The foot and ankle are common sites of Regenerative Therapeutic applications and injections. The related joints, muscles, tendons, and supportive ligaments bear the critical responsibility of transferring the weight and stressors of the entire body to the ground, while providing critical feedback to our bodies from the earth below us. A dense network of neural structures also incorporates sensation, balance, and coordination information necessary for every activity from walking and jogging to more complicated movements such as during athletic activities and dance. Each individual structure works in concert with its adjacent anatomic parts to maintain optimal basic function and allow for more strenuous higher level activities. A failure of one part of this anatomic symphony can lead to severe pain and debility.
It is critical, therefore, to maintain proper function and balance between these various structures. Regenerative Therapies can play a vital role in the recovery of injuries to these structures.
Medial and Lateral Ankle Pain
Pain can occur on the inside (i.e. medial) or outside (i.e. lateral) of your ankle because of sprains and tears in key ligamentous structures of the ankle. The primary structures include the Deltoid ligament on the inside of the ankle and the ATFL (Anterior Talofibular Ligament) on the outside of the ankle. These structures provide the medial and lateral ankle support and are essential for a stable and functional ankle. Strains, tendonitis, tenosynovitis and tears of the muscle and/or tendons on either side of the ankle are common from athletic injuries as well as slips and falls. The sinus tarsi joint on the outside (i.e. lateral) aspect of the ankle helps to distribute weight bearing forces between the ankle and more distal joints of the foot, but also contains a complex network of pain and proprioceptive (i.e. balance) nerves, in addition to sympathetic nerves that modulate pain as well as temperature and autonomic activity of the foot and ankle. The sinus tarsi is an all too often overlooked source of pain and debility in foot/ankle injuries which fail to respond to standard treatments. These structures all may be amenable to Regenerative Therapy, especially when the conservative treatments have failed and may help avoid surgery.
Posterior Ankle Pain
The Achilles tendon, which is the large tendon in the back of the ankle, and the plantar fascia, which arises near its origin on the heel, are very common sites of pain and inflammation in the back of the ankle and the bottom of the foot. These structures can become painful from a multitude of causes, including overuse or sudden change in activity. Additionally, major nerves and their smaller branches can also become entrapped in this area from trauma or underlying arch deformities. Examples of nerve entrapment of the ankle include to the tibial nerve resulting in tarsal tunnel syndrome, or to the inferior calcaneal branch resulting in posterior ankle and severe heel pain, which can make jogging, running, cycling, or even standing impossible without pain. Trauma, degenerative arthritis, and developmental spurs can lead to inflammation of the subtalar joint (the joint below the ankle itself) and are also often under-diagnosed causes of intractable foot and ankle pain. These conditions can be extremely difficult to treat, but with targeted application of Stem Cell Therapy or PRP, the doctors at RIC have been able to improve pain and function for many people suffering from these debilitating conditions.
Anterior Ankle Pain
Degenerative and traumatic arthritis within the ankle joints (e.g. talar dome) or proximal bones of the foot can cause pain with standing, walking, toe movement, and make activities such as running impossible. The tendons, which control movement of the ankle and toes, can also cause pain and weakness in the foot and ankle, which may occur as a result of altered foot mechanics, degenerative joint disease, poor posture, ill-fitting shoes and sports injuries.
Inflammation and injuries to the smaller joints of the toes, such as metatarsalgia, ligament injuries, stress fractures, and nerve damage can cause severe discomfort in the distal foot. Nerve swelling (Neuromas) and damage from trauma, overuse or ill-fitting shoes can yield surprisingly significant and unbearable pain with activities, which can progress to pain at rest as well. Morton’s Neuroma is a common painful foot condition that may respond to Regenerative Therapy.
Your Plan of Action
Your physicians at RIC Clinic will start with a comprehensive and detailed examination after listening to your underlying complaints. This will help decide what additional workup is needed, which may include imaging studies such as x-ray, diagnostic ultrasound or MRI, and may also include nerve conduction studies to assess the integrity of the nerves critical for normal function. They will incorporate appropriate therapeutic interventions, activity restriction and possibly bracing with Diagnostic injections to help clarify and determine the underlying issues. Often these syndromes can be managed with non-invasive therapies like medications, exercises and bracing with temporary activity modification ONCE A FIRM DIAGNOSIS IS ESTABLISHED.
For more severe or recalcitrant cases, your RIC physicians may offer you a myriad of Regenerative Therapies tailored to your diagnosis and dependent on YOUR specific goals and activity levels. This can include PRP injections, your own Bone Marrow derived stem cells (BMAC), or allograft injections with amniotic tissue, which can be offered in various forms with or without chorionic tissue as well. We feel the ideal treatment paradigm must be made in concert with your own wishes and comfort level from both a medical and financial perspective. This is why we offer a host of conservative and invasive regenerative therapeutic options to all of our patients.