Tissue damage from acute injury, “wear and tear” or chronic degradation is a problem that podiatrists see every day.
Tissue damage from acute injury, “wear and tear” or chronic degradation is a problem that podiatrists see every day. However, the fairly recent distinction between musculoskeletal inflammatory changes and tissue chronicity has been a turning point for all who treat musculoskeletal injuries and pathology.
While “tendinopathy” is an umbrella term including non-rupture injury, it’s only within the past 15 to 20 years that we’ve begun to recognize the pathology of tendinosis contributing to the structural and mechanical deficiencies resulting from tendon stress. It’s important to note that there are many areas of tension in the foot and ankle (such as abnormal bony prominences) that directly contribute to tendinopathy due to increased friction. Tendons, as well as the plantar fascia, experience repetitive cycles of injury and repair, which is often left incomplete from continued activity resulting in an accumulation of less-than-optimal tissue. The resulting tissue is thicker, has reduced energy-storing capacity and strains more easily. Understanding the histological, biological and pathological differences between chronic tissue and acutely-injured tissue has given rise to the field of regenerative medicine.
Regenerative medicine involves mechanical, biological or cellular treatments altering the tissue environment and/or providing a foundation for the regenerative process of pathologic tissue for cell attachment, proliferation and/or attraction. Grafts can be used in surgery to preserve tissue plane boundaries by limiting adhesion. By modulation inflammation, the use of regenerative principles is evident in newer treatment approaches for everything from bunion surgery to tendon repair, to bone/ cartilage replacement and treatments for plantar fascial pathology.
Biologics, cellular therapy and the use of amniotic tissues have all greatly enhanced our treatment options. Newer treatments such as platelet-rich plasma injections are based on the premise that platelets create an upsurge in growth factors. Other regenerative treatments including mesenchymal stem cells modulate inflammation. My own personal experience with regenerative medicine began with mechanotransductive procedures such as high-energy shockwave therapy (ESWT). The emergence of ESWT in the 1990s coincided with the understanding that chronicity of soft tissues was an entity distinct from tendinitis, and we now understand the cellular significance. Radiofrequency became available at the same time that ESWT was omitted from insurance coverage, partially due to overuse. I found similar success in my own practice with RF for both Achilles tendinosis and fasciosis as compared to ESWT. Today, many podiatric practices such as mine routinely use amniotic membrane injections as their primary means of regenerative treatment.
With that said, the intent of this issue of Foot and Ankle Quarterly is not to compare competing technologies and products, but to help the reader to understand their differences. Dr. Stephen Brigido’s Audio Lecture explores the healing components that are unique to regenerative healing, and my own Lecture reviews the reasons why traditional cortisone injections are no longer standard for chronic heel pain. More broadly, the Feature Article offers a clearer understanding of how various currently-available biotechnologies work, and gives a comprehensive overview of this rapidly-expanding field.
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Article Authors and Lecturers
David G. Armstrong, DPM (n.)
Steven A. Brigido, DPM (n.)
James Cottom (n.)
Lawrence A. DiDomenico, DPM (n.)
Emlyn K. Forsung, DPM (n.)
Colin T. Graney, DPM (n.)
Mohammed K. Hassan, DPM (n.)
Alex Kor, DPM, MS (n.)
Lawrence M. Kosova, DPM (n.)
Patrick A. McEneaney, DPM (n.)
Howard G. Osterman, DPM (n.)
Britton S. Plemmons, DPM (n.)
James W. Ratcliff, DPM (n.)
Marlene Reid, DPM (1. Data Trace Publishing Company)
Laura Shin, DPM, PhD (n.)
Marlene Reid, DPM Family Podiatry Center, Naperville, IL; Past President, Illinois Podiatric Medical Association; Past President, American Association for Women Podiatrists; Past Chair, Podiatric Academy, National Academies of Practice; Fellow, American College of Foot and Ankle Surgeons; Fellow, National Academies of Practice
David G. Armstrong, DPM
Professor of Surgery and Director, Southwestern Academic Limb Salvage Alliance, Keck School of Medicine of University of Southern California, Los Angeles, CA
Steven A. Brigido, DPM Section Chief, Foot and Ankle Reconstruction, Director, Foot and Ankle Fellowship, Coordinated Health, Bethlehem PA; Clinical Professor of Surgery, The Geisinger Commonwealth Medical College, Scranton, PA
James M. Cottom, DPM Director, Florida Orthopedic Foot and Ankle Center Fellowship; Private Practice, Florida Orthopedic Foot and Ankle Center, Sarasota, FL
Lawrence A. DiDomenico, DPM Director, Podiatric Residency Training, East Liverpool City Hospital, East Liverpool, OH; Director of Residency Training, Section Chief, St. Elizabeth Hospital, Youngstown, OH; Fellow, American College of Foot and Ankle Surgeons; Certified Wound Specialist; Fellow, Certified Corporate Wellness Specialist
Emlyn K. Forsung, DPM Resident, East Liverpool City Hospital, East Liverpool, OH
Colin T. Graney, DPM Fellow, Florida Orthopedic Foot and Ankle Center, Sarasota, FL; Associate, American College of Foot and Ankle Surgeons
Mohammed K. Hassan, DPM Resident, East Liverpool City Hospital, East Liverpool, OH
Alex Kor, DPM, MS Private Practice, Witham Health Services, Lebanon, PA; Fellow, Past President, American Academy of Podiatric Sports Medicine; Fellow, American Society of Podiatric Surgeons; Diplomate, American Board of Podiatric Surgery
Lawrence M. Kosova, DPM Family Podiatry Center, Naperville, IL; Fellow, American College of Foot and Ankle Surgeons; Fellow, American College of Foot and Ankle Orthopedic Surgeons
Patrick A. McEneaney, DPM CEO/Owner, Northern Illinois Foot and Ankle Specialists, LLC, Cary, IL; Head, Section of Podiatry, Department of Surgery, Northwestern Memorial Hospital/Centegra Health Systems, McHenry, IL: Staff Wound Physician, Northwestern Memorial Hospital/Healogics; McHenry, IL; Fellow, American College of Foot and Ankle Surgeons, Associate, American Professional Wound Care Association
Howard G. Osterman, DPM Partner, Foot and Ankle Specialists of the Mid-Atlantic; President, American Academy of Podiatric Sports Medicine; Team Podiatrist, Washington Wizards, NBA
Britton S. Plemmons, DPM Partner, Longview Orthopaedic Clinic Association, Longview, TX; Associate, American College of Foot and Ankle Surgeons
James W. Ratcliff, DPM
Private Practice, Los Gatos, CA; Diplomate, American Board of Foot and Ankle Surgery; Fellow, American College of Foot and Ankle Surgeons; Fellow, American Academy of Podiatric Sports Medicine
Laura Shin, DPM, PhD Assistant Professor of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
In This Issue
FEATURE ARTICLE: Podiatric Applications of Regenerative Medicine: Where We Came From, Where We Are and Where We Are Going
Marlene Reid, DPM
Direct Radiofrequency Application Improves Pain and Gait in Collagenase-Induced Acute Achilles Tendon Injury
Commentary by Alex Kor, DPM, MS
A Biomechanical Assessment of Tendon Repair after Radiofrequency Treatment
Commentary by James Ratcliff, DPM
The Effects of Irreversible Electroporation on the Achilles Tendon: An Experimental Study in a Rabbit Model
Commentary by Britton S. Plemmons, DPM
The Placenta: Applications in Orthopaedic Sports Medicine
Commentary by Howard G. Osterman, DPM
The Use of Decellularized Human Placenta in Full-Thickness Wound Repair and Periarticular Soft Tissue Reconstruction: An Update on Regenerative Healing
Commentary by James M. Cottom, DPM and Colin T. Graney, DPM
The Bio in the Ink: Cartilage Regeneration with Bioprintable Hydrogels and Articular Cartilage-Derived Progenitor Cells
Commentary by Stephen A. Brigido, DPM
Topical Review: MACI as an Emerging Technology for the Treatment of Talar Osteochondral Lesions
Commentary by Lawrence A. DiDomenico, DPM and Mohammed K. Hassan, DPM
Matrix-Associated Stem Cell Transplantation (MAST) in Chondral Defects of the First Metatarsophalangeal Joint is Safe and Effective: Two-Year Follow-Up in 20 Patients
Commentary by Britton S. Plemmons, DPM
Sports Medicine and Platelet-Rich Plasma Nonsurgical Therapy
Commentary by Patrick A. McEneaney, DPM
Synthesis, Development, Characterization and Effectiveness of Bovine Pure Platelet Gel-Collagen-Polydioxanone Bioactive Graft on Tendon Healing
Commentary by Lawrence A. DiDomenico, DPM and Emlyn K. Forsung, DPM
Regenerative Rehabilitation: Applied Biophysics Meets Stem Cell Therapeutics
Commentary by Lawrence M. Kosova, DPM
Adipose-Derived Stem Cells in Orthopaedic Pathologies
Commentary by Stephen Brigido, DPM
Lipofilling for Functional Reconstruction of the Sole of the Foot
Commentary by David G. Armstrong, DPM and Laura Shin, DPM, PhD
AUDIO LECTURE 1: Plantar Fascia Treatment Options in the 21st Century
Marlene Reid, DPM
AUDIO LECTURE 2: Regeneration vs. Repair: What’s the Difference?
Stephen A. Brigido, DPM