4.Plantar Fascia Technique
(1)ZimmerWave radial pulse therapy was applied to the painful area, typically 1500 pulses, at 10 hertz and 110 mJ.
(2)The plantar fascia was visualized under ultrasound imaging, and the area was aseptically prepared with Betadine or alcohol.
(3)0.5 mL of PalinGen SportFLOW and 0.5 mL of 1% lidocaine were drawn into a 3 mL syringe with a 22- Gauge needle.
(4)Observing the plantar fascia under ultrasound guid- ance, the approach was from medial to lateral. The needle was directed to the superior surface of the plantar fascia, not directly into the plantar fascia, and
0.3 mL was deposited along the medial and central bands of the fascia.
(5)The needle was then redirected to the plantar aspect of the plantar fascia and another 0.3 mL was deposited along the fascial band.
(6)The needle was then redirected towards the central plantar calcaneal bursa between the medial and lateral tubercles and the remainder of the allograft was implanted.
(7)The patient was instructed to stretch every 30 minutes with a traditional runners calf stretch during waking hours.
(8)Patients were also instructed to wear lace up stable shoes, to minimize time being barefoot and to min- imize wearing flip-flops or slip-on shoes.
(9)No anti-inflammatory medication was taken for 3–6 weeks.
(10)No ice was applied to the affected area.
Achilles tendinopathy patients were chosen from a pool of patients with Achilles pain, who were unresponsive to a variety of therapies including stretching, physical therapy, and modified shoe gear and in some cases low energy radial pulse therapy. Imaging confirmed that there was no rupture using either MRI or diagnostic ultrasound.
5.Achilles Tendon Technique
(1)ZimmerWave radial pulse therapy was applied to the painful area, typically 1500 pulses, at 10 hertz and 110 mJ.
(2)The Achilles tendon was visualized under ultrasound imaging, and the area was aseptically prepared with Betadine or alcohol.
(3)1.0 mL of PalinGen SportFLOW and 1.0 mL of 1% lidocaine were drawn into a 3 mL syringe with a 22- Gauge needle.
(4)Observing the Achilles tendon under ultrasound guidance, the needle was directed along the paratenon starting on the medial aspect, not into the tendon substance, and 0.5 mL was deposited along the medial aspect of the tendon. The needle was then redirected to the posterior aspect of the tendon and the remain- der was deposited along the lateral aspect.
(5)Patient was instructed to stretch every 30 minutes with a traditional runners calf stretch during waking hours.
(6)Patients were also instructed to wear lace up stable shoes, to minimize time being barefoot and to min- imize wearing flip-flops or slip-on shoes.
(7)No anti-inflammatory medication was taken for 3–6 weeks.
(8)No ice was applied to the affected area.
6.Results
In total, 44 patients experiencing chronic plantar fasciosis and Achilles tendinosis, with a mean age of 55.1 and 47.7 years, respectively, who were all unresponsive to multiple standard therapies for a minimum of 6 months, were treated with one implantation of PalinGen SportFLOW around the plantar fascia and/or into and around the Achilles paratenon. Following treatment they were instructed to wear laced shoes and perform posterior muscle group stretching exercises or rolling pin massage instructions. No changes were made to their exercise routines.