Platelet-Rich Plasma (PRP) for Foot and Ankle Ligament Tears

by Katy

Your foot and ankle ligaments play a vital role in enabling everyday movements such as walking, running, jumping, or climbing stairs – but they are not entirely immune to injuries such as tears and sprains. 

Today, it is estimated that nearly 40% of adults will suffer from foot pain at least once in their lives, and acute ankle sprains account for approximately 20% of all injury-related emergency department visits. Despite how common and impactful these musculoskeletal problems are, the common lines of treatment prescribed – such as painkillers and corticosteroid injections – are still inefficient in treating the root cause of pain and inflammation.  

Fortunately, you no longer need to endure the side effects of medications or resort to surgery to regain your foot and ankle function. Thanks to the superior Platelet-Rich Plasma injections offered at Orthagenex, you can support your body’s self-healing capabilities and get back on your feet. Here’s all you need to know.

Foot and Ankle Ligament Tears – Overview

Ligaments are strong bands of connective tissues that link one bone to another. They are responsible for keeping your joints stable, controlling movement, and preventing injuries such as dislocations. 

Each foot has over 30 ligaments. These resilient “ropes” stabilize the gait, redistribute your body weight as you walk, provide support to the arch of the foot, and act as powerful shock absorbers. 

The ligaments in the foot and ankle – which include the plantar fascia, the calcaneocuboid ligament, and the lisfranc ligament – run along the arch of the foot, across its width, and over the heel. This structure connects the different structures of the foot, such as the heel, ankle joint, toes, and sole.

Arthritis at ankle joint (Gout , Rheumatoid arthritis)

Several factors, such as direct trauma, overuse, and non-contact injuries, can cause these ligaments to stretch beyond capacity, extend in the wrong direction, or wear down. This can lead to tears, sprains, or, in severe cases, ruptures (which occur when the ligament is completely detached from the bone). 

Causes of foot and ankle ligament tears include:

  • Direct blows and traumatic injuries that involve the ankle or foot
  • Falling or landing on your feet in an awkward position, which can lead to twisting your ankle
  • Objects or another person falling on the foot
  • Regularly running or walking on uneven surfaces (i.e.: participating in jogging or trail running)

Ligament tears are made more likely due to the degeneration that occurs normally as you age. This wear and tear can be aggravated by factors such as smoking, drinking alcohol, wearing improper footwear, or having a sedentary lifestyle. 
Additionally, due to the extra weight your body may carry, you can be at higher risk of foot ligament and tendon injuries if you are overweight or obese.

Symptoms of Foot and Ankle Ligament Tears

If you have mildly twisted your ankle, the chances are that the pain you are experiencing is nothing more than a minor, temporary issue. In these cases, you may regain your foot function through some at-home remedies and rest. 

Nonetheless, recurring or acute ligament tears should not be underestimated. According to studies, approximately 70% of acute ankle sprain cases lead to long-lasting complications such as chronic ankle instability (CAI), chronic pain, and reduced mobility. 

Ligament tears are categorized into three grades of severity:

  • Grade I – Light stretching of the ligament that causes a very mild tear
  • Grade II – A more serious but incomplete tear that can cause some ankle instability
  • Grade III – A completely torn (ruptured) ligament, which causes significant instability.

Ankle ligament tears can occur due to different movements, which will determine the location of the symptoms:

  • Inversion, or rolling your ankle inwards
  • Eversion, or rolling your ankle outward
  • High ankle sprain, which occurs when the foot is stretched upwards (toward the shin) beyond capacity

Depending on the nature and severity of your ligament tear, you are likely to experience the following symptoms: 

  • A “popping” sound, usually accompanied by acute pain, at the time of injury
  • Pain that spreads around the ankle and across the lower leg area
  • Pain that intensifies during movement or after periods of rest 
  • Swelling, stiffness, and a sensation of warmth, which are consequences of the inflammatory response
  • Bruising 
  • Ankle weakness
  • Joint instability and difficulty in load-bearing
  • Having trouble walking 
  • Reduced range of motion 

If the tears are associated with improper foot mechanics, you may also suffer other complications, such as abnormal bony growth. These occur when the body attempts to repair tissues damaged by inflammation and overuse by growing new bone tissue.

Conventional Treatment Options

Foot ligament sprains are, in some cases, a minor problem that will resolve on its own in just a few days or weeks. For a mild tear, techniques such as RICE (Rest, Ice, Compression, and Elevation) can help decrease swelling and inflammation, thus improving foot and ankle function. 

However, if you’ve suffered an acute tear or you are experiencing chronic foot pain and dysfunction, your doctor may prescribe one of the conventional treatment options available: NSAIDs, corticosteroid injections, or surgery. 

These lines of treatment do very little to tackle the root cause of your foot condition, and they may expose you to significant risks and side effects. Let’s look at these options in more detail below.

Corticosteroid Injections

Corticosteroids work by mimicking the action of cortisol, a hormone produced naturally by your body, which is responsible for regulating inflammation and pain perception.

Typically, corticosteroids are injected directly into the area causing discomfort (the ankle or foot, in this case). Once injected, the crystals contained in the formulation gradually release pain-killing substances, which lead to a more sustained analgesic effect compared to other pain medications. 

Despite their widespread usage in treating various types of pain, corticosteroids may not always be the most suitable or safest treatment option available. Long-term usage of corticosteroids can interfere with your adrenal glands – the cortisol-producing powerhouses of your body – and even lead to cartilage breakdown. 

NSAIDs

Non-steroidal anti-inflammatory drugs (NSAIDs) are the most commonly prescribed medications during emergency department visits for ankle and foot ligament tears.

These medications work by inhibiting the COX (cyclooxygenase) enzyme, which plays a crucial role in producing prostaglandins. These are essentially chemicals that trigger inflammation within your body. Lower prostaglandin production equals lessened inflammation and pain – temporarily, at least. 
While these medications are affordable and accessible as an over-the-counter solution, their consumption should not be taken lightly. Indeed, long-term use of NSAIDs has been seen to be associated with side effects such as stomach ulcers, kidney dysfunction, risk of addiction, and higher likelihood of heart attack and stroke.

Arthroscopy

If you are suffering from serious ligament tears or rupture, your doctor may suggest one of two surgeries: arthroscopy or open ligament reconstruction surgery. 

Arthroscopy is a minimally invasive strategy, offering surgeons a clear view of the joint’s inner structures. This is achieved by making a small cut and inserting a tiny camera attached to a narrow, flexible tube. The viewing instrument can be used to diagnose the extent of the damage, as well as to guide surgical techniques to alleviate ligament pressure and remove any debris causing discomfort and inflammation.

However, while arthroscopy is less invasive than other methods, it’s not devoid of risk. For example, there could be negative reactions to anesthesia, infection risks, and less effective outcomes.

Ligament Reconstruction Surgery 

If your ligaments are severely damaged, your physician might suggest a reconstruction. This procedure can follow two methods: Brostrom-Gould or tendon transfer. 

In the Brostrom-Gould method, surgeons stabilize the ligaments using stitches. On the other hand, tendon transfer replaces the damaged ligament with tissue from a healthy tendon. This replacement could be harvested from elsewhere in your body or from a donor, and, during the operation, it is securely fastened using stitches, screws, and pins.

Before opting for ligament reconstruction surgery, it’s crucial to weigh its risks. Complications can include infection, bleeding, or nerve damage during surgery, or even problems with the healing process post-operation. Moreover, the transplanted tendon might not integrate well into your foot or ankle, leading to limited mobility or potential future injuries.

Even in the best-case scenarios, invasive procedures come with lengthy recovery and rehabilitation periods.

What is Platelet-Rich Plasma, or PRP? 

PRP – which stands for Platelet-Rich Plasma – is a form of regenerative therapy that uses the patient’s own blood. After being collected, these blood samples are concentrated to offer far higher concentrations of platelets than baseline values. 

Platelets are the component of the blood responsible for enabling healing processes such as blood clotting. To add to the healing potential of platelets is the fact that they are extraordinarily rich in growth factors

Found within platelets in “pockets” known as alpha granulate, growth factors are proteins capable of stimulating the activity of stem cells within the site of injury. What’s more, these proteins are able to activate the transformation process of adult stem cells into other cells needed to replace and regenerate damaged tissues.  

They can also “call to action” repair cells from across the body to the injured site. 

Being rich in platelets, PRP offers a simple, safe, and effective way of delivering growth factors to the area in need. Acting as “espresso shots”, these growth factors will stimulate the body’s ability to heal damaged tissues – such as torn ankle and foot ligaments.

PRP for Foot and Ankle Ligament Tears 

The capacity of Platelet Rich Plasma (PRP) to boost your body’s natural healing abilities makes it an integral component of regenerative therapies. Regenerative orthopedics, for example, utilizes PRP to effectively address conditions like joint instability, arthritis, muscle strains, and tears in ligaments and tendons.

Up to this point, more than 30 randomized trials have demonstrated how PRP can stimulate the healing abilities of stem cells at injury sites. Given the safety level of PRP injections and their efficiency in boosting the body’s self-healing capabilities, this is now considered a superior alternative to treatment options such as corticosteroids and pain medications. 

Specifically, in the treatment of foot and ankle ligament tears, studies have confirmed the potential of PRP. Here’s an overview of current research:

  • Although there are several factors influencing the outcomes of PRP, this therapy can be used in the treatment of connective tissue injuries (i.e.: ligament and tendon tears), and it can aid the recovery process. (2014)
  • PRP can significantly reduce the pain associated with ankle sprains, and lead to better clinical results than other treatment options. (2022)
  • Patients with a lateral ankle sprain treated with PRP achieved a higher reduction in pain and better functional scores than patients treated with immobilization 8 weeks following the injection. (2020)
  • A single PRP injection contributed to the quick and safe return to play of Rugby Union athletes suffering from chronic ankle ligament conditions. (2015)

Why are Orthagenex PRP Injections Superior?

The studies reported above show that Platelet Rich Plasma has the potential to be a far safer and more efficient alternative to painkillers, corticosteroid injections, and surgery for the treatment of foot and ankle ligament tears. 

Nonetheless, not all PRP therapies advertised on the market are equally efficient – nor do they lead to the same results. So, what makes the solutions offered at Orthagenex superior?

There are four main features that take the Orthagenex PRP protocol to the next level:

  • The use of image guidance to accurately deliver PRP injections to the site of injury
  • Lab-processed solutions to boost the concentrations of platelets and reduce unfavorable components
  • Ad hoc injectates that are customized around the unique needs and health goals of each patient
  • Doctors who are highly trained in Interventional Orthopedics

The combination of these features allows Orthagenex to offer a superior form of PRP – a high-dose PRP.

Below, we’ll look in detail at each of these features and discover how our core competencies help us achieve better health outcomes. 

Interventional Orthopedics

Orthagenex’s cutting-edge protocols have pioneered the development of a new, recognized medical specialty: interventional orthopedics. This field is based on three pillars: 

  1. The use of injections, like PRP, to promote tissue regeneration and support the body’s own healing capabilities.
  2. The use of imaging guidance to boost precision in needle positioning
  3. The continuous improvement of injection solutions and delivery techniques that can lead to better health outcomes.

Image-Guidance to Place PRP Solutions

Imaging guidance refers to all of those techniques and tools used to reduce reliance on tactile sensations while delivering injections to the site of injury. These techniques allow the physician performing the injection to maintain real-time visuals of the needle from the moment it enters the skin onward. 

Currently, as standard procedure, US clinics offering PRP do not use imaging guidance. This can lead to a higher rate of mispositioning of the needle, thus causing surgeons to miss the target location of PRP injections. Even in those cases when imaging guidance is used, physicians usually don’t have the knowledge and training necessary to accurately interpret results. 

That’s where Orthagenex sets itself apart. At our clinics, imaging guidance is used throughout each PRP injection as part of our standard protocol. To achieve greater precision, we take advantage of two of the most advanced imaging guidance techniques available:

  • Ultrasound guidance, which uses ultrasound waves to offer real-time position data of the needle as it enters the skin
  • Fluoroscopy, which offers real-time, multi-angle X-ray images of the needle’s positioning as it targets the site of injury.

Not only are these techniques used in combination, but they are also delivered by a team of specialized technicians trained to accurately interpret results.

Lab-Processed for Higher Concentrations of Platelets

Besides the accuracy of needle positioning, the efficacy of PRP therapies in boosting the body’s ability to heal damaged tissues is also determined by two factors: the concentration of platelets and the purity of the injectates.

However, the tools and techniques used by most clinics offering PRP in the use aren’t powerful enough to create super-concentrated, pure injections. This is because, in most cases, standard bedside centrifuges are used. 

These centrifuges work by spinning the blood sample and separating the different components of the blood. They are not, however, efficient in optimizing the concentrations of platelets – nor in removing unfavorable components (i.e.: white and red blood cells). What makes these injections even less efficient is the fact that they are immediately delivered to the site of injury after processing, without further customization processes. 

To offer superior High-Dose PRP, Orthagenex employs in-house laboratories. After collection, blood samples are delivered to our cellular labs, where they are processed using cutting-edge techniques. These processes help guarantee optimal platelet volumes, as well as purer and entirely customized injections. 

The chart below offers an overview of the differences between Orthagenex’s protocols and the techniques used by most other orthopedic clinics in the nation. 

Other clinicsOrthagenex
Tools used to create PRPBedside centrifuges, usually located on the patient’s bedside. Specialized laboratories equipped with cutting-edge equipment
Protocol to perform PRPAfter being centrifuged, PRP is immediately injected into the site of the injury The blood sample is concentrated, purified, and customized before injection. 
Resulting concentration of platelets in PRPMaximum 2-4 times higher than “normal blood” values 10-30 times higher than “normal blood” values. 

Amber PRP vs. Red PRP

Platelet Rich Plasma comes in two forms, which can be distinguished by their color:

  • Red PRP: This solution appears red, due to the high presence of both white and red blood cells along with platelets. The medical term for this is Leukocyte-Rich PRP or LR-PRP. 
  • Amber PRP: This type of PRP has a distinct amber color due to the lower concentration of white and red blood cells. It is referred to medically as Leukocyte-Poor PRP or LP-PRP.

In essence, the color difference is determined by the presence specific blood cells. According to the lab tests conducted at Orthagenex, these blood cells can have an unfavorable effect on PRP outcomes. Simply, red and white blood cells can contribute to inflammation at the site of injury, and they may have an inhibiting effect on the repair cells that PRP is attempting to stimulate. 

Amber PRP is purer, less inflammatory, and offers higher concentrations of platelets. These features make Amber LP-PRP the solution of choice at Orthagenex

Next-Generation Platelet Lysate 

Just like Platelet Rich Plasma (PRP), Platelet Lysate (PL) enhances the action of repair cells at the site of injury thanks to optimized concentrations of platelets and growth factors. 

However, some characteristics of PL make it a better alternative in some cases. Firstly PL is remarkably anti-inflammatory. Additionally, these injections release growth factors en-masse to the site of injury, thus leading to faster results. 

The chart below offers an overview of the two therapies offered at Orthagenex. 

PRPPL
Releases platelets and growth factors over time to the site of the injury, usually over a week.Growth factors are released immediately, en masse, to the site of the injury. 
May cause some degree of inflammation upon injection.It is anti-inflammatory. 
May not be as suitable for treating sensitive areas. It can be used around sensitive areas (e.g. near nerves and the spinal cord).

While most clinics across the US are just beginning to offer Platelet Lysate to their patients, Orthagenex is now making the third and fourth generations of PL injections available as part of our standard treatments. Our main focus remains on continuously developing better, more efficient PL injectates. 

PRP Customized To Every Patient’s Need

Besides the high concentrations of platelets, what makes our high-dose PRP protocol superior is the level of customization we offer to each patient

At Orthagenex, we understand that foot and ankle ligament tears are complex disorders that can manifest themselves with a variety of symptoms and impacts. Because of this, we leverage specialized in-house cellular laboratories to tailor each injection to the patient’s needs and desired health outcomes. 

Here’s an overview of our customization process: 

Lab-Processed PRP Solutions

At Orthagenex, we believe in going beyond conventional practices. Instead of using basic centrifuge machines, we take advantage of cutting-edge cellular lab environments. Here, our highly trained specialists use state-of-the-art equipment to tailor each injection for optimized health outcomes. 

Each formulation is created ad hoc, and it undergoes several stages of processing to ensure greater concentrations of platelets, higher levels of purity, and fine-tuned components. 

Bone Marrow Concentrate Can Be Used 

Bone marrow concentrate (BMC) works alongside PRP as an additional regenerative therapy. BMC’s primary aim is to boost the levels of restorative repair cells in the areas of the body (such as the ankle and foot) that have suffered injuries, degeneration, pain, and inflammation.

In BMC, samples of the liquid part of the bone marrow are collected by creating a thin tunnel into the bone, usually near the pelvis. This bone marrow, which is extraordinarily rich in stem cells, is then concentrated and purified, before being re-injected into the site of injury. Here, the injectate replenishes the levels of stem cells and optimizes the body’s ability to heal naturally. 

Doctors Specializing in Interventional Orthopedics

If, at Orthagenex, we are able to offer superior Platelet-Rich Plasma therapies it is thanks to our team of highly trained technicians and doctors. 

Each member of our team is a specialist in musculoskeletal disciplines, board-certified, and fellowship-trained. Our doctors are also among the 1% of physicians in the US who are trained in Interventional Orthopedics and imaging guidance. These numbers alone show how Orthagenex has been able to help more orthopedic patients than any other regenerative medicine clinic in the nation. 

Core Competencies

  • The use of imaging guidance to boost needle placement accuracy
  • Lab-processed solutions for higher concentrations of platelets
  • Formulations entirely customized to each patient’s needs
  • The use of the purer Amber LP-PRP injections
  • The availability of supplementary regenerative therapies, such as lysate (PL) and bone marrow concentrate (BMC)
  • The use of SANS – our proprietary method of evaluation for systemic inflammation and chronic pain conditions. 

Most chronic pain conditions deriving from systemic inflammation are non-specific, meaning that they can result from a wide range of causes and risk factors (including lifestyle and environmental factors). Without having a clear understanding of what’s causing a patient’s chronic pain, it can be hard for doctors to perform an accurate diagnosis and decide on a safe and efficient form of treatment. 

That’s where SANS comes in. SANS stands for Stability, Articulation, Neuromuscular, and Symmetry. Analyzing these aspects of chronic pain conditions allows our physicians to more accurately determine the extent, nature, location, and cause of chronic pain and inflammation. This knowledge can then help guide treatment decisions. 

Orthagenex – Your Alternative to Foot and Ankle Ligament Tears Surgery

Mild ankle sprains are something we have all experienced at least once in our lives. And, in most cases, they are nothing more than a temporary condition that can be resolved with at-home remedies. 

However, in some cases, ankle and foot ligament tears can be acute or chronic, which can lead to long-lasting instability, reduced range of motion, and inhibited performance. When this happens, you may be recommended one of three, equally undesirable lines of treatment: NSAIDs, corticosteroid injections, or surgery. 
Nonetheless, there is no longer reason to endure the risks and side effects of these treatment options. The superior Platelet Rich Plasma injections offered at Orthaganex may help you regain your foot function and health by boosting your body’s natural ability to heal itself – without medications or surgery.

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