Platelet Rich Plasma Injections for Morton’s Neuroma
Platelet rich plasma therapy (abbreviated as PRP) is the re-administration of your own platelets to activate the body’s natural healing cascade for repair and regeneration to treat Morton’s neuroma. It is successfully used for various musculoskeletal problems, such as of injured tendons, ligaments, muscles and joints. In fact, Platelet rich plasma injections are replacing traditional orthopedic surgery in many instances for conditions ranging from soft tissue injuries (tendonitis, muscle tears, ligamentous injuries) to various joint afflictions, such as a torn meniscus or mild to moderate arthritis of the joint.
Platelet activation plays a key role in the process of wound and soft tissue healing, especially when inflammation is present. Platelet rich plasma injections involves the use of a portion of your own blood, which has a high platelet concentration. PRP injections are prepared by using a small amount of your own blood which is centrifuged and then a portion of concentrated blood containing activated platelets is injected into the abnormal tissue.
The injection of your own platelets causes a local inflammatory reaction, releasing growth factors that stimulate healing and muscle regeneration, and limiting the amount of scar tissue. The treatment exert positive effects via multiple mechanisms including:
- Activation and release of the body’s natural growth factors in the abnormal tissue. This response has been proven to stimulate the tissue regeneration processes.
- Localized inflammatory response that increases the blood flow to the abnormal tissue.
- Limitation of scar tissue formation.
We use ultrasound imaging to guide the injection and this increases the accuracy of the PRP procedure, and potentially reduces post-procedural pain. We also use light activation of our platelets, which increases the effectiveness of the platelets and also decreases the post procedure discomfort. PRP injection therapy is generally completed in just one session, but may require additional injections depending upon the clinical circumstances.
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Step 1: Collect Blood
Step 2: Centrifuge Blood
Step 3: Light Activation
Step 4: Inject Under Ultrasound Guidance
Your body’s growth factors that are present in Platelet Rich Plasma include:
Indications for a Platelet Rich Plasma injection in Morton’s neuroma management:
- Morton’s neuroma refractory to conservative treatments: Most cases of Morton’s neuroma responds to conservative care or ultrasound guided ablation procedures. However, if symptoms does not improve, PRP injections for Morton’s Neuroma can be used as a final step before resorting to surgery.
- Morton’s neuroma with co-existing bursitis, capsulitis, synovitis, plantar fasciitis or arthritis: Morton’s neuroma often co-exists with other lesions of muscles and joints such as bursitis, capsulitis, synovitis, plantar fasciitis and arthritis. In all these cases, platelet rich plasma injections are not only safe but a preferred therapy to alleviate these other conditions as well as Morton’s neuroma.
- Routinely after Morton’s neuroma surgery: Surgical intervention is rarely but sometimes necessary to treat refractory cases of Mortons neuroma. Platelet rich plasma injections can be used to hasten the pace of recovery after Mortons neuroma surgery.
- To treat pain or complications after Morton’s neuroma surgery: Even with best practices and aseptic care, the risk of complications of Mortons neuroma surgery is fairly high. For example, tendon exposure, fibrosis, scarring and wound dehiscence are some complications that are often reported in patients after surgical repair.
Platelet Rich Plasma injections can be very helpful in post Morton’s Neuroma surgery pain. In fact, we recommend Platelet Rich Plasma injections in all post Morton’s neuroma surgery pain cases. Your body’s natural growth factors can be very helpful in fighting some of the complications that can occur with Morton’s Neuroma surgery. In fact, we’ve had some great results with PRP in patients with post Morton’s neuroma surgery pain.
How Do We Use PRP Injections in Morton’s Neuroma?
We use PRP injections in certain patients with Morton’s neuroma:
- Patients who have indications of a co-exisiting bursitis, capsulitis, synovitis, plantar fasciitis or arthritis;
- Patients who have had Morton’s neuroma surgery and have considerable post surgical scarring where PRP can be very effective; and,
- Patients with complex or multiple Morton’s neuromas.
A PRP injection can be uncomfortable and cause post-procedural pain that lasts a few days. When used to treat Morton’s neuroma, PRP injections should always be combined with other treatments.
Improving the Quality of Results with PRP Injections
The results of platelet rich plasma therapy can be further improved by:
- Using light activation. We activate the platelets using light activation which stimulates the platelets before they are injected back into you. This decreases post-procedure pain and discomfort as well as increasing the effectiveness of the platelets.
- Using ultrasound guidance to increase the precision of the injection. This increases the accuracy of the procedure and deceases the likelihood of complications.
Any contraindications to Platelet Rich Plasma Injections?
Although the treatment is generally well-tolerated by individuals of all age groups, there are certain contraindications to PRP Injections. For example:
- Recent history of anti-coagulant therapy/ course
- Bleeding disorders
- Pregnant or breastfeeding mothers
- Active malignancy, severe infection or thrombocytopenia
What to Expect After the PRP Injections
The aftercare for most PRP injections is relatively simple. Patients will resume activity at their own pace. The pain from the process typically will last a few days, occasionally longer, and some patients have more severe or sporadic pain than others. Because your own blood is used, there is no risk of a transmittable infection and a very low risk of allergic reaction to the treatment.
Who should give Platelet Rich Plasma Injections?
We recommend going to a clinician with experience in giving Platelet Rich Plasma injections. We activate PRP using light activation to increase their effectiveness and give Platelet Rich Plasma injections under ultrasound guidance to increase the accuracy of the procedure.
Side Effects of PRP injections
Most patients will experience some post-procedural pain at the injection site for up to 3 days and in some cases longer. This is typically managed with ice and over-the-counter pain relievers like Acetaminophen (Tylenol); however the physician may prescribe stronger pain relievers. Non-steroidal anti-inflammatory agents (NSAIDS) should be avoided since they interfere with the effectiveness of the PRP treatment.
Other side effects of PRP injections are very limited as the patient is utilizing their own blood, which they should have no reaction to. Sometimes the color around the skin of a PRP injection will appear bruised. Most of these side effects are temporary and resolve spontaneously within a couple of days after the initial procedure. Rare complications includes infection at the injection site and bleeding especially with anticoagulant therapy or bleeding disorders.
References:
- Murawski, C. D., Smyth, N. A., Newman, H., & Kennedy, J. G. (2014). A Single Platelet-Rich Plasma Injection for Chronic Midsubstance Achilles Tendinopathy A Retrospective Preliminary Analysis. Foot & ankle specialist, 1938640014532129.
- Abate, M. (2013). Hyaluronic Acid and Platelet Rich Plasma in Hip Osteoarthritis: Work in Progress. Surgery Curr Res, 3, e110.