How to Treat the Foot/Ankle with Stem Cells
Harvested adult adipose derived stem cells are precisely injected into the foot/ankle joint under fluoroscopic guidance using local anesthesia. Once inside the foot/ankle joint, the stem cells begin to repair the cartilage in many ways.
Stem cells make various soluble factors which can change the tissue microenvironment in ways such as:
- Cytokines (controls joint inflammation.)
- Growth factors that stimulate cartilage repair.
Stem cells have the ability to proliferate into cartilage cell lines.
Osteoarthritis is also known as degenerative joint disease. This occurs when the cartilage that covers the top of the bones, known as articular cartilage, degenerates or wears down. This causes swelling, joint pain, stiffness, and decreased range of motion. Damage from mechanical stress with insufficient self-repair by joints is believed to be the primary cause of osteoarthritis.
Osteoarthritis most often occurs in people who are over 50. In younger people, osteoarthritis can result from an injury or trauma such as a fractured or dislocated joint. Rarely, osteoarthritis may also be hereditary.
The risk of ankle osteoarthritis is greatest in those who are overweight, have one leg of a different length than the other, or have jobs that result in the high levels of ankle joint stress. Diagnosis is typically based on signs and symptoms, x-ray results, and Magnetic Resonance Imaging or CAT scan studies. Ankle fractures, chronic ankle sprains with instability, also result in degenerative traumatic arthritis over time.
The main symptom is ankle pain, stiffness, difficulty with walking squatting kneeling or climbing, made worse by prolonged activity, and relieved by rest. Osteoarthritis can often cause a cracking noise (crepitus) when the ankle joint is moved or twisted.
Lifestyle modifications, such as weight loss and exercise, ankle bracing, physical therapy, and use of non-steroidal anti-inflammatory medications are part of conservative treatment for symptomatic ankle osteoarthritis.
Tendonitis / Tendinosis
Tendinitis refers to inflammation of a tendon, a flexible band of tissue that connects the muscles to the bones.
The pull of the muscles is transmitted to the bone by the tendons which allow movement. When the tendons are inflamed and irritated, the pulling action of the muscle is impaired with loss of function of the joint. Symptoms can vary from aches or pains and local joint stiffness, to a burning that surrounds the whole joint around the inflamed tendon. In some cases, swelling occurs along with heat and redness, and there may be visible knots surrounding the joint. With this condition, the pain is usually worse during and after activity, and a tendon and joint area can become stiff the following day, as muscles tighten from the movement of the tendon.
Tendinosis, however, is a chronic injury caused by an accumulation of small tears in the tendon that have failed to heal properly over time. Patients commonly find it almost impossible to keep from restraining the tendon, because even when the pain is gone, the tendon still hasn’t fully healed.
Achilles tendinitis is inflammation of the Achilles tendon generally caused by overuse of the affected foot/ankle. Achilles tendinitis is thought to have physiological, mechanical and / or extrinsic (footwear or training) causes. Physiologically, the Achilles tendon is subject to poor blood supply through the synovial sheath that surrounds it. This lack of blood supply can lead to degradation of collagen fibers and therefore inflammation. Tightness of the calf muscles is also been known to be involved in the onset Achilles tendinitis.
Symptoms can vary from an ache, or pain and swelling to the local area of the ankle, or a burning sensation that surrounds the whole joint. With this condition, pain is usually worse during and after activity, and the tendon and joint area can become stiffer the following day, as swelling impinges on the movement of the tendon and therefore the ankle.
Plantar fasciitis is a disorder that results in pain in the heel at the bottom of the foot. The pain is usually most severe with the first steps of the day after arising out of bed, or following a period of rest. Pain is also frequently brought on by bending the foot and toes upward to the shin and may be worsened by a tight Achilles tendon. The condition comes on slowly, and in about one third of individuals both legs may be affected.
Risk factors include overuse such as from long periods of standing and increasing exercise, as well as obesity. It also is associated with inward rolling of the foot.
Plantar fasciitis is a disorder of the insertion site of the ligament on the bone, characterized by micro tears, breakdown of collagen, and scarring. The diagnosis is typically based on signs and symptoms, with ultrasound sometime used to help.
When plantar fasciitis occurs, the pain is typically sharp, and usually involves only one side.
Symptoms are often reported to be more intense during the first steps as when getting out of bed, or after prolonged periods of sitting. Rare but reported symptoms include numbness / tingling, swelling, or radiating pain. If the plantar fascia continues to be overused in the setting of plantar fasciitis, the plantar fascia can rupture. Typical signs and symptoms of plantar fascia rupture include a clicking or snapping sound, significant local swelling, and acute pain involving the sole of the foot under the heel.
Risk factors for plantar fasciitis include excessive running, standing on hard surfaces for prolonged periods of time, high arched feet, leg length inequality, and flat feet. The tendency of flat feet is to excessively roll inward during walking and running, which makes them more susceptible to plantar fasciitis. Obesity is seen in 70% of individuals who present with plantar fasciitis, and appears to be an independent risk factor for the development of this disease.
Rheumatoid arthritis (RA) is a long-lasting autoimmune disorder that primarily affects joints. It commonly results in warm, swollen, and painful joints. Although most commonly, the wrist and hand are involved, the disease also affects other parts and joints of the body.
Although the cause of rheumatoid arthritis is not completely clear, it involves a combination of genetic and environmental factors. The underlying mechanism involves the body’s immune system attacking joints. This affects the underlying bone and cartilage. The diagnosis is primarily based on the person’s signs and symptoms, with the assistance of x-rays and laboratory testing. The goal of treatment is to reduce pain, decrease inflammation, and improve the individual’s overall functioning. This is assisted by balancing rest and exercise, uses of splints, braces, or assistive devices, and use of various medications, including steroids, NSAIDs, or the use of disease-modifying anti-rheumatic drugs to slow the progression of disease.
RA typically presents with signs of inflammation with the affected joints being swollen, warm, painful and stiff, particularly early in the morning upon awakening, or following prolonged activity. Increased stiffness early in the morning is a prominent feature of this disease, and typically last for more than an hour. As the pathology progresses, the inflammatory activity leads to tendon tethering with erosion and destruction of the joint surface. This ultimately impairs range of movement and can lead to deformity.
RA also can involve the skin, lungs, kidneys, heart and vessels, as well as multiple other body systems. RA reduces lifespan an average from 3 to 12 years, but a positive response to treatment may indicate a better prognosis.
Early rheumatoid arthritis symptoms generally affect the smaller joints, including ankles and feet, and in most cases, the same joints on both sides of the body in a symmetrical fashion. RA synovitis can lead to tethering tissue with loss of movement and erosion of the joint surface, causing deformity and loss of function. Diagnosis of rheumatoid arthritis is made based on signs and findings, x-ray images, and blood tests.
Ligament injuries are sustained where an ankle sprain occurs which injures one or more ligaments of the ankle. This can include the anterior talofibular ligament, calcaneofibular ligament, deltoid ligament, or other intrinsic ligaments. When ankle ligaments are torn such as when sustaining an ankle sprain, blood vessels leak fluid into the tissue that surrounds the joint, and white blood cells will be attracted to the injured ligament area. Along with this inflammation, swelling from the fluid and pain is experienced. Also present is diminished ability to move the ankle joint, and difficulty using the injured foot and ankle.
The risk of the ankle ligament injury is greatest during activities that involve explosive side to side motion, such as athletic activities, and can occur during normal activities such as stepping off a curb, or slipping on ice.
Returning to activity before the ligaments a fully healed, may cause them to heal in a stretched out position, resulting in less stability at the ankle joint. This can lead to a condition known as chronic ankle instability, with an increased risk of future ankle sprains. Individuals can be predisposed to sustaining ankle ligament injuries with weak muscles/tendons, inadequate joint proprioception, running on uneven surfaces, utilizing shoes without adequate heal support or wearing high heeled shoes which places the ankle in a weak position, leaving the person susceptible to ankle sprains.