David T. Weiss, DPM
Fellow, American College of Foot & Ankle Surgeons
Diplomate, American Board of Foot & Ankle Surgery
Associate, American College of Stem Cell Physicians
Regenerative Medicine is an exciting new advancement in the field of medicine. This is a term that is used to describe using special cells called “stem cells” to help repair the damaged areas in the body that ultimately cause pain.
The human body is an amazing machine. When the “machine” is running properly and one of the “parts” of the “machine” break, it is able to repair itself. The healing is done through a series of complex processes within the cells and tissues of our body.
When you cut your hand, it heals with a scab, and eventually new skin forms. This happens because there are stem cells in your body that work to repair the damage. One of the most powerful cells are called “Mesenchymal Stem Cells, or MSCs”.
There is a complex series of events that take place in order to repair the injury. The end result is new skin. When you break a bone, the same thing happens: stem cells from your body create new bone cells and the fracture heals. If you tear a tendon, eventually the fibroblasts in the body form collagen, and the tendon heals. When you are a child, the tissues in the body are able to heal themselves almost perfectly. As we get older, or if diseases affect our health, the body become less efficient at healing. Our own stem cells become less active, and less plentiful. This leads to poor healing, and prolonged injury and pain.
Traditionally, doctors have used “cortisone” injections to help with pain and inflammation. Cortisone, or “corticosteroids” are extremely powerful chemicals that limit inflammation, but they DO NOT fix the problem. The body’s own stem cells fix the problem. However, cortisone also destroys the body’s collagen, and causes breakdown of the tissues.
Too many cortisone injections cause many problems:
Loss of blood supply to the area (avascular necrosis)
Tendon / Ligament Ruptures
Severe joint damage (arthritis)
Osteoporosis
Loss of skin elasticity
Loss of fat under the skin
Endocrine problems: eg., Diabetes
Regenerative Medicine injections, like cortisone, also inhibit inflammation, and continue to act as an anti-inflammatory for many months. More importantly, they help FIX the problem. They deliver an enormous amount of compounds called “growth factors”, which enable the body to start repairing itself. The placental tissues also help prevent scar formation. There are 2 main types of advanced Regenerative Medicine injections: 1) PRP, a/k/a “Platelet Rich Plasma”, and 2) Placental tissue.
PRP (Platelet Rich Plasma) is when the patient’s own blood is taken, placed in a centrifuge, and the concentrated platelets are injected into the injured area. This is occasionally helpful, and requires many injections to achieve the desired result. PRP is a “Monoclonal”. This means they are less effective in activating the body’s own system to repair the damaged tissues.
Placental Injections, also known as “Amnion” does not require using the patient’s own blood, and does not cause an Immune response or rejection. They are significantly less differentiated than an adult stem cell. In other words, they are much more powerful in helping the injured tissues heal.
Placenta-derived cells have properties that are Osteogenic (bone-healing), and Adipogenic (process that forms chondrocytes, myocytes, and “good fat” cells). These all work together to prevent scar tissue, and heal the injured cells.
We are now able to inject the powerful MSCs obtained from placental tissue into the injured area to start the healing process. These MSCs will control inflammation, regenerate damaged tissue, and regenerate a healthy blood supply to the area (angiogenic). In addition, they also fight off bacteria. More or less, MSCs are the body’s “Navy Seals.”
MSCs come from our bone marrow. When we are babies, 1 out of every 10,000 bone marrow cells are MSCs. When we are in our 80’s, this ratio declines to 1 out of every 2,000,000 cells! This is one of the main reasons why adults have injuries that don’t heal, or take a long time to heal.
When there is an acute injury in our body, or a chronic problem (tendonosis, arthritis, non-healing fracture, nerve inflammation), the body’s response to the injury weakens over time, and especially with age. A child who has a simple cut, or a broken bone, will heal very quickly. Adults take longer to heal because they do not have as many stem cells. When there is a medical condition such as diabetes, auto-immune diseases (rheumatoid, lupus, IBS, psoriasis, etc), the healing process is even more compromised. Poor circulation, or “peripheral vascular disease” is a very common cause of delayed healing. Smoking affects the small vessels in the tissues by constricting them (vasoconstriction), and therefore decrease the amount of blood to the area. Some medications, such as NSAIDs, Chemotherapy Drugs, and Auto-Immune drugs (Methotrexate, Plaquenil, Prednisone) also impair the healing process.
This is why these Placental Injections are so amazing. These “supercells” are placed directly into the injured tissue, and the healing process begins, and begins rapidly and efficiently.
Examples of conditions in the Foot & Ankle that respond well to Placental Injections:
Plantar Fasciitis / Heel Spurs
Achilles Tendon Problems
Tendon Tears
Tendinitis / Tendonosis
Arthritis
Avascular Necrosis (loss of blood supply)
Fractures (acute fractures, delayed unions, nonunions)
Wounds (diabetic, venous, trauma, burns, pressure)
Commonly Asked Questions
How Many Injections do I need?
The injections are extremely effective in controlling inflammation, and jump-starting the healing process. Typically only one injection is needed, however, it is not unusual for someone to need multiple injections in different areas - especially if there are numerous problems.
Where do the Placenta Cells come from?
These cells come from the placentas of Full-Term healthy pregnancies. The donors are screened, and tested for any communicable diseases. These cells do not illicit an immune response which means your body cannot “reject them.”
Are there any Side-Effects
It is important to know that Placental Tissue injections are safe, and the most common side-effect is a “flare-up” after the injection. This can also happen with a cortisone injection. A recent study of a large number of patients undergoing Stem Cell injections showed that there was statistically no greater incidences of post-injection problems compared to standard cortisone injections.
What are my limitations after a treatment?
It depends on the condition being treated. You are able to walk immediately. Some people need to be placed into a Boot for 3-4 weeks, while some just need to use supportive shoes with a splint. It is encouraged not to do any rigorous walking, running, or weight bearing exercises for about 4 weeks.
Can Stem Cells be used to treat Neuropathy?
No. There are no reputable studies showing that placental tissue helps peripheral neuropathy. Neuropathy is extremely difficult to manage, but localized areas of neuropathy caused by external factors can be treated.
ONE LAST WORD...
Diet & Nutrition needs to be optimized in order for the regenerative cells to do their job. It is highly recommended that intake of dietary sugar be limited; as sugars are very inflammatory. Recommended supplements include: Omega 3 Fatty Acids, Vitamin C, Vitamin D, Agmatine, Collagen. Smoking should be stopped. Oral anti-inflammatories (NSAIDs) should not be taken for a period of time (because they inhibit normal healing). Diabetics should have good blood sugar control. People who have auto-immune diseases (Rheumatoid, Lupus, etc) should ask Dr. Weiss if they need to withhold their medication regimen for a short period of time.
For more information, please call our office, (804) 346 -1779.
*****Watch the procedure here: https://www.youtube.com/watch?v=9xgusD1ot8o
