March 2014

Can Plantar Fasciitis Patients Get Long-Term Relief From PRP?

By Brian McCurdy, Senior Editor

A new study in Foot and Ankle International finds that platelet rich plasma (PRP) is more effective over a longer time period for patients with plantar fasciitis in comparison with cortisone injections.

   Researchers focused on 40 patients with unilateral chronic plantar fasciitis that did not respond to a minimum of four months of standardized traditional, non-operative treatment modalities. Patients had either a single ultrasound guided injection of 3 cc PRP or 40 mg of methylprednisolone (Depo-Medrol, Pfizer) cortisone.

   The PRP group started with an average pre-treatment American Orthopedic Foot and Ankle Society (AOFAS) score of 37, which increased to 95 at three months and was 92 at 24 months, according to the study. The study notes that the cortisone group had a pre-treatment average AOFAS score of 52, which initially improved to 81 three months after treatment but by 24 months had declined to a final score of 56.

   In his practice, Bob Baravarian, DPM, has seen success rates of 60 to 70 percent when treating chronic plantar fasciosis with PRP. He uses two to three injections three to four weeks apart, and says the key is repeated injections.

   David Soomekh, DPM, has seen patients do very well after PRP injections for the treatment of chronic plantar fasciitis. In his experience, 60 percent of patients will relate complete recovery after two months while 80 percent will relate at least 50 percent relief of their symptoms. Ninety percent of the remaining patients have significant relief after a second injection, notes Dr. Soomekh, a Fellow of the American College of Foot and Ankle Surgeons, the Founder/Director of the Foot & Ankle Specialty Group in Beverly Hills and Official Physician for the Los Angeles Ballet. In comparison to cortisone injections, PRP relieves pain and symptoms for a longer period of time, according to Dr. Soomekh.

   “(Platelet rich plasma) will not give instant relief like a cortisone injection can, yet it will give them longer relief,” notes Dr. Soomekh.

   Cortisone is a good early treatment for fasciitis cases with inflammation while PRP is better for fasciosis cases with scar tissue and no inflammation, according to Dr. Baravarian, the Chief of Podiatric Foot and Ankle Surgery at the Santa Monica UCLA Medical Center and Orthopedic Hospital, and the Director of the University Foot and Ankle Institute in Los Angeles.

   How do patients tolerate PRP injections? Dr. Baravarian finds that they usually have an inflammatory reaction and some early pain for a day. He restricts the use of ice and anti-inflammatories but otherwise says patients can stretch and take Tylenol. Usually, he says pain resolves and improvement starts at three to five days with resolution at three or four weeks.

   One would draw the patient’s blood in the office with little discomfort, says Dr. Soomekh. With the administration of local anesthesia at the posterior tibial nerve, the injection is much less painful, according to Dr. Soomekh. He does concede though that most patents will still complain of a deep, achy discomfort during the injection. Dr. Soomekh says patients will have some increased pain over two to seven days, which is tolerable, and he notes that patients can use rescue medications as needed.

   For further reading, see “Platelet-Rich Plasma: Can It Have An Impact For Plantar Fasciitis?” in the November 2012 issue of Podiatry Today.

Kent State Welcomes New Dean Of Podiatric Medicine

By Brian McCurdy, Senior Editor

On July 1, Allan Boike, DPM, FACFAS, will take over as the new Dean of the Kent State University College of Podiatric Medicine.

   Dr. Boike currently serves as the Director of the Podiatric Medical and Surgical Residency Training Programs and is also the Section Head of Podiatric Medicine and Surgery in the Foot and Ankle Center of the Orthopaedic and Rheumatology Institute at the Cleveland Clinic, according to Kent State. The university notes that he is also in private practice at Cleveland Clinic’s main campus and the Strongsville Family Health Center in Strongsville, Ohio. 

   Dr. Boike notes one challenge for the college will be the fact that not enough students can find residency programs. He notes the American Podiatric Medical Association is working on solving the residency shortage, making practitioners aware of how they can become residency directors. Dr. Boike notes a “cultural change” may be necessary to combat the problem so established practitioners become more willing to help with education.

   “It is a huge problem for us right now,” says Dr. Boike, who also graduated from the Kent State program when it was known as the Ohio College of Podiatric Medicine.

   Dr. Boike says another challenge is ensuring podiatric physicians have parity with other areas of medicine. He suggests one solution is having third- and fourth-year students do rotations in large teaching hospitals and interact with medical students and residents in other disciplines.

Study Abstract: Weekly Human Amnion/Chorion More Effective Than Biweekly For DFUs

By Brian McCurdy, Senior Editor

An abstract submitted to the Symposium on Advanced Wound Care Spring (SAWC Spring) finds that weekly treatment with dehydrated human amnion/chorion membrane (dHACM) allograft can effectively treat diabetic foot ulcers (DFU), and lead to quicker healing versus biweekly application.

   Researchers conducted a prospective, randomized, comparative, parallel group, single-center clinical trial on patients with non-infected DFUs of at least four weeks in duration. Patients received dHACM either weekly or biweekly in addition to non-adherent dressing with compressive wrapping. The study found that over 12 weeks, 37 of 40 of ulcers treated with dHACM had healed completely with healing occurring statistically significantly faster in those who received weekly treatments.

   Abstract principal investigator Charles Zelen, DPM, FACFAS, notes that amnion and chorion combined provide an “incredible amount of growth factors” that are key to wound healing. As he notes, recent studies on diabetic foot ulcers have demonstrated that using dehydrated human amniotic membrane allografts can reduce the time to wound closure, lower the overall cost to treat wounds and reduce scarring. In comparison to human fibroblast-derived dermal substitutes and xenografts, he notes one may consider dehydrated human amniotic membrane allografts to reduce the overall costs of wounds that require regenerative skin substrates.

   Dr. Zelen notes that although wound therapies such as dHACM come at a higher cost compared to standard wound care measures, one can justify its use as the rates of healing with EpiFix (MiMedx) reduce morbidity and risk for lower extremity amputation and in fact the episode of care costs may be less than standard of care as many of the wounds healed with just one graft. As he emphasizes, the longer a diabetic wound stays open the more likely it will get infected and lead to hospitalization and greater costs.

   “A treatment that invokes rapid healing reduces overall medical costs associated with frequent clinic visits and treatments,” adds Dr. Zelen, the Director of the Professional Education and Research Institute in Roanoke, Va. “By reducing the recurrence of wounds, we can strive to improve the quality and duration of patients’ lives using a product derived from a substance that helped bring us into this world.”

   The Symposium on Advanced Wound Care Spring/Wound Healing Society (SAWC Spring/WHS) meeting will be held April 23-27 in Orlando, FL. For more info, visit .

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