18 month follow-up on a patient with chronic ankle pain treated with stem cells...
POSTED ON IN Foot and Ankle BY Christopher Centeno
PB is a 32 year old male with a history of ankle problems due to congenital absence of the fibula (he was born without the small outside leg bone). This means that the remaining talus bone has to bear more load than it was designed to carry. As a result, the cartilage on top of the talus (frequently called the talar dome) was beginning to get damaged (the light color in the cartilage in the white dashed circle in the before image above).
One option given to him for chronic ankle pain at that point was an ankle fusion. PB's case was interesting and details how difficult musculoskeltal diagnosis can be and why randomly placing magic stem cells in a patient is a prescription for failure. We initially injected his own stem cells into his talar dome area. While his tibio-talar joint responded (as evidenced by the less bright cartilage signal in the 6 month post image above), he still had pain below this area. Additional exam and x-ray guided diagnostic blocks (numbing specific areas to see if the pain goes away) revealed that he still had pain coming from the talo-calcaneal joint as well (the one below the initially treated joint), so this joint was treated along with the supporting lateral ligaments.
I just met with the patient yesterday at approximately 18 months out from his procedures. He did very well, reporting a significant reduction in pain and improved function. PB knows that because of the continued overload of this area (due to the absence of the fibula), he will likely need additional touch up treatments as times goes on. As a result, we will plan on treating this every 1-2 years to see if it's possible to stave off arthritic changes. While his ankle isn't perfect at this point, it's much improved. As always, not every ankle patient can expect to get these same results.
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