For patients with severe chronic plantar fasciitis not manageable with traditional non-operative treatments, injections with platelet-rich plasma (PRP) is significantly more effective than using cortisone.  This is according to a study presented by Raymond R. Monto, M.D., from the Nantucket Cottage Hospital in Massachusetts at the annual meeting of the American Academy of Orthopaedic Surgeons, held recently in San Francisco.

Dr. Monto compared PRP with cortisone injections for the treatment of 36 patients with plantar fasciitis that was resistant to traditional non-operative management.  Patients underwent pretreatment magnetic resonance imaging and ultrasound studies.  Group 1, with an average age of 59 years, an average of 5.4 months of failed standard non-operative treatment, and an average pretreatment American Orthopaedic Foot & Ankle Society (AOFAS) score of 52, was treated with a single injection of methylprednisolone at the injury site.  Group 2, with an average age of 51 years, an average of 5.7 months of failed standard non-operative treatment, and an average pretreatment AOFAS score of 37, was treated with a single injection of un-buffered autologous PRP.

Monto found that, in Group 1, the average post-treatment AOFAS score improved to 81 at three months, decreased to 74 at six months, and then decreased to 58 at 12 months. In Group 2, the average post-treatment AOFAS score improved to 95 at three months, and remained at 94 at six and 12 months (P = 0.001).

Based on the improved AOFAS score, platelet-rich plasma injection was more effective and durable than cortisone injection for the treatment of severe chronic plantar fasciitis.

While there are still no large-scale studies of PRP’s effectiveness, this study does support the growing body of antidotal evidence that indicates that PRP is effective in treating musculoskeletal injuries and conditions.  It is used widely and openly in professional sports, the veterinary world, and we have seen patients have positive results following PRP treatment in this office.

If you weren’t aware, plantar fasciitis is a common source of foot pain.  The pain may sometimes be diffuse and confused with ankle pain.  The plantar fascia is a fibrous aponeurosis (a thick cord-like tissue).  It originates off the calcaneus or heel bone and fans out to attach to the plantar surfaces of the phalanges bones (foot bones). 

Plantar fasciitis is a common source of foot pain in athletes, especially ones who compete in running athletics.  However, plantar fasciitis may also been seen in over-weight non-athletes

The plantar fascia may either be caused by an inflammatory process or there may be an underlying degenerative process, such as seen in tendinopathies where there is thickening, scarring and abnormal collagen formations.  Rupture of the plantar fascia may occur with an extremely forceful injury, usually in the mid portion of the fascia. 

Information contained in this blog is intended for educational purposes only and not for medical diagnosis or treatment.  If you have a medical concern or issue, please consult with your physician.

A recent study presented at the American Orthopaedic Society for Sports Medicine’s (AOSSM) Annual Meeting in San Diego in July 2011, suggests that low vitamin D levels might increase the chance of muscle injuries in athletes.

Michael Shindle, MD, lead researcher and member of Summit Medical Group, presented the study results.  The study focused on NFL football players.  According to Dr. Shindle, 80 percent of the football players studied had vitamin D insufficiency.  African American players and players who suffered muscle injuries had significantly lower levels.

Researchers identified 89 football players from a single NFL team and provided laboratory testing of vitamin D levels in the spring 2010 as part of routine pre-season evaluations.  The team provided data to determine the number of players who had lost time due to muscle injuries.  Twenty-seven players had deficient levels (<20 ng/ML) and an additional 45 had levels consistent with insufficiency (20-31.9 ng/mL).  Seventeen players had values within normal limits (>32 ng/mL).  The mean vitamin D level in white players was 30.3 ng/mL, while the mean level for black players was 20.4 ng/mL.  Sixteen players suffered a muscle injury with a mean vitamin D level of 19.9 ng/mL.

Dr. Scott Rodeo, MD, co-chief of the Sports Medicine and Shoulder Service at the Hospital for Special Surgery, said that screening and treatment of vitamin D insufficiency in professional athletes may be a simple way to help prevent injuries.  But, according to Dr. Joseph Lane, MD, director of the Metabolic Bone Disease Service at the Hospital for Special Surgery, further research also needs to be conducted in order to determine if increasing vitamin D leads to improved maximum muscle function.

Normally, our bodies take in vitamin D in the form of sun synthesis through the skin.  Additionally, eating the right foods can also increase our vitamin D levels.  Foods such as: 

·         Fish –salmon, mackerel, herring, canned tuna or sardines, or cod liver oil

·         Meat – beef, lamb, chicken or pork liver, or eggs

·         Foods fortified with vitamin D

More info on vitamin D-rich foods can be found at LiveStrong.com or the Global Healing Center.

Information contained in this blog is intended for educational purposes only and not for medical diagnosis or treatment.  If you have a medical concern or issue, please consult with your physician.

Novak Djokovic’s rise from world tennis’ number three player to number one has generated a lot of interest – not just in the feat itself, but in speculation that Djokovic’s change in diet is a key to his success.

At the end of 2010, Djokovic began working with Igor Cetojevic, a Serbian doctor and nutritionist.  At this point in his career, he had won only one Grand Slam title (2008 Australian Open).  During the 2011 season, Djokovic has won the Australian Open, Wimbledon and the US Open, and compiled an amazing 64-3 record.

What therapy did Dr. Cetojevic prescribe for Djokovic that accounts for his stellar performance this year? 

Diet.  Djokovic changed his diet to a gluten-free diet. 

Gluten, a protein found in foods such as bread, pasta and other starchy foods, can trigger reactions in people.  Apparently, Djokovic had enough of an allergy to gluten that, eliminating it has made a big difference in his performance.

But could something as simple as a diet change account for Djokovic’s higher performance?

According to Dr. Dennis Lox, diet can have a huge influence on performance.  If you look at how diet impacts a person who is diabetic, then yes – diet plays a big factor in how that person performs.

Does it account for Djokovic’s success?  It is hard to say exactly, but at that level of performance, even a small adjustment, physical or mental, can have a big influence.

Leaving nothing to chance, world tennis’ number four player, Andy Murray adopted the “Djokovic diet.”  Murray’s performance?  He is one of only three players to have beaten Djokovic this year (although Djokovic had a shoulder injury and was forced to withdraw after a set).

Information contained in this blog is intended for educational purposes only and not for medical diagnosis or treatment.  If you have a medical concern or issue, please consult with your physician.

Here is a well-written article on stem cell therapy in athletes.

The article, by David Epstein in Inside Baseball on sportsillustrated.com, tells the story of New York Yankee pitcher Bartolo Colon’s elbow and shoulder stem cell treatment. 

In his article, Epstein also points out that stem cell therapy is nothing new and that it has been utilized for an extended period in many athletes who have undergone microfracture techniques.  Epstein’s article is interesting and worth the read.

Nothing contained in this blog is intended to be instructional for medical diagnosis or treatment. If you have a medical concern or issue, please consult with your physician.