CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 22 0000. ref SDS 20 0000.
040502 -
040503 -
040504 -
040506 - ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - On 180105 1321 letter to Doctor Thuillier in VA Orthopedics notified
040902 - have been unable to download radiologist report on MRI of both feet
040903 - performed on 171229. ref SDS 20 O46F Further explained plan on
040904 - driving to VAMCSF to get the report from VA Release of Information
040905 - (ROI). ref SDS 20 I492 Also planned to schedule meeting with Doctor
040906 - Thuillier for review results of MRI studies on feet and knees. 180105
040907 - 1321, ref SDS 20 I495
040909 - ..
040910 - On 180108 letter to Doctor Thuillier reported PRP treatment in both
040911 - feet and both knees on 180105 1630, ref SDS 21 HP5O, and related
040912 - research indicating PRP yields measurable increase in minisucs
040913 - cartilage over 6 months. ref SDS 21 JX67
040915 - ..
040916 - Meeting today, was scheduled with Jane in Orthopedics on 180108 1030.
040917 - ref SDS 22 JS9O
040919 - ..
040920 - Doctor Thuillier concurred with radiologist report that MRI study on
040921 - 171229, does not show increased thickness of cartilage, including left
040922 - knee miniscus compared to prior MRI on 160805, and 5 months after PRP
040923 - injection treatment on 170726 1600, ref SDS 4 4Y8K, as discussed with
040924 - Doctor Tucker prior to PRP on 180105 1630. ref SDS 21 AY9J
040926 - ..
040927 - The doctor noted significant recovery from multiple bone fractures in
040928 - right leg femur and tibia, and bone marrow edema reported in the MRI
040929 - on 171229 0745. ref SDS 18 DR55 Explained this followed implementing
040930 - Doctor Dang's prescription to avoid running and sprinting for a year,
040931 - presented during a meeting at VAMCSF on 161212 1632. ref SDS 3 ON35
040933 - ..
040934 - Doctor Thuillier was pleased recovery while hiking 2,300 miles since
040935 - 160805, and including Half Done on 160914 0530. ref SDS 2 0001
040937 - ..
040938 - Doctor Thuillier noted explanation by Doctor Tucker during treatment
040939 - last Friday, that PRP injections relieved pain by repairing soft
040940 - tissues, like collagen, reported on 180105 1630, ref SDS 21 T14I He
040941 - advised that pain in the feet from hiking occurs from reduction of fat
040942 - pads that protect forefoot metatarsals. MRI studies cannot detect
040943 - this wear, nor regeneration that occurs with PRP injections.
040945 - ..
040946 - He seemed to explain that collegan eventually transforms into
040947 - cartilage that can repair knee miniscus, and also repairs torn
040948 - ligaments and tendons. This occurs over a long time.
040950 - ..
040951 - PRP injections in the feet on...
040952 -
040953 - 170726 1600..................... ref SDS 4 GU6N
040954 - 170816 1400..................... ref SDS 5 K65M
040955 - 180105 1630..................... ref SDS 21 F28K
040957 - ..
040958 - This line of care has reduced pain in the feet while hiking. Several
040959 - months ago noticed balls of feet seem thicker, which may correlate
040960 - with PRP regeneration of collagen in the forefeet.
040962 - ..
040963 - After the meeting today, research on the Internet found...
040964 -
040965 - Institute for Preventive Foot Health
040966 - IPFH.org
040967 -
040968 - Foot Care Essentials
040970 - ..
040971 - Fat Pads: What You Need to Know
040972 -
040973 -
040974 - https://www.ipfh.org/foot-care-essentials/fat-pads-what-you-need-to-know
040975 -
040976 - All of us have fat pads (technically, "plantar fat pads") on
040977 - the bottoms of our feet. These fat pads protect the feet's
040978 - bones, tendons, ligaments, blood vessels and nerves. They
040979 - provide this protection by absorbing the impact, shear forces
040980 - and pressures that are involved in nearly every type of
040981 - activitye.g., walking, running, playing sports and even
040982 - simply standing still.
040984 - ..
040985 - The plantar fat pads are composed of many microchambers that
040986 - contain fatty tissue. These chambers are formed by walls of
040987 - elastin (mainly collagen) that are flexible and pliable. They
040988 - stretch and rebound to help absorb and dissipate the forces
040989 - and pressures especially shock and vibrationthat occur during
040990 - activity. However, this fat pad protection tends to diminish
040991 - with age and everyday activities.
040993 - ..
040994 - Age, Activity, Trauma
040996 - ..
040997 - By age 50, a normally active person will have walked or run
040998 - about 75,000 miles, and will have lost as much as half of the
040999 - fat pad protection on his or her feet. If we all walked
041000 - barefooted on natural surfaces such as sand and grass, the
041001 - damage would not be nearly as severe. But most of us spend the
041002 - bulk of our time moving around on man-made surfaces
041003 - (pavement, hard floors and other non-yielding surfaces).
041004 - This takes a toll on the fat pads, making the feet more
041005 - vulnerable to pain and injury. (For more on how hard surfaces
041006 - affect the feets fat pads, see the IPFH white paper New
041007 - Treatment Modalities for the Human Foot ). Thinning fat pads
041008 - also leave the outer skin and underlying areas more vulnerable
041009 - to shear stress, which can cause lesions, wounds, and
041010 - eventually ulceration of the skin.
041012 - ..
041013 - In addition, trauma caused by landing heel-first on a hard
041014 - surface (after a fall or jump, for example), or from spending
041015 - long periods of time standing and walking on hard surfaces in
041016 - poorly designed and/or poorly fitted footwear, can lead to
041017 - fat-pad displacement. When this happens, the fat pads do not
041018 - fully protect the bones and other structures beneath the pads.
041019 -
041021 - ..
041022 - Another article says...
041023 -
041024 - Mortons Neuroma Home
041026 - ..
041027 - 10 Signs You May Have Morton's Neuroma
041028 -
041029 -
041030 - Fat Pad Atrophy of the Foot
041031 - Foot Care, Foot Pain
041032 -
041033 - https://www.mortonsneuroma.com/fat-pad-atrophy-foot/
041035 - ..
041036 - One of the complications of Morton's neuroma surgery and
041037 - Morton's neuroma corticosteroid injections is Fat Pad Atrophy.
041038 - It causes significant foot pain and metatarsalgia.
041040 - ..
041041 - What is the Pedal Fat pad and what does it do?
041043 - ..
041044 - The fat pad is the thick pad of connective tissue that runs
041045 - under the main arch of the foot and forms the lower aspect of
041046 - foot. The purpose of the fat pad is:
041047 -
041048 - 1. To provide cushioning to minimize the effect of friction,
041049 - pressure and gravitational forces on the foot musculature;
041050 - and,
041052 - ..
041053 - 2. To serve as a mechanical anchor that helps in shifting the
041054 - body weight without overwhelming connective tissue
041055 - elements.
041057 - ..
041058 - What is Fat Pad Atrophy?
041060 - ..
041061 - Fat pad atrophy the gradual loss of the fat pad in the arch of
041062 - the foot. Conditions like fat pad atrophy of the foot are more
041063 - common in aging population and usually presents with severe
041064 - foot pain during walking. Fat Pad atrophy is the thinning of
041065 - the pad that exposes the delicate connective tissue elements to
041066 - strain and pressure creating inflammation and micro-injury. In
041067 - poorly managed cases, patients present with severe pain and
041068 - discomfort.
041070 - ..
041071 - Some characteristic symptoms of fat pad atrophy include:
041072 -
041073 - 1. Pain in the foot (Metatarsalgia) which becomes worse when
041074 - wearing high heels or walking over a hard flat surface.
041076 - ..
041077 - 2. Pain in the foot when a person is in standing position for
041078 - extended periods of time. (62% of diagnosed sufferers
041079 - report excessive foot pain after a long walk or long period
041080 - of standing.)
041082 - ..
041083 - 3. Feeling of the development of a mass or swelling in the foot/ heel.
041085 - ..
041086 - 4. The ball of foot may become excessively thick due to callus
041087 - formation.
041089 - ..
041090 - Who is at risk of getting Fat Pad Atrophy?
041092 - ..
041093 - The risk profile and prevalence of fat pad atrophy is fairly
041094 - comparable in males and females. However, some experts believe
041095 - that females are relatively more vulnerable to develop this
041096 - condition because of:
041098 - ..
041099 - Certain factors that may aggravate the risk of developing Fat
041100 - Pad Atrophy such as:
041101 -
041102 - 1. Age: The risk of developing degenerative foot conditions
041103 - increases with progressing age. With increasing age new
041104 - cartilage and fat tissue formation decreases which makes
041105 - the bones weaker and more prone to damage. (By our
041106 - mid-30?s, foot fat pads begin to deteriorate or thin.
041107 - Sometimes, the thinning doesn?t happen evenly.
041109 - ..
041110 - By our 50's, some people lose as much as half of the fat
041111 - that normally pads and protects the ball and heel area of
041112 - the foot. By our 70?s, the fat pads can be quite thin.)
041114 - ..
041115 - This aligns with experience in 2013 - 2014. Balls of feet hurt badly
041116 - after hiking 11 - 22 miles per day. By next morning, feet felt good,
041117 - enalbing another hike.
041119 - ..
041120 - By middle of 2014, feet continued to hurt next day, so needed
041121 - treatment at VAMCSF on 140805 1030. ref SDS 1 556J
041123 - ..
041124 - Article continues...
041125 -
041126 - 2. Collapsed bone: Degeneration or damage to the long bones of
041127 - the foot can exert significant pressure over the fat pad
041128 - leading to increased wear and tear damage..
041130 - ..
041131 - 3. Footwear: As discussed previously, the footwear selection
041132 - can cause as well as aggravate the risk of foot pad
041133 - atrophy.
041135 - ..
041136 - 4. High arch: Certain anatomical characteristics, such as high
041137 - pedal arches can also cause changes in the foot pad by
041138 - applying direct pressure on the connective tissue
041139 - architecture.
041141 - ..
041142 - 5. Injury: Injuries caused by significant trauma such as an
041143 - accident, or other forms of trauma which leads to multiple
041144 - fractures or surgeries can also increase the risk of
041145 - developing fat pad atrophy
041147 - ..
041148 - 6. Family history: Family history or genetics plays a very
041149 - important role in development of atrophic and degenerative
041150 - conditions.
041152 - ..
041153 - 7. Arthritis: Inflammation of joints especially in the setting
041154 - of rheumatoid arthritis aggravates the risk of fat pad
041155 - atrophy as the bones becomes more vulnerable to damage as a
041156 - result of ongoing inflammation
041158 - ..
041159 - 8. Diabetes: Individuals with persistently high blood sugar
041160 - levels are vulnerable to develop neuropathy (which leads to
041161 - numbness and loss of sensation in the foot). The chances of
041162 - developing pressure-induced atrophic changes increases
041163 - resulting in fat pad atrophy.
041165 - ..
041166 - 9. Steroid Injections: Steroid injections in the foot,
041167 - especially if done too frequently can cause fat pad
041168 - atrophy.
041170 - ..
041171 - 10. Medications: Chronic use of steroids is also known to cause
041172 - fat pad atrophy in adults.
041174 - ..
041175 - Fortunately, Doctor Tang has always resisted providing steriod
041176 - injections to resolve feet pain.
041177 -
041179 - ..
041180 - Article continues...
041181 -
041182 - Treatment of Fat Pad Atrophy:
041183 -
041184 - 1. Avoid activities which puts too much pressure on the foot
041185 - such as walking on hard, flat or uneven surfaces.
041187 - ..
041188 - Goal is hiking 3000 miles per year to maintain HDL, EPCs and
041189 - Telomeres at levels that sustain longevity with quality of life.
041191 - ..
041192 - Article continues...
041193 -
041194 - 2. Avoid wearing high heel and switch to comfortable footwear.
041196 - ..
041197 - 3. Opt instead for low impact weight bearing exercises to
041198 - optimize healing and regeneration processes.
041200 - ..
041201 - 4. Use paddings or insoles to allow even distribution of
041202 - weight to minimize the direct impact of pressure.
041204 - ..
041205 - On 170929 purchased Satallite Elite insoles, ref SDS 8 TZ56, with
041206 - relief cutout on bottom for plantar plate injury. ref SDS 8 DH8F
041208 - ..
041209 - Article continues...
041210 -
041211 - 5. Chose footwear that supports the foot (especially the heel
041212 - and arches) to provide cushioning and shock absorbing.
041214 - ..
041215 - On 170829 Doctor Tang in VAMCSF Podiatry recommended getting shoes
041216 - with better cushioning. ref SDS 6 9N77
041218 - ..
041219 - On 170929 purchased Bondi 5 Wide shoes from On-the-Run because
041220 - superior plush cushioning felt like walking on pillows. ref SDS 8 TZ5H
041222 - ..
041223 - Article continues...
041224 -
041225 - 6. Regenerative medicine is a new field that shows significant
041226 - potential in the treatment of fat pad Atrophy, especially
041227 - Platelet Rich Plasma injections and Stem Cell Therapy.
041229 - ..
041230 - Three (3) treatments with PRP have stimulated regeneration of collegan
041231 - and other soft tissues, per above. ref SDS 0 ZG6F
041233 - ..
041234 - There is a link to another cite explaining...
041236 - ..
041237 - Platelet Rich Plasma Injections for Morton?s Neuroma
041238 -
041239 -
041240 - https://www.mortonsneuroma.com/mortons-neuroma/treatments-mortons-neuroma/platelet-rich-plasma-injections-mortons-neuroma/
041242 - ..
041243 - Platelet rich plasma therapy (abbreviated as PRP) is the
041244 - re-administration of your own platelets to activate the
041245 - body's natural healing cascade for repair and regeneration
041246 - to treat Morton?s neuroma. It is successfully used for
041247 - various musculoskeletal problems, such as of injured
041248 - tendons, ligaments, muscles and joints. In fact, Platelet
041249 - rich plasma injections are replacing traditional orthopedic
041250 - surgery in many instances for conditions ranging from soft
041251 - tissue injuries (tendonitis, muscle tears, ligamentous
041252 - injuries) to various joint afflictions, such as a torn
041253 - meniscus or mild to moderate arthritis of the joint.
041255 - ..
041256 - Platelet activation plays a key role in the process of
041257 - wound and soft tissue healing, especially when
041258 - inflammation is present. Platelet rich plasma injection
041259 - involves the use of a portion of your own blood, which has
041260 - a high platelet concentration. PRP injections are
041261 - prepared by using a small amount of your own blood which
041262 - is centrifuged and then a portion of concentrated blood
041263 - containing activated platelets is injected into the
041264 - abnormal tissue.
041266 - ..
041267 - The injection of your own platelets causes a local
041268 - inflammatory reaction, releasing growth factors that
041269 - stimulate healing and muscle regeneration, and limiting the
041270 - amount of scar tissue. The treatment exert positive
041271 - effects via multiple mechanisms including:
041272 -
041273 - 1. Activation and release of the body's natural growth
041274 - factors in the abnormal tissue. This response has been
041275 - proven to stimulate the tissue regeneration processes.
041277 - ..
041278 - 2. Localized inflammatory response that increases the blood
041279 - flow to the abnormal tissue.
041281 - ..
041282 - 3. Limitation of scar tissue formation.
041284 - ..
041285 - We use ultrasound imaging to guide the injection and this
041286 - increases the accuracy of the PRP procedure, and
041287 - potentially reduces post-procedural pain. We also use light
041288 - activation of our platelets, which increases the
041289 - effectiveness of the platelets and also decreases the post
041290 - procedure discomfort. PRP injection therapy is generally
041291 - completed in just one session, but may require additional
041292 - injections depending upon the clinical circumstances.
041293 -
041295 - ..
041296 - Doctor Thuillier noted PRP treatment for feet and knees that enable
041297 - hiking extended miles to regress plaque buildup in circulatory system,
041298 - may also extend quality of life by preventing the natural loss of
041299 - telomeres.
041301 - ..
041302 - He explained telomeres exist at each end of DNA chromosomes, and the
041303 - ends are lost each time cells replicate. When telomeres are
041304 - completely gone, cell replication cannot occur, resulting in atrophy
041305 - of body througout, similar to athrosclerosis.
041307 - ..
041308 - Fortunately, telomeres can be maintained with extended endurance
041309 - exercise, similar to raising HDL and EPCs that maintain the
041310 - circulatory system.
041312 - ..
041313 - Doctor Thuillier ended the meeting noting the patient is doing well.
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