If you are a runner suffering with Achilles tendonitis, chronic plantar fasciitis or peroneal tendontis the very last thing you want is surgery. If you are a runner, the issue is not that surgery won’t work, it is just that the recovery from surgery will have a detrimental affect on your running in the short term and possibly the long term as well. Platelet rich plasma is a new leading-edge treatment alternative to surgery. It is one of the best treatment options for runners with chronic tendinitis.
Achilles tendon surgery disrupts your normal anatomy and can alter your running biomechanics. When possible, it is always better to focus on treatments that are less invasive, have a faster recovery time and avoid all of the stiffness and other competitions associated with surgery. PRP is one such option. Platelet rich plasma injections use your body’s own healing potential to increase blood flow to injured tendons and ligaments and restore them to a functional state.
You should understand some basics about how the PRP injection works to help turn on tendon and ligament repair. Platelet Rich Plasma (PRP) is a biologic substance that can be prepared from your own blood in the operating room, surgery center, or even in your own home during a house call. It is created by concentrating platelets from your whole blood into Platelet Rich Plasma (PRP) via centrifugation. Platelets are know to release multiple growth factors that directly stimulate soft tissue healing, produce growth factors, lead to destruction of bacteria and foreign material and the digestive removal of damaged tissue in the wound. Growth factors specifically involved in the function of PRP are described below:
• Platelet Derived Growth Factor (PDGF), plays a role in tendon healing specifically by stimulating mitogenesis (the proliferation of healing healing cells), angiogenesis (creating new capillaries in the tendon to help increase local blood flow), and macrophage activation (bring the cells to the area that “clean up” damaged collagen Achilles fibers in the tendon).• Epidermal Growth Factors (EGF) induces skin cell development and also stimulates new blood flow.
• Vascular Endothelial Growth Factors (VEGF) are potent stimulators of both angiogenesis and mitogenesis. They also increase the permeability of endothelial cells, which helps heal the tendon through circulating blood cells. The Achilles tendinosis, chronic plantar fasciitis, and chronic peroneal tendinitis all usually have decreased blood flow that impedes healing.
• Transforming Growth Factor Beta (TGF-ß) plays an important role in the regulation of the cell cycle by affecting cellular growth through cell-signaling pathways. It is also believed to be important in regulating the immune system. Without an optimized immune system, poor tissue healing results.
After the platelets have been separated and concentrated into PRP they will remain stable for a number of hours. However, Dr. Segler will inject the PRP into your Achilles tendon, right into the area of Achilles tendinosis, within a few minutes of preparing the PRP Achilles injection. This is the best way to ensure that you will get the full healing inducing effects of the Platelet Rich Plasma.
Most runners who develop Achilles tendon problems will have pain in the back of the leg, just one or two inches above the point where the Achilles tendon attaches to the heel bone. This area is known as the “watershed region” of the Achilles tendon. Studies have shown that this area of the Achilles tendon is the area with the least blood flow. It is the area of the tendon most often damaged from overtraining, insufficient recovery from long runs, too much speed work, or other training errors when preparing for a marathon or Ironman triathlon.
The ironic part of all of this is that most runners I see who have Achilles tendon problems is that they have known they have had trouble for a long period of time before they seek treatment. They most often are just hoping that the pain will go away. They chalk it up just to another discomfort from training. The reality is that muscle soreness is to be expected when training for a marathon or Ironman triathlon. But as you ignore this pain and inflammation (known as Achilles tendinitis) you can get damage to the Achilles tendon itself and Achilles tendinosis sets in. The collagen fibers that make up the individual tendon fibers become weaker and disorganized. The area often develops into a firm lump that you can feel if you push on the Achilles tendon. It often appears chronically swollen. Sometimes it’s only tender if you squeeze the Achilles tendon.
Achilles tendonosis is catastrophic for a runner for several reasons:
1. It hurts when you run and interferes with your training. It may even hurt when you ride a bike.
2. The Achilles tendon will continue to get weaker if it’s not treated.
3. Achilles tendon rupture (where the tendon completely tears apart) is always preceded by Achilles tendinosis.
Any one of these reasons alone would be enough to want to heal the Achilles tendons so that you can continue running. Understanding that this is a progressive condition that typically gets worse if you continue running is a good reason to seek treatment as soon as you notice a problem with the Achilles tendon. If you have had some swelling in the Achilles tendon that is only been there for a brief period of time, you probably don’t even need a PRP injection to get to heal. You just have to see a sports medicine physician who focuses on runners.
If you just ignore the aching swelling Achilles tendon, it will gradually get worse and may develop into tendinosis or an Achilles tendon tear. Once that happens the best treatments for the Achilles tendon are basically PRP injections and surgery.
If you have a question about an aching Achilles tendon that hurts you whenever you are running, you can call Dr. Segler to ask him about the condition and what suggestions you might have it help you prevent the problem from becoming worse. You can reach him directly at 415–308–0833.
To learn more about the recovery from a PRP injection for Achilles tendinitis and return to running click here.
To learn more about the what to do to prepare for a PRP injection for Achilles tendinitis click here.
Chronic heel pain is another condition that responds well to PRP injections. The recovery is much faster than surgery and there is no risk that your arch will collapse when you run. If you have surgery, we simply cut part of the plantar fascia which makes the whole ligament weaker. Some people who have this condition will end up with a ruptured plantar fascia later. Oftentimes runners who are told that they have plantar fasciitis actually have a partially ruptured plantar fascia. This condition also responds well to PRP injections.
The peroneal tendons are frequently injured in runners with high arches. If the tendon gets thicker (or torn), surgery is the most often recommended treatment. However PRP injections can help stimulate healing in the peroneal tendons the same way that they stimulate healing in damaged Achilles tendons. It is certainly worth considering before thinking about surgery. It is usually necessary to have an MRI to decide whether or not a PRP injection will be effective for your peroneal tendonitis. Dr. Segler can order your MRI and help you determine this through a remote consultation even if you’re not in San Francisco.
The posterior tibial tendons are frequently injured in runners with high arches. If the posterior tibial tendon gets weaker, becomes dysfunctional (or tears), surgery is often recommended as the best treatment. However PRP injections can help stimulate healing in the posterior tibial tendons the same way that they stimulate healing in damaged Achilles tendons. It is certainly worth considering before thinking about surgery. It is usually necessary to have an MRI to decide whether or not a PRP injection will be effective for your posterior tibial tendonitis. Dr. Segler can order your MRI and help you determine this through a remote consultation even if you’re not in San Francisco.
Pain in the ball of the foot when you run may be a signal that a tiny little ligament on the bottom of the joint capsule is torn. This ligament is called plantar plate. The plantar plate has a poor blood supply. Although surgery can be the best treatment if the toe is completely dislocated and a hammer toe has formed, is not usually necessary and runners. An alternative to surgery is a PRP injection for pre-dislocation syndrome. This is much less invasive than surgery and heals much faster.
Dr. Christopher Segler is a reconstructive foot and ankle surgeon and sports medicine podiatrist in San Francisco. He his practice focuses on runners and triathletes. His patients are world champion triathletes, members of the US Ski Team, and elite ultra-marathoners. He has successfully treated professional athletes who flew into San Francisco just to see him for a PRP injection. He has been working with PRP for more than 10 years. if you have a question about an aching Achilles tendon that hurts you whenever you are running, you can call Dr. Segler to ask him about the condition and what suggestions you might have it help you prevent the problem from becoming worse. You can reach him directly at 415–308–0833.