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Stem Cell Therapy for Morton’s Neuroma – Is it right for you?

What is Stem Cell Therapy?Stem cell therapy

Stem Cell Therapy is also called “regenerative therapy” uses the body’s most basic “raw material,” stem cells, to grow or regenerate new cells that the body needs. Stem cells are “undifferentiated” or “unspecialized” cells, meaning that they are “blanks” that can be developed into another type of cell that is required to repair or replace damaged tissue. In the musculoskeletal field, stem cell therapy can stimulate the formation of new bone, cartilage, tendon, ligaments, fat, and fibrous connective tissue.

Stem Cell Therapy creates specialized cells that have a particular life cycle and purpose, like bone or connective tissue. Stem cells can replicate themselves, too, so it is theoretically possible to have an unending supply of these regenerative “machines” that can then divide and be guided to produce the cells your doctor needs to fulfill specific purposes in your treatment.

Stem Cell Therapy can:

  • Repair tissue that is too damaged to heal on its own
  • Regenerate tissue that is missing (ex.: cartilage in arthritic joints)
  • Provide a renewable source of replacement cells and tissues
  • Release cytokines which are chemical messenger like compounds which further promote the regeneration process.
  • Provide hyaluronic acid which helps in restoring mobility and flexibility.

Stem cells are now being studied for use in a wide range of conditions, from diabetes, to heart disease, to musculoskeletal disorders, to neurological disorders. Investigators believe that breakthrough therapeutic tools like stem cell therapy can be used to manage degenerative musculoskeletal disorders such as arthritis, plantar fasciitis, Morton neuroma and other disabling conditions.

What are stem cells?

Stem cell mechanism of action
Stem cell mechanism of action: How one type of stem cell can become another and repair injured bone, blood vessels, cartilage and tendons.

Stem cells can be characterized as the body’s repairmen. The most common type is the hematopoietic stem cell (HSC-CD 34+). These are the cells that are the true drivers of tissue regeneration. The good news about these cells is that their numbers do not diminish with age. The other type of stem cell associated with tissue healing is the mesenchymal stem cell (MSC), which usually travels to injured areas of the body via the bloodstream. It prepares the area for the other stem cells to do their work.

If the area in question has an insufficient blood supply, this is termed an area of hypoxia, otherwise known as low oxygen content. Hypoxia areas can include the rotator cuff, the joints, meniscus tissue, the webspaces between the toes, the Plantar Fascia and other spots with tendon injuries. Typically, these areas are unable to heal properly without help, as the body does not send enough repair cells to the afflicted areas. The inadequate supply of blood in these areas means that the body fails to sense the injury. Fortunately, we are generally able to treat the area, if the injury isn’t severe, with platelet-rich plasma. This works by effectively mimicking a blood supply, allowing the platelets to sense the injury and release growth factors, which then prompt the body to send various stem cells to the area.

 What is the process for Stem Cell Therapy?

Although stem cells are naturally present in almost all the tissues in varying degrees, the highest concentration occurs in the bone marrow. Stem cells are gathered by aspirating (removing through suction) bone marrow from the back of a patient’s pelvis. This substance is removed from the patient’s pelvis with a tiny needle. Since the patient is given a local anesthetic, only minimal discomfort results from the procedure.

Stem cell treatmentIn most cases, 2 oz. (60 cc) of bone marrow aspirate is required. The aspirate includes platelets, mesenchymal stem cells, and other kinds of stem cells used in adult stem cell therapy. After aspiration, the stem cell tissue is separated from non-useful substances and cells via multiple filtration techniques. The bone marrow is placed inside a special container, which in turn is placed into a machine known as a centrifuge. The centrifuge spins the material at a high rate of speed, and this process separates the platelets and stem cells from the remainder of the blood products. It is this concentration of bone marrow—called BMAC, or bone marrow aspiration concentrate that is injected to the site of tissue damage or injury. We use ultrasound and nerve stimulator guidance to increase the accuracy of administration

Once introduced, the platelets then release signal proteins and growth factors which activate the stem cells to divide rapidly. Stem cells by themselves are unable to repair the injured area. These cells have to be properly directed, and platelets perform this function. In effect, stem cells are construction workers and the platelets are their supervisors. Once they are activated, these stem cells perform a variety of valuable functions. Apart from repairing damage to the injured areas, they help damaged cells repair themselves and participate in the repairing process.

Is Stem Cell Therapy right for you?

Although Stem Cell Therapy is considered by some folks to be experimental, various research studies show that regenerative stem cell therapy and platelet rich plasma can provide excellent relief from musculoskeletal pain and ongoing inflammation which occurs in cases of difficult to treat Morton’s neuroma and Plantar Fasciitis.

We believe that Stem Cell Therapy and Plasma Rich Platelet injections should be utilized before any surgical attempt is made especially if you are considering redo surgery in cases of ongoing pain after initial Morton’s neuroma surgery or after Plantar Fasciitis surgery.

What are some other conditions for which Stem Cell Therapy can be utilized?

Serious or severe foot and ankle musculoskeletal foot injuries are excellent candidates for stem cell therapy. Besides Morton neuroma and plantar fasciitis; other indications of using stem cell therapy are:

  • Severe sports related injuries
  • Genetic factors or hereditary musculoskeletal conditions
  • Foot and ankle overuse or abuse injuries
  • History of traumatic accidents
  • Osteoarthritis
  • Osteonecrosis
  • Fractures and other traumatic injuries

Stem Cell Therapy Frequently Asked Questions (FAQ’s):

  1. Does Stem Cell Therapy hurt? There may be some pressure at the injection site, but the process is fairly quick. You will be giving a numbing agent to help maintain comfort during your treatment.
  2. How do I prepare for Stem Cell Therapy? Do not take over-the-counter medications that can thin your blood (aspirin, Motrin, Aleve Advil, Naproxen, etc.). Drink as much water as possible on the day of your injection. Arrange for someone to drive you home after treatment.
  3. What should I expect following Stem Cell Therapy? You will be numb for an hour or two at the injection site, and may experience much more soreness than usual for the first few days after treatment. After the numbness wears off, refrain from any activities that increase your discomfort, and refrain from taking anti-inflammatory medications for at least four weeks after treatment. Control your pain with acetaminophen (Tylenol®) or medications that your doctor prescribes. Use ice sparingly, for up to 20 minutes at a time every two to three hours. Resume any physical therapy regimen about a week after treatment. Your recovery time will depend on the specific condition that is being treated. In all cases, the stem cell injections at the site of your injury will need time to grow your new cells. As the regeneration of new cells proceeds, you should notice a gradual improvement in your level of discomfort, and in your range of motion.
  4. What else should I know about Stem Cell Therapy?
    • A lot of people are concerned about the efficacy, reliability and safety of stem cell procedure. Stem cell therapy is safe since your own stem cells (autologous) are used. This minimizes the risk of reaction, adverse effects or rejection.
    • Stem cell therapy has been statistically proven to aid in the regeneration of meniscal tissues and articular cartilage. In addition, these cells also help in reducing the subchondral and osteophytic remodeling. When used in combination with platelet rich plasma therapy, the efficacy of combination is compared with the bone grafting procedure.
    • According to a one study, in which stem cell therapy was administered after Achilles tendon surgery, investigators reported remarkable improvement in the process of the healing and recovery of the Achilles tendon. The positive effects were also reported in the surrounding connective tissue elements.

References:

  1. Davidson, J., & Jayaraman, S. (2011). Guided interventions in musculoskeletal ultrasound: what’s the evidence?. Clinical radiology, 66(2), 140-152.
  2. Hanselman, A. E., Lalli, T. A., & Santrock, R. D. (2015). Topical Review Use of Fetal Tissue in Foot and Ankle Surgery. Foot & ankle specialist, 1938640015578513.
  3. Finnoff, J. T., Hall, M. M., Adams, E., Berkoff, D., Concoff, A. L., Dexter, W., & Smith, J. (2015). American Medical Society for Sports Medicine Position Statement: Interventional Musculoskeletal Ultrasound in Sports Medicine. Clinical Journal of Sport Medicine, 25(1), 6-22.
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