Stem Cells and Severe Ankle Arthritis: A Nepal Trekker Gets Her Hike Back


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Regenexx Blog
by Chris Centeno, MD / May 23, 2019

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I see great stories from patients who we’ve treated with interventional orthobiologics all day, but I tend to write about the ones that surprise me. This is the story of a truly crazy path to recovery that begins in Nepal, circles through Grand Cayman, and then finally back to Denver. The craziest thing about this one is that it is that rare story of making the crippled walk. Let me explain.

Tracy’s Story
Tracy used to live and work in Nepal. She loved trekking in the Himalayas and was quite the world traveler, but much of that came to a screeching halt when she was diagnosed with severe ankle arthritis. At the ripe old age of 39, she was told she needed an ankle fusion. Why? Because at that point wakling more than a few hundred steps was tough. She spent most of her days seated and her max ankle pain was unbearable at a 9-10/10.

She was first seen in 2017 in our Colorado office by Dr. Hyzy. As an example of her disability, she was unable to attempt a standing squat in the office. Her MRI images are below showing severe subtalar joint arthritis (yellow arrowheads point to the areas of dead bone and lost cartilage):

She also had ankle instability due to lax ligaments as well as severe tendon hypertrophy. Let’s dive into what all of that means.

What is the Subtalar Joint?
There’s the main hinge ankle joint and then a joint below that called the subtalar joint:

What is Instability and Tendon Hypertrophy?
By far, the biggest cause of ankle arthritis is instability. This happens when you turn your ankle, damaging the ankle ligaments. For most people, the ankle seems to heal just fine, but at some later date begins to hurt. This happens because the ankle ligaments that protect the joint never fully heal and are loose, allowing too much motion in the joint. This extra motion leads to wear and tear arthritis. Watch my video below to learn more:

Tendon hypertrophy is also caused by ankle instability and sometimes bad nerves in the low back. This means that the tendons that cross the ankle get bigger and weaker. This happens because the tendons are getting beat up and can’t fully heal. This then leads to the tendons adding more tissue to increase their overall strength, while their strength per unit area is poor. Hence the tendons hypertrophy or get bigger.

Tracy’s Cayman Treatment
Tracy went to our licensed advanced culture expansion site in Grand Cayman which allowed her to get a higher stem cell dose and save cells for future use. She had these culture-expanded stem cells injected into the joint using x-ray and ultrasound guidance. Why both? The sub-talar joint can be technically demanding to access, hence the dual imaging guidance. I also placed her stem cells into the damaged bone (intraosseous). Finally, we also treated her damaged ligaments and tendons. To learn more about Grand Cayman, see my video below:

Back in Colorado
When I first performed an exam about 6 weeks later in Colorado, I noted something wasn’t quite right. She was still not walking much and was spending too much time in a wheelchair for that stage in her recovery. She was also getting new numbness in her foot. A quick ultrasound exam showed what was wrong. Her already big tendons were swollen from the aggressive fenestration I had to do to get them to heal with the stem cells. This caused some pressure on her adjacent posterior tibial nerve and therefore the numbness. I was able to fix this with specific ultrasound-guided procedures to reduce the swelling and protect the nerve. All of that got her walking again.

This treatment detour is an important thing to discuss. This is a new field, so there is no textbook to go to understand what’s happening when a patient who you’ve treated suddenly gets new numbness in their foot. Given that regenerative therapies like this to avoid tendon surgery are brand new, this is where experience and quick thinking are critical.

Back to Life, Back to Re-al-ity
While the Soul II Soul song reference is a bit cheesy, it probably fits here. How do you take a woman who is literally crippled at the beginning and get her back to walking again? The answer is through lots of care. She needed multiple follow-up treatments with PRP and other therapies to continue to heal her severely damaged ligaments and tendons. I also had to add in a Prolon diet to help reduce her severe whole body inflammation.

The Final Result
I saw Tracy yesterday. I was dumbfounded. She now hiking several miles and has even begun a HIIT class. She has gone from walking a few hundred steps a day to often more than 10,000. She has some aches and pains, but she even jumped up and down for me yesterday as I wanted to check out how she handled her knees under stress. After she did that, I remembered the 39-year-old who couldn’t walk more than a few steps in the office. This was truly a “making the crippled walk” type result.

The upshot? As I said from the outset, I get bombarded with great patient outcomes all week. I saw a woman yesterday who was told she needed a low back fusion who was 90% better after a single treatment. However, that result pales in comparison to Tracy. This is a woman who literally couldn’t walk without severe pain. While I needed to move her slowly from point A to B and we had at least one small scare in there, the fact that we’re talking about some mild aches and pains after a High-Intensity Training class or a several mile hike is amazing! It’s results like these that get me up each morning!