Dr Arockia Doss, Interventional Radiologist, www.imageguidedtherapyclinic.com
Nedlands Western Australia 6009
Case report:
A 50 year old lady presented with two years of heel pain. Heel pain restricted walking to just 5 minutes. She was worried that she was gaining weight and loosing fitness due to inactivity. There were no major comorbidities. She was a non smoker.
She had previously undergone cortisone injections, iontophoresis and other conservative measures with no relief. She was advised surgery. She sought nonsurgical options and presented to IGTC.
In examination she was thin built. There was marked tenderness corresponding to the findings on the Xrays and Ultrasound results of Achilles Tendinosis. Pre treatment Foot and Ankle Disability Index (FADI Score) was 49.0. She underwent PRP treatment for Achilles tendinosis.
At six months post treatment she returned for follow up and reported excellent pain relief. She was able to walk for about an hour. He post treatment FADI score was 88.5 (absolute increase of 39.5 points, 80.6% improvement). She was very happy with the good outcome.
Compare the pre treatment FADI score at presentation in July 2013 with the improved FADI score in December 2013 (an improvement of 80.6%).
Learning Points:
In recalcitrant cases of Achilles tendinosis, percutaneous treatment with PRP provides significant clinical benefit.
This is a single case report. Therefore this cannot be used as a standard bench mark for routine clinical practice.
This is a single case report that highlights the basic science concept of PRP in recalcitrant Achilles tendinosis. Large volume studies may be supported on the basis of such reports.
The significant benefit was related to PRP treatment under high resolution ultrasound guidance.
Discussion:
Achilles tendon is the largest and strongest tendon in the human body. The Achilles tendon is a continuation of the calf muscles and inserts into the back of the heel bone (calcaneum).
Forces that generate movement of the ankle are transmitted from the soft calf muscles through to the tense Achilles tendon and into hard bone. At the junction of the tendon and the bone there is a firm to hard cartilage structure called enthesis.
A variety of factors can lead to injury to the muscles, tendon and or enthesis. An initial assessment of Achilles tendon injuries should include the mechanism of macro injury, presence of any chronic biomechanical issues that may lead to microinjury, smoking, possible genetic or metabolic predisposition etc.
Conclusion:
Percutaneous treatment with PRP of the Achilles tendon is a reasonable option for recalcitrant Achilles tendinosis that has failed conservative measures.
