Orthobiologics for Foot & Ankle

Podiatrists at Massachusetts General Hospital offer cutting-edge, regenerative orthobiologic medicine as a non-surgical option for treating below-the-knee ailments.

Explore Orthobiologics for Foot & Ankle

About Orthobiologic Medicine for Foot and Ankle

Orthobiologic medicine is a branch of regenerative medicine that aims to stimulate the body to regenerate or replace cells and tissues damaged due to aging, disease, or injury instead of treating orthopedic conditions through medication and invasive surgical procedures. Clinicians in the Foot and Ankle Center at Massachusetts General Hospital use these non-surgical treatments for foot and ankle conditions and currently offer the below with the goals of stimulating growth and healing:

Growth factors
Cytokines
Collagen
Platelet-rich plasma (PRP)
Amniotic-derived materials
Cell therapy

The Department of Orthopaedic Surgery at Mass General is home to the latest innovations in surgical technology. Our practitioners are board-certified, Harvard Medical School-affiliated physicians with a shared goal to make the patient experience as smooth, fast, precise and painless as possible. You can feel confident in the care that you and your loved ones receive at Mass General and in the expert hands of our multidisciplinary Foot and Ankle team.

A podiatrist from the team featured below will administer your orthobiologic treatments. Podiatrists have focused exclusively on the foot and ankle throughout their training and education, and also specialize in the dermatology and biomechanics of the foot. Mass General’s teams of podiatrists and foot and ankle orthopedic surgeons are among the best in the nation.

Risks & Benefits of Orthobiologic Medicine

Orthobiologic medicines for the foot and ankle are fast and simple treatments sometimes recommended by clinicians as an alternative to surgery. Studies have shown some of the potential benefits of the use of orthobiologics include:

Non-steroidal
Promotes local healing
Acts as a potent anti-inflammatory
Reduces injury scarring
Recruits a patient’s own cells
Fewer complications than surgery
Quicker recovery

Some of the potential risks include:

Temporary pain and swelling at injection site
Injection site infection
Failure of treatment

Foot and Ankle Conditions Treated by Orthobiologic Medicine

Mass General podiatrists offer regenerative medicine procedures as an option for treating:

Arthritis
Bursitis
Diabetic foot ulcers
Venous stasis ulcers
Fat pad atrophy and associated metatarsalgia
Fibroma
Joint Pain in the foot and ankle
Metatarsalgia

Neuroma
Nonunions
Plantar fasciitis
Plantar plate injury
Porokeratosis
Tendonitis of the foot and ankle
Wounds (chronic and post-operative)

To learn more about non-surgical options for foot and ankle, including orthobiologic medicine, call the Podiatry line of the Mass General Foot and Ankle Center at 617-726-3487. Our team offers a variety of foot and ankle treatments, including orthobiologic medicine, at both our main Boston campus and our convenient Waltham location. The team also offers virtual consultations and appointments as appropriate.

Frequently Asked Questions about Orthobiologic Medicine

Where do the tissues and cells used in orthobiologics come from?

Tissues and cells used in orthobiologics can be autologous, meaning they come from the patient themselves. Platelet-rich plasma (PRP) is a concentrated form of a patient’s own blood, for example. Regardless of the source, the new cells produce building blocks, such as collagen and growth factors, that are part of the healing process. The actual cells introduced are rejected by your immune system after stimulating growth. Your provider can answer additional questions you have regarding the sources used for your specific treatment.

Is orthobiologic medicine covered by my insurance?

In some cases, but not always. Similar to wound treatment, the use of these treatments may be covered by insurance when specific indications are met. Some insurance companies may not cover certain procedures because they are still considered experimental. Patients should work closely with their insurance carriers to determine coverage limitations prior to receiving treatment.

How long does an orthobiologic appointment take?

Once you make an appointment, the doctor will evaluate your condition and suggest the appropriate treatment. Orthobiologic medicine is typically administered by injection and may be administered as soon as immediately following your consultation. PRP treatment involves drawing and concentrating your blood, and therefore takes a bit longer than a simple injection but is still a relatively fast outpatient treatment.

How long does an orthobiologic treatment last? What if it doesn’t work?

The duration following treatment is variable. For wounds, treatment is completed with wound closure. For musculoskeletal conditions, more than one treatment may be required, and typically, the response to an injection lasts between 3 months and 1 year, although in some cases, a single injection is sufficient to resolve the condition. Your doctor will follow up with you after treatment to monitor healing and functional changes and may recommend additional treatments as necessary.

How soon after an orthobiologic treatment for foot and ankle can I stand/walk?

Orthobiologics are minimally invasive treatments. Typically, you should rest for one week following treatment. Your doctor will discuss a recovery plan and any activity limitations with you prior to your treatment.

Is it safe to receive orthobiologic treatments during a pandemic?

Mass General mandates masks for all patients and providers in accordance with state and federal guidelines and our Safe Care Commitment. Because we are treating your lower leg and/or foot, it will not be necessary to remove your mask during orthobiologic treatments. Follow up appointments can be done virtually and don’t necessarily involve return trips to the doctor’s office.

Meet the team

Adam Landsman, DPM, PhD
- Podiatrist
- Podiatric Surgeon
- Bioengineering Researcher
Sara Rose-Sauld, DPM
- Podiatrist
- Podiatric Surgeon
Jennifer Skolnik, DPM
- Podiatrist
- Podiatric Surgeon

More About Orthobiologics for Foot and Ankle

Orthobiologics is a relatively new field of medicine, and Mass General researchers are constantly researching and testing outcomes and efficacy for all the treatments on offer. Below is a list of citations providing more information on orthobiologic medicine for foot and ankle. These sources were consulted by clinicians when drafting the orthobiologic information on this webpage.

Risks & Benefits of Orthobiologic Medicine

Cohen MM, Altman RD, Hollstrom R, Hollstrom C, Sun C, Gipson B. “Safety and efficacy of intra-articular sodium hyaluronate (Hyalgan) in a randomized, double-blind study for osteoarthritis of the ankle.” Foot Ankle International. 2008;29(7):657-63.
Fukawa T, Yamaguchi S, Akatsu Y, Yamamoto Y, Akagi R, Sasho T. “Safety and Efficacy of Intra-articular Injection of Platelet-Rich Plasma in Patients with Ankle Osteoarthritis.” Foot Ankle International. 2017;38(6):596-604.
Usuelli FG, Grassi M, Maccario C, Vigano M, Lanfranchi L, Alfieri Montrasio U, de Girolamo L. “Intratendinous adipose-derived stromal vascular fraction (SVF) injection provides a safe, efficacious treatment for Achilles tendinopathy: results of a randomized controlled clinical trial at a 6-month follow-up.” Knee Surg Sports Traumatol Arthroscopy. 2018;26(7):2000-2010.

Foot & Ankle Conditions Treated by Orthobiologic Medicine

Agenor A, Dvoracek L, Leu A, Hunter DA, Newton P, Yan T, Johnson PJ, Mackinnon SE, Moore AM, Wood MD. “Hyaluronic acid/carboxymethyl cellulose directly applied to transected nerve decreases axonal outgrowth.” Journal of Biomed Mater Res B Appl Biomater. 2017;105(3):568-574.
Akpancar S, Gul D. “Comparison of Platelet Rich Plasma and Prolotherapy in the Management of Osteochondral Lesions of the Talus: A Retrospective Cohort Study.” Medical Science Monitor. 2019; 25:5640-5647.
Bianchi C, Cazzell S, Vayser D, Reyzelman AM, Dosluoglu H, Tovmassian G, Epifix VLU Study Group. “A multicentre randomised controlled trial evaluating the efficacy of dehydrated human amnion/chorion membrane (Epifix(R)) allograft for the treatment of venous leg ulcers.” International Wound Journal. 2018;15(1):114-122.
Cazzell S, Stewart J, Agnew PS, Senatore J, Walters J, Murdoch D, Reyzelman A, Miller SD. “Randomized Controlled Trial of Micronized Dehydrated Human Amnion/Chorion Membrane (dHACM) Injection Compared to Placebo for the Treatment for Plantar Fasciitis.” Foot & Ankle International. 2018;39(10):1151-1161.
DeGroot H 3rd, Uzunishvili S, Weir R, Al-omari A, Gomes B. “Intra-articular injection of hyaluronic acid is not superior to saline solution injection for ankle arthritis: a randomized, double-blind, placebo-controlled study.” JBJS. 2012;94(1):2-8.
de Vos RJ, Weir A, van Schie HT, Bierma-Zeinstra SM, Verhaar JA, Weinans H, Tol JL. “Platelet-rich plasma injection for chronic Achilles tendinopathy: a randomized controlled trial.” JAMA. 2010;303(2):144-9.
DiDomenico LA, Orgill DP, Galiano RD, Serena TE, Carter MJ, Kaufman JP, Young NJ, Jacobs AM, Zelen CM. “Use of an aseptically processed, dehydrated human amnion and chorion membrane improves likelihood and rate of healing in chronic diabetic foot ulcers: A prospective, randomised, multi-centre clinical trial in 80 patients.” International Wound Journal. 2018;15(6):950-957.
Ducic I, Yoon J, Eberlin KR. “Treatment of Neuroma-Induced Chronic Pain and Management of Nerve Defects with Processed Nerve Allografts.” Plastic and Reconstructive Surgery. 2019; 7(12):e2467. Fetterolf DE, Snyder RJ. “Scientific and clinical support for the use of dehydrated amniotic membrane in wound management.” Wounds. 2012;24(10):299-307.
Fitzpatrick J, Bulsara M, Zheng MH. “The effectiveness of platelet-rich plasma in the treatment of tendinopathy: a meta-analysis of randomized controlled clinical trials.” American Journal of Sports Medicine. 2017;45(1):226-233.
Foumenteze JP, Simpson H, Kerrouche N. “Hyaluronic Acid Filler Injections Under the Metatarsal Heads Provide a Significant and Long-Lasting Improvement in Metatarsalgia From Wearing High-Heeled Shoes.” Dermatologic Surgery. 2018;44(78):994-1001.
Jantzen C, Ebskov LB, Andersen KH, Benyahia M, Rasmussen PB, Johansen JK. “The Effect of a Single Hyaluronic Acid Injection in Ankle Arthritis: A Prospective Cohort Study.” JFAS. 2020;59(5):961-963.
Jauwealers AK, Van Oost L, Peers K. “Evidence for the use of PRP in chronic midsubstance Achilles tendinopathy: A systematic review with meta-analysis.” Foot & Ankle Surgery. 2021;27(5):486-495.
Krogh TP, Ellingsen T, Christensen R, Jensen P, Fredberg U. “Ultrasound-guided injection therapy of Achilles tendinopathy with platelet-rich plasma or saline: a randomized, blinded, placebo-controlled trial.” American Journal of Sports Medicine. 2016;44(8):1990-7.
Landsman A, Roukis TS, DeFronzo DJ, et al. “Living cells or collagen matrix: which is more beneficial in the treatment of diabetic foot ulcers?” Wounds : a Compendium of Clinical Research and Practice. 2008;20(5):111-116.
Landsman AS, Cook J, Cook E, et al. “A Retrospective Clinical Study of 188 Consecutive Patients to Examine the Effectiveness of a Biologically Active Cryopreserved Human Skin Allograft (TheraSkin ®) on the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers.” Foot & Ankle Specialist. 2011;4(1):29-41.
Landsman A, Rosines E, Houck A, Murchison A, Jones A, Qin X, Chen S, Landsman AR. “Characterization of a Cryopreserved Split-Thickness Human Skin Allograft-TheraSkin.” Adv Skin Wound Care. 2016;29(9):399-406.
Laurent I, Astere M, Wang KR, Cheng QF, Li QF. “Efficacy and Time Sensitivity of Amniotic Membrane treatment in Patients with Diabetic Foot Ulcers: A Systematic Review and Meta-analysis.” Diabetes Therapy. 2017;8(5):967-979.
Lee K, Hwang IY, Ryu CH, Lee JW, Kang SW. “Ultrasound-Guided Hyaluronic Acid Injection for the Management of Morton's Neuroma.” Foot Ankle International. 2018;39(2):201-204.
Lin MT, Chiang CF, Wu CH, Hsu HH, Tu YK. “Meta-analysis comparing autologous blood-derived products (including platelet-rich plasma) injection versus placebo in patients with Achilles tendinopathy.” Arthroscopy. 2018;34(6):1966-1975.
Liu CJ, Yu KL, Bai JB, Tian DH, Liu GL. “Platelet-rich plasma injection for the treatment of chronic Achilles tendinopathy: A meta-analysis.” Medicine (Baltimore). 2019;98(16): e15278.
Miranda EP, Friedman A. “Dehydrated Human Amnion/Chorion Grafts May Accelerate the Healing of Ulcers on Free Flaps in Patients with Venous Insufficiency and/or Lymphedema.” ePlasty. 2016;16: e26.
Mrugala A, Sui A, Plummer M, Altman I, Papineau E, Frandsen D, Hill D, Ennis WJ. “Amniotic membrane is a potential regenerative option for chronic non-healing wounds: a report of five cases receiving dehydrated human amnion/chorion membrane allograft.” International Wound Journal. 2016;13: 485-492.
Patel VR, Samavedi S, Bates AS, Kumar A, Coelho R, Rocco B, Palmer K. “Dehydrated Human Amnion/Chorion Membrane Allograft Nerve Wrap Around the Prostatic Neurovascular Bundle Accelerates Early Return to Continence and Potency Following Robot-assisted Radical Prostatectomy: Propensity Score-matched Analysis.” European Urology. 2015;67(6):977-980.
Penny H, Rifkah M, Weaver A, Zaki P, Young A, Meloy G, Flores R. “Dehydrated human amnion/chorion tissue in difficult-to-heal DFUs: a case series.” Journal of Wound Care. 2015;24(3):106-9.
Serena TE, Carter MJ, Le LT, Sabo MJ, DiMarco DT, EpiFix VLU Study Group. “A multicenter, randomized, controlled clinical trial evaluating the use of dehydrated human amnion/chorion membrane allografts and multilayer compression therapy vs. multilayer compression therapy alone in the treatment of venous leg ulcers.” Wound Repair Regeneration. 2014;22(6):688-93.
Serena TE, Yaakov R, DiMarco D, Le L, Taffee E, Donaldson M, Miller M. “Dehydrated human amnion/chorion membrane treatment of venous leg ulcers: correlation between 4-week and 24-week outcomes.” Journal of Wound Care. 2015;24(11):530-4.
Shah AP. “Using amniotic membrane allografts in the treatment of neuropathic foot ulcers.” JAPMA. 2014;104(2):198-202.
Sheikh ES, Fetterolf DE. “Use of dehydrated human amniotic membrane allografts to promote healing in patients with refractory non-healing wounds.” International Wound Journal. 2014;11(6):711-7.
Vannabouathong C, Fabbro GD, Sales B, Smith C, Li CS, Yardley D, Bhandari M, Petrisor BA. “Intra-articular Injections in the Treatment of Symptoms from Ankle Arthritis: A Systematic Review.” Foot Ankle International. 2018;39(10):1141-1150.
von Wehren L, Pokorny K, BLanke F, Sailer J, Majewski M. “Injection with autologous conditioned serum has better clinical results than eccentric training for chronic Achilles tendinopathy.” Knee Surg Sports Traumatol Arthrosc. 2019;27(9):2744-2753.
Willett NJ, Thote T, Lin AS, Moran S, Raji Y, Sridaran S, Stevens HY, Guldberg RE. “Intra-articular injection of micronized dehydrated human amnion/chorion membrane attenuates osteoarthritis development.” Arthritis Research & Therapy. 2014;16(1): R47.
Younger ASE, Penner M, Wing K, Veljkovic A, Nacht J, Wang Z, Wester T, Harrison A. “Nonanimal Hyaluronic Acid for the Treatment of Ankle Osteoarthritis: A Prospective, Single-Arm Cohort Study.” JFAS. 2019;58(3):514-518.
Zelen CM, Serena TE, Gould L, Le L, Carter MJ, Keller J, Li WW. “Treatment of chronic diabetic lower extremity ulcers with advanced therapies: a prospective, randomised, controlled, multi-centre comparative study examining clinical efficacy and cost.” International Wound Journal. 2016;13(2):272-82.
Zelen CM, Serena TE, Fetterolf DE. “Dehydrated human amnion/chorion membrane allografts in patients with chronic diabetic foot ulcers: A long-term follow-up study.” Wound Medicine. 2014;4:1-4.
Zelen CM, Serena TE, Snyder RJ. “A prospective, randomised comparative study of weekly versus biweekly application of dehydrated human amnion/chorion membrane allograft in the management of diabetic foot ulcers.” International Wound Journal. 2014;11(2):122-8.
Zelen CM, Serena TE, Denoziere G, Fetterolf DE. “A prospective randomized comparative parallel study of amniotic membrane wound graft in the management of diabetic foot ulcers.” International Wound Journal. 2013;10(5):502-7.
Zelen CM. “An evaluation of dehydrated human amniotic membrane allografts in patients with DFUs.” Journal of Wound Care. 2013;22(7):347-8.
Zhang YJ, Xu SZ, Gu PC, Du JY, Cai YZ, Zhang C, Lin XJ. “Is platelet-rich plasma injection effective for chronic Achilles tendinopathy? A meta-analysis.” Clinical Orthopedics and Related Research. 2018;476(8):1633-1641.