Recovering from Metatarsal Injury: PRP vs. Shockwave Therapy for Runners

Metatarsal injury

Hello, Doctor.
About five months ago (November 2022), I kicked the threshold of my bathroom with the bottom of my foot.
It hurt a lot at the time, but I thought it was just a bruise and assumed it would heal in a few days, so I didn't pay much attention to it.
Since I have a long-standing habit of training for marathons, I continued to maintain a high running volume after the injury.
Eventually, I started to feel increasing pain in the forefoot, which became more severe.
About a month ago (March 2023), I realized I could no longer ignore the situation, so I went to the rehabilitation department at the hospital.
An MRI showed no stress fractures, but an ultrasound revealed fluid accumulation in the forefoot.
I haven't run for the entire month, and I feel that as long as I don't run or walk for too long, I don't experience discomfort.
However, I'm very worried that once I resume training, the issue will flare up again.
A rehabilitation physician suggested PRP or glucose injections.
I would like to ask you: if the goal is to "return to high-intensity marathon training," would you recommend PRP injections or extracorporeal shockwave therapy? Which one has a faster effect? Thank you for your response.

Mav, 40~49 year old female. Ask Date: 2023/04/19

Dr. Wang Zhaomin reply Rehabilitation

Both PRP injections and extracorporeal shock wave therapy have their respective benefits, but they may not be suitable for everyone or every condition.
Each patient's situation is unique, and it is not possible to make a blanket statement.
Please discuss with your treating physician to choose the most appropriate treatment based on your specific condition.

Reply Date: 2023/04/19

More Info

When considering recovery from a metatarsal injury, particularly for someone who is an avid marathon runner, the choice between Platelet-Rich Plasma (PRP) therapy and Extracorporeal Shockwave Therapy (ESWT) is crucial. Both treatment modalities have their own benefits and can be effective, but the decision should be tailored to your specific condition and recovery goals.

Understanding the Treatments:
1. Platelet-Rich Plasma (PRP) Therapy:
PRP therapy involves drawing a small amount of your blood, processing it to concentrate the platelets, and then injecting this concentrated solution into the injured area. The growth factors in platelets can promote healing by stimulating tissue regeneration and reducing inflammation. PRP has been shown to be effective in treating various musculoskeletal injuries, including tendon injuries and joint pain. For runners, PRP can potentially accelerate recovery from soft tissue injuries, allowing for a quicker return to high-intensity training.

2. Extracorporeal Shockwave Therapy (ESWT):
ESWT uses acoustic waves to promote healing in injured tissues. It is non-invasive and can help reduce pain and inflammation while promoting blood flow to the affected area. This therapy is often used for chronic conditions and can be beneficial for conditions like plantar fasciitis or tendonitis. The treatment typically requires multiple sessions and may take longer to show results compared to PRP.

Comparative Effectiveness:
In terms of speed of recovery, PRP may offer a more immediate response due to its regenerative properties. Many patients report a reduction in pain and improvement in function within a few weeks after the injection. However, the effectiveness can vary based on individual healing responses and the severity of the injury.

On the other hand, while ESWT can be effective, it may take several sessions to achieve significant results, and some patients may not experience immediate relief. The cumulative effect of multiple treatments can lead to improvement, but it may not be as rapid as PRP.

Considerations for Runners:
As a marathon runner, your primary goal is to return to high-intensity training as quickly and safely as possible. If you are looking for a treatment that can potentially expedite your recovery, PRP might be the more suitable option. However, it is essential to consider the following:
- Severity of Injury: If your injury involves significant soft tissue damage, PRP may provide the necessary growth factors to enhance healing.

- Response to Previous Treatments: If you have already tried conservative treatments (like rest, ice, compression, and elevation) without success, PRP could be a more aggressive approach to facilitate recovery.

- Consultation with a Specialist: It is crucial to discuss your specific case with a healthcare provider who specializes in sports medicine or rehabilitation. They can assess your injury, review imaging results, and help you weigh the pros and cons of each treatment option based on your unique circumstances.

Conclusion:
In summary, both PRP and ESWT have their merits, but for a runner aiming to return to high-intensity training, PRP may provide a faster and more effective recovery pathway. However, individual responses can vary, and it is essential to have a thorough discussion with your healthcare provider to determine the best course of action tailored to your injury and training goals. Additionally, consider incorporating a comprehensive rehabilitation program that includes physical therapy to strengthen the foot and prevent future injuries as you transition back to running.

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