Soft tissue injury in the foot and ankle often involves MRI or Ultrasound for diagnosis.
Ultrasound is the imaging test of choice in the clinic to diagnose the presence of pathology within tendons, ligaments and fascia among other anatomical structures. Normal tendons, ligaments and fascia appear as darkened bands. The collagen that comprises these structures are very linear when uninjured. When injured, however, they become wavier and darker (known as hypoechogenicity). Tears in these anatomical structures can often be identified during ultrasound evaluation.
Our Orthobiologic Medicine practice uses ultrasound imaging to precisely guide Platelet Rich Plasma or Bone Marrow Aspirate injections directly into an area of injury. Following diagnosis of the problem, the ultrasound becomes an essential tool for delivery of regenerative and orthobiological substances to facilitate the healing process. The direct visualization of foot and ankle anatomy by ultrasound allows injection of healing cells exactly where they needed for greatest benefit. Furthermore, ultrasound guided injections result in more accurate placement without injury to vital structures leading to better clinical outcomes especially when compared to blind injections.
Local anesthesia must first be administered prior to injection. Once the anesthesia is effective, the regenerative agent is injected. The ultrasound is used for the exact placement of the solution into the area of injury. This is important since Platelet Rich Plasma and Bone Marrow Aspirate do not spread out like steroid injections and only function in the exact spot that they are placed. We can also use a process called “peppering” which involves placing a small amount of Platelet Rich Plasma or Bone Marrow Aspirate into a wider area of injury again under ultrasound guidance.
After the orthobiologic products are administered, it is important to avoid Non Steroidal Anti-inflammatory medications (NSAIDs) and ice. We inject important healing cells which often act by inducing a further healing response. Often some tenderness or pain will ensue as a result of this fluid influx. Depending on the location, it may be counterproductive to use ice and NSAID’s. Tylenol, warmth (not heat) application and mobilization of the extremity are often the recommended alternatives to address discomfort. (Pain medication may also be required in select cases).
Physical therapy is strongly encouraged one week following the procedure. We have a specific protocol for our patients. Gentle activity/exercise is encouraged after 1-2 weeks. Most patients will receive great if not complete relief within 6 weeks of the procedure.
It is important to remember that healing is a process that takes time. No one should expect to be completely healed within the first week or two after the procedure. Give it time!