I’m Going to Disney World: Regenerative Injection Therapy(REGENEXX) Enabling Functional Recovery in Chronic Ankle Dorsiflexion

Suwanee, GA

Chronic foot drop, weakness or inability to dorsiflex the ankle and toes. Gait deficits such as this can originate from issues in the motor pathway of the cerebral cortex or from injury to peripheral nerves that innervate the foot musculature. The most common cause is L5 radiculopathy and peroneal nerve injury, but can also include lumbar herniation, spinal stenosis, and degenerative nerve diseases. Physical therapy has been the fundamental means of treating this issue with a focus on muscle strengthening, adjusting gait patterns and engaging the mechanisms of neural plasticity to improve muscle activation. In lieu of these methods, Ankle-foot orthotics(AFOs) have been utilized to help individuals with dorsiflexion on a consistent basis. However, recent advancements have allowed orthobiologic therapies such as prolotherapy to take centerstage as an effective option for helping these patients reclaim independence, muscle tone and proper gait function again.

This 33 yo female patient worked through chronic foot drop and low back pain for 7 years before prolotherapy was introduced as an option. After multiple rounds of physical therapy, lower back steroid injections for pain that radiated down her leg and compensatory hypertonicity of her hamstrings, her therapist advised her to stop using the AFO as it was not maintaining its purpose stating “Her foot flopped around too much.” When Regenexx with plasma rich platelets was introduced to the clinic, she took the opportunity. The injections were done at her L4-L5 and L6-S1 segments and she was provided exercises to adhere to following the procedure. Within a few months, she was able to take her children to Disney world and walk throughout the park without the AFO. Her dorsiflexion had improved, the muscle tone in the right foot increased and she experienced 80% reduction in pain at the sites of injection.

Prolotherapy with platelet rich plasma has potential to become a front runner in addressing chronic musculoskeletal issues and even shows promise in treating acute injuries as well. This case highlights the role orthobiologic prolotherapy has in improving functional outcomes providing a new tool for recovery.