injuries. When a part is immobilized over an extended period of time, adverse biochemical changes occur in collagenous tissue. Early mobilization used in exercise rehabilitation that is highly controlled may enhance the healing process.

Fracture healing
The osteoblast is the cellular component of bone and forms its matrix; the osteocyte both forms and destroys bone, and osteoclasts destroy and resorb bone. The constant ongoing remodeling of bone is caused by osteocytes; osteoclasts are related mainly to pathological responses. Osteoclasts come from the cambium layer of the periosteum, which is the fibrous covering of the bone, and are involved in bone healing. The inner cambium layer, in contrast to the highly vascular and dense external layer, is more cellular and less vascular. It serves as a foundation for blood vessels and provides a place for attaching muscles, tendons, and ligaments.

Acute fracture healing
Acute fracture healing follows the same three phases that soft tissue does but is more complex. In general acute fracture healing has five stages: hematoma formation, cellular proliferation, callus formation, ossification, and remodeling.

Hematoma formation
Acute inflammation usually lasts approximately four days. When a bone fractures, there is trauma to the periosteum and surrounding soft tissue. With hemorrhaging, a hematoma accumulates in the medullary canal and surrounding soft tissue in the first 48 to 72 hours. The exposed ends of vascular channels become occluded with clotted blood accompanied by dying of the osteocytes, disrupting the intact blood supply. The dead bone and related soft tissue begin to elicit a typical inflammatory reaction, including vasodilation, plasma exudates, and inflammatory cells.

Cellular formation
The hematoma in a bony fracture, like in a soft-tissue injury, begins its organization in granulation tissue and gradually builds a fibrous junction between the fractured ends. At this time the environment is acid, but it will slowly change to neutral or slightly alkaline. A major influx of capillary buds that carry endosteal cells from the bones cambium layer occurs. These cells first produce a fibrous callus, then cartilage, and finally a woven bone. When there is an environment of high oxygen tension, fibrous tissue predominates, whereas when oxygen tension is low, cartilage develops. Bone will develop at the fracture site when oxygen tension and compression are in the proper amounts.

Callus formation
The soft callus, in general, is an unorganized network of woven bone formed at the ends of the broken bone that is later absorbed and replaced by bone. At the soft-callus stage, both internal and external calluses are produced that bring an influx of osteoblasts that begin to immobilize the fracture site. The internal and external calluses are formed by bone fragments that grow to bridge the fracture gap. The internal callus grows rapidly to create a rigid immobilization. Beginning in the three to four weeks, and lasting three to four months, the hard callus forms. Hard callus is depicted by a gradual connecting of bone filament to the woven bone at the fractured ends. Less than satisfactory immobilization produces a cartilaginous rather than bony union.

Ossification
With adequate immobilization and compression, the bone ends become crossed with a new haversian system that will eventually lead to the laying down of primary bone. The ossification stage is the completion of the laying down bone. The fracture has been bridged and firmly united. Excess has been resorbed by osteoclasts.

Remodeling
Remodeling occurs after the callus has been resorbed and trabecular bone is laid down along the lines of stress. Complete remodeling may take many years. The influence of biochemical stimulation (piezoelectric effect) is the basis for development of new trabecular bone to be laid down at a point of greatest stress. This influence is predicted on the fact that bone is electropositive on its convex side and electronegative on its concave side. The convex considered the tension side, whereas the concave is the compression side. Significantly, osteoclasts are drawn to a positive electrical charge and osteoblasts to a negative electrical charge. Remodeling is considered complete when a fractured bone has been restored to its former shape or has developed a shape that can withstand imposed stresses.

Management of Acute Fractures
1. If there is poor blood supply to the fractured area and one of the parts of the broken bone is not properly supplied by the blood, that part will die and union or healing of the fracture will not take place. This condition is known as avascular necrosis and often occurs in the head of the femur, the navicular of the wrist, the talus of the ankle, and isolated bone fragments.

2. Poor immobilization of the fracture site, resulting from poor casting by the physician and permitting motion between the bone parts, may not only prevent proper union but may also, in the event that union does transpire, cause deformity to develop.

3. Infection can materially interfere with the normal healing process, particularly in the case of a compound fracture, which offers an ideal situation for development of a severe streptococcal or staphylococcal infection.

Pain

Nociception
Pain receptors, known as nociceptors, or free nerve endings, are sensitive to extreme mechanical, thermal, and chemical energy. They are commonly found in meninges, periosteum, skin, teeth, and some organs.
A nociceptive neuron transmits pain information to the spinal cord via the unmyelinated C fibers and the myelinated A-delta fibers. The smaller C fibers carry the impulses at a rate of 0.5 to 2.0 m per second and larger A-delta fibers at a rate of 5 to 30 m per second. When a nociceptor is stimulated there is release of a neuropeptide (substance P) that initiates an electrical impulse along the afferent fiber toward the spinal cord. The faster A-delta afferent fiber impulse moves up the spinal cord at a moderately rapid speed to the thalamus, which gives a precise location of the acute pain, which is perceived as being bright, sharp, or stabbing. In contrast the slower-conducting smaller unmyelinated C fibers are concerned with pain that is diffused, dull, aching, and unpleasant. It also terminates in the thalamus, with projections to the limbic cortex that provide an emotional aspect to this pain. Nociceptive stimuli are at close to an intensity that produces tissue damage.

Endogenous analgesics
The nervous system is powered electromechanically. Chemicals released by a presynaptic cell cross a synapse, stimulating or inhibiting a postsynaptic cell. This is called a neurotransmitter. Two types of chemical neurotransmitters that mediate pain are the endorphins and serotonin. They are generated by noxious stimuli, which activate inhibition of pain transmission.
Stimulation of the periaqueductal gray area (PGA) of the midbrain and the raphe nucleus in the pons and medulla causes analgesia. Analgesia is produced by the stimulation of opiods, morphine-like substances manufactured in the PGA and many other areas of the central nervous system. These endogenous opoid peptides are known as endorphins and enkephalins.
Noradrenergic neurons stimulating norepinephrine can also inhibit pain transmission. Serotonin has also been identified as a neuromodulator.

Pain Categories
1. Fast or slow fast pain is localized and carried through A-delta axons located in the skin. Slow pain is perceived as aching, throbbing, or burning. It is conducted through the C-fibers.

2. Acute or chronic acute pain is less than 6 months. Chronic pain has a duration longer than 6 months.

3. Projected (referred) pain. Such pain occurring away from actual sire of irritation. Example Kehrs sign indicates an involved spleen.

Common to musculoskeletal injuries is the cyclic condition of pain-spasm-hypoxia-pain. Disrupting this cycle can occur trough a variety of means such as heat or cold, electrical stimulation-induced analgesia, or selected pharmacological approaches.
The gate theory and TENS
The gate theory, as developed by Melzack and Wall, sets forth the idea that the spinal cord is organized in such a way that pain or other sensations may be experienced. An area located in the dorsal horn causes inhibition of the pain impulses ascending to the cortex for perception. The area, or gate, within the dorsal horn is composed of T cells and substantia gelatinosa. T cells apparently are neurons that organize stimulus input and transmit the stimulus to the brain. The substantia gelatinosa functions as a gate-control system. It determines the stimulus input sent to the T cells from peripheral nerves. If the stimulus from a noxious material exceeds a certain threshold, pain is experienced. Apparently the smaller and slower nerve fibers carry pain impulses, and larger and faster nerve fibers carry other sensations. Impulses from the faster fibers arriving at the gate first inhibit pain impulses. In other words, stimulation of large, rapidly conducting fibers can selectively close the gate against the smaller pain fiber input. This concept explains why acupuncture, acupressure, cold, heat, and chemical skin irritation can provide some relief against pain. It also provides a rationale for the current success of TENS.

Result number: 121
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Message Number 143663

Re: Diagnostics to discern reason for forefoot pain View Thread
Posted by Gregg W on 2/05/04 at 08:26

An excellent recommendation. I have had numerous blood tests done. My white count and platelets are borderline low. I've had ANA, Lyme disease, and a host of arthritic tests. They were all negative, except I was positive for HLA-B27. I've been taking Sulfasalizine for 5 weeks, no difference so far, but I hear that it takes a while. Still slowly increasing the dosage at this point.

Result number: 122

Message Number 142359

Re: have u haerd of kids getting this? View Thread
Posted by Rick R on 1/19/04 at 08:39

Heather,

I had Seaver's disease in 4th grade just as I was turning 9. It started in October and by June I was good to go. I was allowed to walk to school and back but that was it. By the way, this has absolutely no bearing on my PF. They are completly different conditions that happen to have quite similar symptoms. Seaver's disease (warning I'm not a doctor) is a compression of the cartilage and growth platelets in the heel of a growing child.

What I'd like to share with you that you is the bizzare reaction of my classmates. When they heard the word disease it struck fear as though I would somehow contaminate them all. The other strange reaction was the assumption that since I walked to school and back it was all an artfull ruse to get out of playing at lunch time, recess and gym class. I know it makes no sense but 4th graders didn't get it. I was very lucky to have my dear friend Mary. She was the most active athletic girl in the school but she stayed with me. Boy did we get into some mischief! We're still trouble whenever we get together, which is not often enough. At any rate, get involved whth the school and your daughter's teacher. The message delivered to the kids can have a significant impact on her situation.

Rick

Result number: 123
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Message Number 138781

Re: check this out View Thread
Posted by Pauline on 11/26/03 at 12:58

Rochelle,
I find myself torn when I say your web site is great because in all honesty, there should be NO need for such a site.

It's my belief that what has happened to you happens to many patients who undergo P.f. surgery, only we don't hear about it unless they find heelspurs.

For anyone considering P.F. surgery, your site serves a very important purpose. It should at the very least get people to stop and think about P.F. surgery before they say " yes". For the rest of us, it shows a different face to the "snip and go" surgeries that are often offered to Podiatry patients to make them pain free.

Hopefully your now treating at a wound clinic. Beside the use of oral and topical antiobitics there is a relatively new treatment to heal wounds from the inside out.

I forget the exact name, but I know your own blood platelets are used in making the substance that is put directly on the wound. It's quite costly, but it certainly works very well.

My neighbor, a diabetic and a physician, told no one about the ulcer that was eating away the flesh of his heel. When he arrive at the wound clinic he had an opening down to the bone about the size of a $.50 cent piece.

Nothing seems to help, but the treatment I described above. If you are not making any progress in controling the infection or getting that wound healed make sure you ask them about it.

There is no question in my mind that P.F. surgery of any type should come under an investigation not merely for the type of experience you had, but because so many people experience many other complications that can be directly attributed to this surgery.

Because so many folks suffer from P.F., it's my opinion that P.F. surgery has become thought of as a huge office income producer by many doctors. Doctors who for the most part should not even be doing the procedure.

In every crate there is rotten fruit. The tick is to get rid of the rotten fruit before it spoils the rest, but in medicine it doesn't work that way. Less than competent doctors are still allowed to maintain their practice and often times are protected by their colleagues.

In closing, I thank you for taking the time to make your website. May it glow as a beacon for all patients who are considering surgery to cure their P.F.

I hope your wound heals quickly and you find yourself pain free after this ordeal.

Result number: 124
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Message Number 101111

Carole - COX-2 enzyme inhibitors & the controversy over Vioxx View Thread
Posted by Sharon W on 11/25/02 at 14:06

Carole,

I have read the controversial reports about Vioxx, too.

Although Celebrex, Vioxx, and Bextra are all Cox-2 enzyme inhibitors, they are NOT all the same and they don't work equally well for every patient. Celebrex is a sulfa drug, so people who have an allergy to sulfa drugs (like me) can't take it. Some people have written that they really love Bextra, and it is supposed to be the easiest on the stomach. Bextra may even have less of a tendency to lead to strokes and heart attacks, although research is still being done. But I tried some samples of it at one point and for me, Bextra was TERRIBLE, it didn't help HALF as much as Vioxx does.

Most of the stomach irritation associated with NSAIDs is probably due to the fact that they block COX-1 as well as COX-2, and that's why scientists wanted to create drugs that would only block COX-2. The thing is, COX-1 interferes with the effects of thromboxane, which makes your blood vessels constrict and stimulates the platelets in your blood to stick together, making your blood "thicker". If you block thromboxane, your blood will be "thinner," and "thinning" the blood helps to prevent strokes and heart attacks. That's why many doctors tell people who have had cardiovascular problems to take aspirin.

If you take a specific COX-2 inhibitor (like Vioxx) and you don't take baby aspirin or something along with it to "thin" your blood, then your body is creating thromboxane but has nothing to balance it out and keep your platelets from sticking together. That's not very healthy for your circulatory system.

I do worry about it sometimes, especially since I can't take the baby aspirin. But I take herbs such as Ginko Biloba that tend to "thin" the blood (that's why they tell you not to take certain herbs before surgery). Hopefully, that will be good enough.

I would HATE to have to give up my VIOXX!!

Sharon

Result number: 125
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Message Number 91854

Re: Inflamation View Thread
Posted by Sharon W on 8/07/02 at 12:38

Kathy,

A comment on Vioxx and aspirin:

Vioxx may or may not be responsible for an increased risk of stroke. I have not been following the controversy over this very closely of late, but I was a bit put off by these claims that taking Vioxx is a risk for circulatory problems when I investigated the FIRST reports I found about Vioxx increasing the possibility of stroke and/or heart attack. I discovered that what the study was ACTUALLY doing, was comparing Vioxx with Aleve. Unlike NSAIDS such as Aleve or aspirin, Vioxx reportedly does NOT have the effect of "thinning the blood" (inhibiting platelet aggregation). Anything that DOES "thin the blood" (such as aspirin) will reduce the risk of strokes and heart attack, to some extent. Some doctors are now recommeding that patients taking Vioxx who may be at risk for stroke or heart attack, should take a baby aspirin every day, as well.

Sharon

Result number: 126
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Message Number 77086

Re: heel pain View Thread
Posted by Erika O on 3/21/02 at 08:52

For a few months I have had heel pains. During the night if I had to go to the bathroom I felt like an old person (39 years). My heels were very painful. It felt like swolen heels with a little bit of pin and needles feeling. Now it is so bad that my heels pain the whole day. If I had walked and I sit down it pain. If I start walking it is sore and eventually the pain leeves until I sit down again. It is terrible. It started to change my shoes, buth it didn't help. One year ago I started with low blood platelets. My bloodplates is never more than 90. I have blue markes on my legs and my arms. Sometimes there is nothing on my arm. The next minute there is a little "blue mark" and then I realise there was bleeding inside. My GP referred me to an orthopaedic surgeon because he is afraid that the low blood platelets have something to do with my heels. He also made a diagnoses. He thinks I have idiopatic trombocitomy. Well the orthopaedic surgeon believes that I am in the beginning of forming sporangium (I do not know how you say it in English and hope the word is correct). It was not on the X-rays. According to him something start to calcify and then this is formed and because it is in the beginning stage you cannot see it on the X-ray. Because there is inflammation in my heel he suggested that I come for 4 Cortizone injections in each heel. I do no the side-effects of cortizone. What must I do? Is this the best medication/treatment? If I stay like this - going on with the pain. What will be the end-result?

I hope you can help me.

Thanking you in anticipation

Erika Oosthuysen

Result number: 127
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Message Number 57756

Re: TCAS question View Thread
Posted by linda A on 8/23/01 at 20:14

hello brian ! i will try to answer your questions (just learning myself on diff pain meds ) . the sad thing to realize there are not any real info on pain meds treating foot pain other than trying to link it to muscle (fibromyalgia )or nerve damage (neuropathy or trigegeminal neuralgia ) disorders . most of pain mgmt sites talk about cancer , back pain , and the two that i mention . TCAS include the tertiary amines (amitriptyline=elavil,and doxepin ), and the secondary amines ( nortriptyline=nortab and aventyl and desipramine = norpramin and pertofran ). one pain mgmt site listed these in order of TCAS most likely to be prescribed : 1) desipramine 2) nortriptyline 3) trazadone 4) dothiepin hydrochloride 5) clomipramine . this site also talked about the serious side effects of elavil . however on another site it listed elavil as one of the top three TCAS to be prescribed by the pain mgmt clinic . you also have the sertonin reuptake inhibitor drugs ( prozac , paxil , effexor , zoloft , celexa and wellbutrin , which is one of the weakest SSRI that sometimes is used instead of ELAVIL ) . there are some other drugs worth mentioning ; 1)SOMA - acts on the central nervous system to relax muscles . it helps detach yourself from pain . 2) anti-anxiety meds - xanax helps the formation blood platelets ,which store serotonin and also raise the threshold and atarax is also a pain reliever . 3) the new class of analgesics called CABAs -centrally acting binary agents are non-narcotic central nervous system medications used for moderating and severe pain . 4) anti-convulsants dilantin and tegretol are sometimes prescribed to treat pain associated w/ nerve damage . sorry for being so lengthy , but i thought all the drugs were worth mentioning . these drugs used to treat pain and not intended for their real purpose are called "off the label drugs " . so, if you look them up in a drug book they are not going to list them as pain mgmt drugs because the FDA did not approve them as being used for that purpose . always remember to look at the side effects of drugs and how they relate to the other drugs that you might be taking such as B.P.

Result number: 128

Message Number 57517

Re: celebrex & vioxx View Thread
Posted by john h on 8/22/01 at 07:19

the 50% increased rate of heart attack and stroke from a prestegious medical journal should get anyone's attention. of course i just heard the lead story and the all the data and facts were not out there. i would suspect that any damage would be very reversable if one quit taking the drug as i think it had to do with blood thining or something to do with the platelets. I would immediately ask my doctor about the continued use. These drugs are an anti-inflamatory with the special ability to reduce the chance of bleeding in the stomach. I think, at least in my case, that one pill a day is all that is required. For many arthritis sufferers who were taking 8-12 aspirin a day it was in somecases a godsend. as i said Merck is disputing the study. I think i took one month of celebrex and one month of vioxx and neither provided me with any relief. i would bet that Dotors will be very reluctant to prescribe these drugs until all the facts are known and FDA weighs in.

Result number: 129
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Message Number 47130

Re: To Tigger Plantar Fascia surgery/Hematoma View Thread
Posted by Pauline on 5/09/01 at 07:32

Tigger,
This is good news for you because now it is covered by insurance. If you don't recover by what you are now doing, bring this up to the Doctor and
ask for it. If he refuses head for the nearest wound clinic. My friend paid about $250-$300 per vial which contained a few ml. He is a physician and there was no professional courtesy with the medication. The platelet solution was fragile and didn't keep so I think it was made fresh
every 2 weeks or so. Main thing it worked and saved his foot.

Result number: 130

Message Number 46980

Re: To Tigger Plantar Fascia surgery/Hematoma View Thread
Posted by Pauline on 5/07/01 at 22:07

I'm no doctor and I don't know if this information will help you but I do have experience from watching a dear friend trying to have a large wound
heel also on his heel. It was not caused by the same thing that your experienced but his wound was about the size of a $50 cent piece and went down to expose the bone. He seemed to try everything to get this to heel.
I think that Vac your talking about too. It would always start to heel
more on the outside than on the inside.

Finally I talked him into going to a specialized Wound Clinic in our area. The Dr., Dr Odgin developed a rather new treatment that involved taking his (the patients) blood, spinning out the platelets, highly oxygenating them, then bottling the product. His wife had to put the platelets directly into the wound packing with gause and bandaging. This went on for several weeks, but the wound healed beautifully. Prior to this treatment he had been casted for 6 months to encourage healing too.

As I said this was a new treatment Dr. Odgin developed and published. There was a large write up in the local paper about him and his clinic. I know the blood product was expensive. Perhaps by now his treatment is being used in every wound clinic. You might want to check with one to see if this treatment could help you or perhaps they may have other suggestions for you. I wish you the best and hope this information may be helpful to you.

Result number: 131
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Message Number 14790

bromelain information
Posted by alan k on 1/15/00 at 00:00

I paste an excerpt on bromelain I got off of the neuropathy.org message board:Bromelain
by George E. Meinig, DDS, FACD
Bromelain was first introduced in 1957. Since then it has proved an important aid to so many diseases that more than 600 research articles are now found in the scientific literature about this product.
It is a proteolytic enzyme, one that decomposes protein in the body. One of its first noted benefits was as a digestant. Bromelain is derived from the stem of the pineapple plant. This enzyme is effective not only in the acid present in the stomach, but also in the alkaline environment of the intestine. It is considered a substitute for the digestants pepsin and tryptin.
When I first became acquainted with it as a digestant, it didn't appear to be too effective. Since then, I have learned that patients were using too low a dosage. What will surprise you is the long list of diseases for which bromelain has proved helpful besides MSAL-digestion. Some of these are: angina, heart disease, rheumatoid arthritis, cellulitis, thrombophlebitis, surgical trauma, sports injuries, ecchymosis (black and blue areas), edema, pneumonia, scleroderma, sinusitis, shortens labor, and reduces appetite.
Dr. Hans Nieper, world renowned physician, has had fabulous success in treating heart cases with bromelain, magnesium oratate, and potassium oratate. He reported this therapy was 95 percent successful in preventing heart attacks. Dr. Gary Gordon in Sacramento, California, using the same regime, had 85 percent success.
Nieper's mortality rate in the treatment of strokes and heart attacks is only 2 percent, while that of the Cleveland clinic in Ohio, using conventional therapies, was 21 percent, and that of a Rotterdam Holland clinic, 19 percent.
Dr. Nieper also reported bromelain was slowly and steadily effective in lowering blood pressure and was "one of the most effective anti-arthritics" (ANAVIT-F3). It stops platelet aggregation --the stickiness of blood cells. His clinic since 1975 has found its ability to break up fibrin has reduced leg amputation cases of diabetics and cardiovascular disease patients to zero.
Dentists who are familiar with these studies have been having wonderful success in reducing the swelling that occurs from wisdom tooth extractions and other oral surgical operations.
There are many companies that have bromelain supplements on the market. The one used by Dr. Hans Nieper is called ANAVIT-F3. It is also the one used by most of the researchers. Originally only Hawaiian pineapple was used, but today it is also manufactured in Taiwan, Brazil and Puerto Rico. Naturally, some of these products vary in their constituents and action. Upon testing, many are found to have low stability and activity.
Incidentally, most bromelain products contain only 100 to 125 mg. while ANAVIT-F3 capsules contain 230 mg. If one uses the usual recommended dose for ANAVIT-F3 of one capsule 4 X a day, it would be necessary to double that amount for most other products. Most producers of bromelain do not tell you that it becomes inactivated by heat. If kept in the refrigerator it will keep for 10 years.

******

alan k

Result number: 132
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