Can A Combination Of ESWT And PRP Be Effective For Achilles Tendinopathy?
By Brian McCurdy, Senior Editor
Extracorporeal shockwave therapy (ESWT) has been a time-tested and effective treatment for Achilles tendinopathy. However, combining ESWT with platelet rich plasma (PRP) may be a particularly effective treatment, according to a new poster abstract that was recently presented at the American College of Foot and Ankle Surgeons (ACFAS) Annual Scientific Conference.
The abstract focused on 14 feet with Achilles tendinopathy that received ESWT alone and 14 feet that received both ESWT and PRP. One month after treatment, the abstract authors say patients who had both ESWT and PRP had an average decrease in the Visual Analogue Scale of 4.7 in comparison to a decrease of 2.9 in those who had only ESWT, a result the authors note is statistically significant. The study concludes that the combination of ESWT and PRP can provide quicker pain relief for patients with Achilles tendinopathy.
Abstract co-author Lowell Weil Jr., DPM, FACFAS, notes that ESWT has received more study than any other treatment for Achilles tendinopathy, the treatment is non-invasive and has “virtually no risk.
“People can return to life immediately without immobilization or missed work,” notes Dr. Weil. “Athletes can continue some training.”
Although PRP has received less study and shows mixed results, Dr. Weil says platelet rich plasma has never been shown to do any harm. He notes that an advantage of PRP is its noninvasiveness while a disadvantage is that the process is based on the host and the quality of the host’s healing properties.
“The major advantage of ESWT and PRP in comparison to other modalities is that ESWT and PRP both aim at repairing degenerative tendons whereas other modalities are geared to treat the inflammation associated with tendonitis,” says David Zuckerman, DPM. “ESWT and PRP both resolve degenerative tendinosis without surgical invention.”
Dr. Weil cites studies by Schon showing that ESWT potentiated the effects of PRP in an animal model. “Both have their specific effects on tissue and bone and both have shown benefits individually. They don’t act the same way so you are using a different mediated way to heal the tissue,” notes Dr. Weil, the President and Fellowship Director of the Weil Foot, Ankle and Orthopedic Institute.
As Dr. Zuckerman notes, PRP releases growth factors that recruit fibroblasts and macrophages, enabling the repair of collagen in the tendon structures. He says through cavitation, ESWT allows neovascularization of degenerative tendons. Therefore, PRP and ESWT both stimulate neovascularization and fibroblast production with the potential of increasing the effect of fibroblastic production and decreasing healing times, according to Dr. Zuckerman, the Director of ESWT Services at Excellence Shockwave Therapy in Woodstown, N.J.
Dr. Weil posits that the combination of ESWT and PRP might be effective in any tendinopathy or plantar fasciitis. In addition, Dr. Zuckerman says the combination of ESWT and PRP is in use for pseudarthrosis in the long bones of the lower extremity. He speculates that ESWT/PRP may also be useful for non-healing diabetic wounds and non-healing fractures.
Study Looks At ‘Lateral Ankle Triad’ With Lateral Ankle Instability
By Danielle Chicano, Editorial Associate
A recent poster abstract presented at the ACFAS Annual Scientific Conference encourages podiatric surgeons to investigate more than an isolated lateral ligamentous ankle pathology when treating patients with lateral ankle instability.