What are the risks between an injection like a PRP or platelet rich plasma injection versus something like a cortisone injection when you have hallux rigidus? Well, that’s what we’re talking about today on the Doc On The Run Podcast.
I just had a call from a runner who has had this condition called hallux rigidus and it’s where your big toe joints starts to get stiff, it becomes rigid, it doesn’t move as much. And since the medical term for big toe is hallux, and it’s rigid and doesn’t move, the term is called hallux rigidus.
It’s a progressive condition where you irritate the joint, you damage the joint, you impinged the cartilage because there’s too much pressure when the joint is trying to move. And as a result, you can get arthritis in the joint where the cartilage becomes worn away and you have bone spurs around the joint as a consequence of that.
So, he was asking me about the options on different injections and one of those is a thing called a platelet rich plasma or PRP injection. These are very popular for lots of different things. It was first FDA approved for epicondylitis or tennis elbow. It’s been used for lots of different conditions, some of which don’t actually have FDA approval.
However, the idea is that you actually start improving the joint by getting some healing happening in the joint in the simplest sense. Now, the way that that happens is that you start this whole cascade of healing but it kind of becomes inflamed initially because you get this recruitment of an inflammatory response into the joint. And that is what we think actually starts the process of healing within the joint. So, if you have an area of actual tissue damage in the joint and you do a PRP injection, well, that’s one of the things that could help.
The opposite of that basically is a cortisone injection. Cortisone injections have been around for a very long time and the idea with this is that instead of stimulating an inflammatory response to encourage healing, we basically stop the inflammation cold, we inject something in there it will shut off the inflammatory response so it will stop being inflamed and irritated.
There are different reasons why your doctor might do these injections, but he was asking me about the risks and when we were having the discussion about the comparison of the risks between these two kinds of injections for hallux rigidus, I thought it might be worth talking about so that you can learn a little bit more about those differences yourself.
The first thing with PRP is that you have two things that are primarily the issue. One is the cost. It is way more expensive for a PRP injection than something like a corticosteroid injection. A second risk truthfully is you have a lot of arm pain. Most of us do it, we take the blood from your arm before we spin it down in a centrifuge to extract the platelets. But we use a pretty big needle to do that and that truthfully hurts more than the rest of the procedure in most cases. You also have the possibility of getting an infection in the joint with any kind of injection at all. That one thing is the same for both of them.
But with cortisone there are a couple of different risks that you don’t have with PRP and the first one is that we know that corticosteroids can reduce inflammation, and that’s good. When you inject corticosteroids because you can also weaken collagen with corticosteroids, the collagen bonds themselves, then you can actually get problems if you had a little tear in the cartilage.
If you had a little flap of cartilage where it had torn before, and you inject corticosteroids, any little collagen fibers that have been trying to repair that unstable articular cartilage that actually cushions and is smooth between the bones in the joint, well, if you have that and you inject corticosteroids, then the collagen gets weaker and the tear can propagate or get bigger. It just rips more. That’s what propagate means when a doctor tells you that.
The other thing is you can get atrophy. We know that corticosteroid injections can thin or atrophy tissue, lots of different kinds of tissue. And if part of the problem with the condition called hallux rigidus is that you’re getting thinner cartilage over time because it’s getting compressed and worn out, the last thing you want to do is inject something that makes it even thinner because it gets atrophied and sort of shrinks and gets thinner. But that’s one of the things that can happen.
Your doctor has to talk to you about this and you have to figure out which is right for you. And if you’re a runner, you really need to discuss with them about what your overall goal is. So, if you had for example, just qualified for the Boston Marathon and you started having pain in the joint because you were doing yoga, you’re irritating the joint and that happened right before the Boston Marathon. Well, a PRP injection is not going to fix that right before the race anyway, but corticosteroid injection could shrink down the inflammation in the joints so that it doesn’t bother you during your race.
In some cases, you and your doctor have to discuss this in detail and figure out is it worth the risk long-term doing a cortisone injection right now to make it through this event. And that can only happen if you’re very clear about your goals and you’re very clear about which events either next week, next month, next year, or 10 years from now are most important to you. So don’t let that part get left out of your discussion with your doctor.
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