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Over recent years there has been a surge in research leading to new treatments that utilise the body’s own natural healing capacity to relieve pain and help repair injuries that are not responsive to traditional methods of care. At Cheltenham Podiatry, we have always been passionate in keeping up with the latest developments and proven treatments within the health care industry, allowing us to provide world class support and care for our patients.

These treatments have shown to be safer and more effective in treating numerous podiatric conditions including osteoarthritis, stubborn tendon and  ligament injuries and general sports injuries, than in comparison to more conservative methods such as cortisone injections and other oral anti-inflammatories.

Cheltenham Podiatry, in Melbourne has a specialist podiatry regenerative clinic with the latest in  biological therapies and drug free treatments. These include regenerative injection therapies and photobiomodulation (low level laser). Jacqueline Kan is proud to be  the first podiatrist in Melbourne utilizing various regenerative and biological  injection therapies such as platelet rich plasma.

These  regenerative therapies are used to heal damaged tissues. We have a variety of options and techniques to suit the situation and provide optimal outcomes. Many of the injection therapies are done under precise ultrasound guidance by our highly trained practioners that have trained with world experts to ensure specific placement and thus best outcome.

The  therapies, have an anti-inflammatory affect, provide pain relief and encourage healing of damaged tissues. There is a ever increasing  body of evidence for the efficacy and safety of these treatments.

Examples of podiatric conditions treated include:

  • Osteoarthritis of knee, ankle, large toe and other painful foot joints.
  • Pain relief and healing of stubborn soft tissue injuries that fail conservative treatments –  e.g. Achilles tendinopathy and plantar fasciitis, peroneal tendonopathy, ankle sprains
  • Fractures, stress fractures.
  • Speed up healing post surgery
  • ligament and tendon tears
  • lymphodaemia of the leg, Morton’s neuroma, plantar plate injuries, diabetic wounds,
  • Severe nerve entrapment, neuralgia
  • post surgical nerve pain/damage
  • Often combined with other podiatry treatments –  biomechanical adjustments (paddings, tapings, orthotics and footwear adjustments where appropriate) for best outcome.

Photobiomodulation (Low level laser)

Light (within certain parameters) can regenerate tissue, reduce inflammation and reduce pain. It does this by increasing cellular energy and reducing oxidative stress. These effects have been tested in over 400 clinical trials (RCT’s) and thousands of laboratory studies and published in many leading journals including The Lancet, BMJ, Nature, PNAS, Spine, Muscle and Nerve, Pain, Stroke etc.laser or LED light therapy that improves tissue repair (skin wounds, muscle, tendon, bone, nerves), reduces inflammation and reduces pain wherever the beam is applied. Treatments typically take 20 min minutes and should usually be applied two times a week. LLLT works predominately on a protein in mitochondria (cytochrome c oxidase) to increase ATP and reduce oxidative stress. A cascade of mitochondrial and intracellular downstream effects lead to improved tissue repair and reduced inflammation.

The International Association for the Study of Pain (Global Task force on musculoskeletal pain) found “strong evidence” for Low Level Laser Therapy on myofascial pain syndrome. (2010) Click here

American Physical Therapy Association guidelines recommend LLLT for Achilles tendonitis. (2010) Click here

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Orthobiologics

These are regenerative injection therapies utilising the body’s own healing capacity of platelet concentrate and anti inflammatory properties of cytokines. They are used to heal damaged soft tissues- ligaments, tendons, muscles, nerves and joints that fail conservative measures. They are delivIMG_6718ered via precise ultrasound guidance to ensure best outcome.

The injectant is chosen  to suit the condition and patient situation and generally requires several injections over several weeks or months. For arthritic joints they are often combined with prolotherapy of the surrounding ligaments to improve joint integrity, perineural prolotherapy to release inflamed nerves and biomechanical correction. Nutritional supplements may also be advised to further a positive outcome.

Our podiatrists train under world experts to ensure they follow best technique.

Platelet Rich Plasma

Platelet rich plasma (PRP), is utilized when the normal healing process fails. After an injury, the platelets in our blood are activated, releasing growth factors that help to heal damaged tissues. The process of PRP involves blood collection (venupuncture – akin to pathology for blood tests), which is then centrifuged to separate and concentrate the platelets, and extracted under sterile conditions. The platelet concentration in PRP are at least  3-5 times above normal levels. This platelet rich plasma is injected using sterile technique into the site of injury. Usually 3-4 injections are required 2 weeks apart. It is an effective treatment for damaged tendons, ligaments and osteoarthritis. A recent study  compared a single PRP injection to a cortisone injection to treat chronic plantar fasciitis, which had shown to fail after 4 months of conservative treatment. It concluded, “PRP was more effective and durable than cortisone injection for the treatment of chronic recalcitrant cases of plantar fasciitis”. [1]

prp1

There are many Prp setups that only allow for a one size fits all treatment product. However, each condition, injury, and the age of the patient will require varying concentrations of the essential products of Prp for best outcome . For that reason we individualise the process, and engineer the appropriate concentrations of the essential blood products.

Another  version of prp – Platelet rich fibrin bio active matrix is a novel application that seeks to accelerate wound healing. In this process, after blood is taken, it is centrifuged, activated, then incubated to engineer a clot. The platelet concentration is aimed at a 2-3 fold increase compared to normal blood, which has been reported to provide optimum benefit. It is applied to the wound, progressively releasing a wide range of growth factors for over 5 days, and is particularly useful for difficult Diabetic/Ischaemic wounds/ulcers that fail to heal through traditional methods. This treatment is required on a weekly basis and incorporated with other ulcer treatments in our clinic.

Prolotherapy

Prolotherapy was first developed by a surgeon George Hackett in the U.S.A. in the 1930’s to treat chronic pain. Prolotherapy is a safe and effective regenerative treatment, also known as a proliferant. It is an injection of a natural solution( dextrose) into damaged tissue, producing a cascade of events at the site of injury, stimulating growth factors and regenerating ligaments, tendons and cartilage,and improves nerve function, relieving pain.

Cheltenham podiatry in melbourne suburb of highett utilises two forms of Prolotherapy:

Classical Hackett Prolotherapy

Is  a 15-20% glucose with anesthetic solution is injected into the damaged tissue. It triggers an inflammation and wound healing cascade, so that fibroblasts encourage  new collagen production. As the new collagen matures it increases the strength of the ligament. Microscopic studies have shown increase in collagen fibril size and number.When introduced in a joint , it releases growth factors that can help increase cartilage growth. It can be utilized to strengthen damaged ligaments ( eg.weak ankles), repair damaged tendons and utilized in treating osteoarthritic joints.  Fortnightly to monthly injections are required for Hackett’s prolotherapy, usually 4 – 9 sessions.prolo1

Lyftogt’s Perineural Prolotherapy

John Lyftogt’s perineural prolotherapy ( otherwise known as P.I.T.- Perineural injection therapy ) is an exciting and innovative advancement in the field of Regenerative Medicine.
It is a shallow 5% medical grade  dextrose- D5W (a form of glucose) injection just under the skin with a small fine needle (no anesthetic is required), that is used to treat pain. [3]

The theory behind Neural Prolotherapy is based on “Hilton’s Law”, named after British surgeon Dr. John Hilton.  An extraordinary anatomist, Dr. Hilton noted that the nerves that innervate a joint also innervate the skin overlying that joint and the muscles that move that joint. From this, Dr. Lyftogt hypothesized that irritation to a nerve that supplies sensation to the skin over a joint may also cause dysfunction and pain to the muscles and tissue around that joint.

It has long been known that dextrose in traditional prolotherapy promotes healing in connective tissues such as ligaments and tendons.   Because nerves also contain connective tissue, Dr. Lyftogt postulated that dextrose could allow for the same healing in nerves.  He injected small amounts of dextrose under the skin which resulted in decreased swelling, reduced pain, and improvement of function in many musculoskeletal conditions.

Dr. Lyftogt postulated that restoration of subcutaneous nerve function (those just beneath the surface of the skin) will lead to healing of deeper structures and reduction in pain. This method to treat musculoskeletal injuries and neuropathic pain has been achieving remarkable results. 

It decreases pain  almost immediately as well as improving function. Between 3-8 sessions are required for permanent pain relief, although in some cases 1-3 sessions are sufficient. An immediate reduction in pain  after the first injection is experienced by most patients, which may last anywhere between hours to days. Pain is generally reduced by 20-40% with each subsequent treatment as the tissue progressively heals. As nerves feed all our tissues, it can also  be used to help heal  chronic musculo skeletal conditions, as Achilles tendonopathy.

Injured tissues cause the release of pro-inflammatory substances (e.g. Bradykinin, Prostaglandins) that activate a channel on nerves called the “Transient receptor potential V1” (TRPV-1) cation channel, also known as the capsacin receptor. When activated, this channel results in the nerve releasing substances that cause inflammation (substance P and calcitonin gene related peptide (CGRP)) leading to leaky blood vessels (swelling), hypersensitivity, and painful sensations.  It is thought that the dextrose used in the injections for Neural Prolotherapy bind to and inhibit the TRPV-1 nerve receptors, preventing this inflammatory process and restoring normal nerve function.                

Examples of podiatric conditions treated with these therapies include:

  • Osteoarthritis of knee, ankle, large toe and other painful foot joints, bunion pain
  • Pain relief from stubborn soft tissue injuries – Heel pain, weak ankles, Achilles tendinopathy and plantar fasciitis, ligament damage and weakness (weak ankles), ankle pain, cuboid syndrome, runners knee, jumpers knee, ITB syndrome.
  • neural/nerve pain- morton’s neuroma, nerve trauma after surgery, nerve entrapments and constriction.

It may be combined with other podiatric treatments – Other injection therapies, photobiomodulation, orthotics, footwear adjustments, padding’s and exercise for a more potent result. Nutritional supplements are often advised with Prolotherapy to encourage healing of the tissues.

http://www.lyftogtmed.com

Caring Medical Lateral Ankle Prolotherapy

Nerve Hydrodissection under Ultrasound Guidance

This specialised field of regenerative medicine has moved ahead with improved techniques for recalcitrant nerve entrapments. Their a growing body research utilising ultrasound guided nerve  hydrodissection (freeing entrapped nerves with injectants). This is a simple safe prp2technique using either 5% dextrose, or platelet rich plasma for conditions such as tarsal tunnel syndrome [3], Morton’s neuroma, Baxter’s nerve and other deep nerve entrapments.

[1]              Monto, Raymond Rocco. “Platelet-rich plasma efficacy versus corticosteroid injection treatment for chronic severe plantar fasciitis.” Foot & ankle international 35.4 (2014): 313-318.
[2]              Baltzer, A. W. A., C. Moser, S. A. Jansen, and R. Krauspe. “Autologous conditioned serum (Orthokine) is an effective treatment for knee osteoarthritis.” Osteoarthritis and Cartilage 17, no. 2 (2009): 152-160.
[3].        Wu YT1, Ho TY, Chou YC, Ke MJ, Li TY, Tsai CK, Chen  LC.Six-month Efficacy of Perineural Dextrose for Carpal Tunnel Syndrome: A Prospective, Randomized, Double-Blind, Controlled trial . Mayo Clin Proc. 2017 Aug;92(8):1179-1189

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