Stem Cell Therapy for the Foot and Ankle

The procedure begins with obtaining the stem cells. If taken from bone marrow, the back of the hip (iliac crest) is the best site. The hip skin is cleaned with an antiseptic, and the skin is numbed using lidocaine. After anesthesia, the procedure needle is gently guided into the iliac crest using real-time x-ray to assure correct placement. Stem cells are aspirated out during the procedure. If the adipose tissue is used, the stem cell solution is obtained from the fat tissue using a liposuction technique. The surgeon must make a tiny incision to insert the cannula.

Once the stem cell bone marrow solution or fat tissue is obtained, it must be processed in the laboratory. A centrifuge (spinning machine) is used to separate the stem cells from other body fluid components. After the stem cells are purified and processed, the solution is injected into the foot or ankle region.

When the stem cells are injected into the degenerative joint or injured foot/ankle region, they immediately begin to multiply, flourish, and regenerate. Stem cells can replicate themselves and nearby cells to mimic those cells, which makes healing faster and produces an anti-inflammatory effect that reduces pain. In addition, stem cells contain hyaluronic acid, which is a natural joint lubricant. This eases the pain of injured tendons and joints, allowing for restored mobility.

Donor stem cells are sometimes used in the procedure. The cells often come from amniotic fluid, which is donated during cesarean section surgeries from delivering mothers. The amniotic fluid is extremely high in stem cell concentration, consisting of extra-cellular matrix (ECM). ECM is beneficial for cell migration and attachment, and it signals the body’s own local stem cells to assist in the repair process.

Although approval from the Food and Drug Administration is pending clinical study results, stem cell technology is being used by many orthopedic surgeons and pain management specialists to treat degenerative conditions of the foot and ankle. Once the stem cells are delivered to the arthritic joint or degenerative tendon, local signaling of exogenous factors drive pluripotent cells to differentiate, regenerating the body structure.

In recent studies, stem cell technology contributed to the creation of ligament and tendon grafts in animal subjects. In a recent study, bone marrow-derived stem cells were used to repair a rabbit Achilles tendon. Researchers found that the addition of the stem cells to the foot in a fibrin carrier resulted in improved collagen organization and increased modulus at the 3-week evaluation. The current clinical reports show that stem cell technology is useful for treating tendinopathy.

Chong AK, Ang AD, Goh JC, et al. (2007). Bone marrow-derived mesenchymal stem cells influence early tendon-healing in a rabbit Achilles tendon model. J Bone Joint Surg Am, 89, 74-81

Juncosa-Melvin N, Boivin GP, Gooch C, et al. (2006). The effect of autologous mesenchymal stem cells on the biomechanics and historlogy of gel-collagen sponge constructs used for rabbit patellar tendon repair. Tissue Eng, 12, 369-379.

Kryger GS, Chong AK, Costa M, et al. (2007). A comparison of tenocytes and mesenchymal stem cells for use in flexor tendon tissue engineering, 32, 597-605.