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DrThomasMd
DrThomasMd, Board Certified MD
Category: Neurology
Satisfied Customers: 63757
Experience:  Internal medicine doctor, diagnose and treat neurology patients, many years
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What works better, PRP, AmnioFix, or PX50? All very confusing-

Customer Question

What works better, PRP, AmnioFix, or PX50? All very confusing- I have a toe issue- thanks
Submitted: 1 year ago.
Category: Neurology
Expert:  DrThomasMd replied 1 year ago.
Hello
What is the medical diagnosis for your "toe issue?"
Customer: replied 1 year ago.




MRI Foot Without Contrast (Right)
CLINICAL HISTORY: Foot pain. Possible 2nd metatarsal fracture versus Freiberg's infraction.

TECHNIQUE
Multiplanar, multisequence MR images of the right forefoot were acquired on a 3 Tesla wide bore GE magnet with high performance gradients. No intravenous contrast was administered.

COMPARISON
No prior study available for comparison.

FINDINGS:

OSSEOUS STRUCTURES: There is subchondral marrow edema and cystic change within the 2nd metatarsal head, with mild flattening of the articular surface (series 8 and 9, image 17), which could represent chronic Freiberg's infraction or a chronic osteochondral impaction injury with superimposed degenerative changes. No displaced fracture identified. There is also moderate degenerative arthropathy spanning 1st metatarsal head­tibial (medial) hallux sesamoid articulation, and minimal degenerative changes spanning the 1st metatarsal head­fibular hallux sesamoid articulation. Minimal 1st and mild 2nd MTP joint fluid is noted. No widening of the Lisfranc interval identified.

SESAMOIDS: The hallux sesamoid complex is anatomically aligned. Degenerative changes are noted spanning the 1st metatarsal head­hallux sesamoid articulations as detailed above. No avascular necrosis identified.

PLANTAR PLATES: There is degeneration and minimal chronic fraying of the tibial hallux sesamoid­phalangeal ligament and 1st plantar plate. The 2nd through 5th plantar plates are intact.

BURSAE: No metatarsal interspace bursitis identified.

MORTON NEUROMA: Minimal infiltration of the 2nd metatarsal interspace is noted extending plantar, compatible with nonspecific fibrosis versus a minimal Morton neuroma (series 6, image 19).

MUSCLES: Normal muscle bulk of the imaged right forefoot. TENDONS: The imaged flexor and extensor tendons are intact.

SOFT TISSUES: Minimal nonspecific subcutaneous edema is noted within the forefoot, most prominent dorsomedially and surrounding 2nd MTP joint.










CONCLUSION: MRI Foot Without Contrast (Right)






1. Subchondral marrow edema and cystic change within the 2nd metatarsal head, with flattening of the articular surface. Differential considerations include the sequela of chronic Freiberg's infraction, or a chronic osteochondral impaction injury with superimposed degenerative changes.

2. Degenerative arthropathy spanning the 1st metatarsal head and hallux sesamoid articulations as detailed above.

3. Infiltration of the 2nd metatarsal interspace fat, which could represent nonspecific fibrosis or a minimal Morton neuroma.

4. Lower grade and nonacute incidental findings as detailed in the body of the report.

Thank you for the opportunity to participate in the care of your patient. Please contact us if we can be of further assistance.

Chad Silverberg, D.O. Progressive Radiology

Electronically signed by: Chad Silverberg, D.O. on 5/4/2015 10:03 AM EDT

Patient: MIDDLETON, LELAND
Chart: 129843
Reading Doctor: Chad Silverberg, D.O. Referral Fax: 202­686­0932
CPT: 73718





Expert:  DrThomasMd replied 1 year ago.
No sure what you are asking about the above materials...none of them are tested for this situation.
aminofix is a cempen.
PRP is platelet rich plasma, AND will help regenerate ligaments and cartilage to some degree.
PX 50 is an artificial bone matrix.
Can you clarify where you came up with this, and what you are asking?
Customer: replied 1 year ago.

A PT at Fasttrack therapy has been helping and she recommended an orthopedic who does PRP- went to see him and they think this will help regenerate my toe issue. I went to my podiatrist the the other day and he said PRP is kind of outdated and he has the right answer w/PX 50 (placenta tissue matrix)- or Amniofix. He says both are better than PRP- one shot in toe as opposed to multiple shots,etc. He said amniofix and Placenta tissue matrix are superior- I don't know what to think and am having trouble finding the answer- all of which are supposed to regenerate my cartilage or something like that- otherwise my podiatrist says I could do surgery at some point. Very confusing

Expert:  DrThomasMd replied 1 year ago.
OK
I can help here.
PRP has more data, which is very little.
The others have little to zero data.
It is all based on the doctors experience.
You need to ask each doctor how many situations just like yours they have fixed...what success rate. That is the only data you will have.
OK, so that is an initial answer….
Please use reply to expert if you have further questions. When you are ready, please click a positive rating [hopefully excellent]. If you forgot something, come back. I am here daily.
Customer: replied 1 year ago.

ok good idea- I may have a another question once I ask this to them.

Expert:  DrThomasMd replied 1 year ago.
Please click a positive rating [we are only paid per positive rating]
Come back as needed.