Achilles, Foot & Ankle Pain · Non-Surgical Care · Glastonbury, CT
Achilles tendinopathy, plantar fasciitis, and ankle joint pain evaluated with the same evidence-first approach used since 2007 — starting with live ultrasound diagnosis and treatment matched to the tendon or joint you actually have not the one an X-ray report describes.
Quick answer
Achilles, foot, and ankle pain is most often approached without surgery first: activity modification, footwear changes, and targeted strengthening, then, when that isn't enough, ultrasound-guided orthobiologic injections such as PRP, BMA, or MFAT. The evidence for PRP is stronger in plantar fasciitis than in Achilles tendinopathy specifically, where results have been more mixed. Candidacy depends on how much healthy tendon or cartilage remains and what live ultrasound shows — not age or X-ray severity alone. Surgery remains the right answer for a complete Achilles rupture or end-stage, bone-on-bone ankle arthritis.
Most common conditions
Achilles tendinopathy, plantar fasciitis, ankle arthritis
Diagnosis method
Live, dynamic ultrasound examination
Non-surgical options
PRP, BMA, MFAT, prolotherapy
Return to activity
Usually within days; depends on treatment
First results
Weeks 4 to 16, depending on treatment
Who treats you
Dr. Tortland personally, every visit
When surgery is right
Complete Achilles rupture or bone-on-bone ankle arthritis
Insurance
Not covered; but HSA / FSA applicable
Definition
And why the right diagnosis matters more than the treatment you pick.
Achilles, foot, and ankle pain has several distinct sources — degeneration inside the Achilles tendon, inflammation at the plantar fascia, cartilage wear inside the ankle joint, or ligament laxity from a prior sprain that never fully healed. Two patients describing the same "heel pain" or "ankle pain" can have very different problems underneath. Confirming which structure is actually failing on live ultrasound, rather than assuming from an X-ray alone, is the starting point for any treatment plan.
Not every painful heel or ankle needs an injection, and not every injection is appropriate for every case. Whether conservative care, PRP, a cellular treatment like BMA or MFAT, or a referral for surgery is the right next step depends on how much healthy tendon or cartilage remains, what's actually causing the pain, and the patient's own goals.
Indications
The Achilles, foot, and ankle conditions seen most often in this practice, treated without surgery whenever the evidence and the ultrasound findings support it.
Step by step
01
Before anything is injected, the tendon, fascia, or joint is examined dynamically on ultrasound so the treatment target is confirmed rather than assumed. This is a separate visit from treatment.
02
Whereas most facilities only draw 30-60mL of blood, Dr. Tortland uses a tailored High-Concentrate blood draw, 60 to 250+mL depending on the target. Volume is chosen for the condition being treated, the patient's age, and platelet count.
03
Your blood is spun in office with a double-spin protocol to separate and concentrate the platelet fraction. Preparation takes 20-30 minutes while you wait in the room.
04
The patient's blood platelet count is analyzed by a Cell Counter. The PRP platelet concentration is tailored to each patient's injury, age, and baseline platelet count. Dr. Tortland's High-Concentrate process derives an average blood platelet count of at least 12-15x the patient's baseline platelet count, where most standard kits derive only 2-6x baseline platelet count -- not enough to even be considered true PRP.
05
The area is numbed with local anesthetic, then the needle is advanced under live MSK ultrasound and / or fluoroscopic guidance into the exact structure(s) at fault. You can watch the screen as it happens.
06
You leave with a written loading schedule. Expect two to five days of soreness — that inflammatory response is the treatment working. No anti-inflammatories for two weeks.
07
Follow-up at six to ten weeks with repeat ultrasound and / or an updated MRI to compare tissue appearance and patient symptom progression against baseline and decide whether a second PRP procedure adds value.
Candidacy
Comparison
Frequently asked
Sources
01
Mulvaney SW, Tortland PD, Shiple B, Curtis K. Regenerative medicine options for chronic musculoskeletal conditions: a review of the literature. Endurance and Sports Medicine. 2018.
02
Dai WL, et al. Efficacy of platelet-rich plasma versus hyaluronic acid in knee osteoarthritis: meta-analysis of randomized controlled trials.
03
Filardo G, et al. Platelet-rich plasma intra-articular injections for cartilage degeneration and osteoarthritis: evidence and indications.
05
Bennell KL, et al. Effect of intra-articular platelet-rich plasma on knee pain and cartilage volume: randomized clinical trial.
06
Everts P, et al. Platelet-rich plasma: new performance understandings and therapeutic considerations for classification and dosing.
**Medical Disclaimer:** Information on this page is provided for educational purposes and does not constitute medical advice, diagnosis, or treatment, guarantee a particular outcome, or establish a physician-patient relationship. Treatment suitability and expected results vary by patient and depend on individual clinical circumstances and the available scientific evidence. The inclusion of a procedure, treatment, or therapy on this website does not mean that it is appropriate for every patient, effective for every condition, superior to other treatment options, or guaranteed to produce a particular result. Orthobiologic procedures discussed on this website are medical procedures performed under the practice of medicine. The FDA regulatory status of any particular product, device, or use may vary, and FDA approval or clearance should not be inferred unless specifically stated. Dr. Tortland reports no financial interest in the products or devices described on this page. Individual results vary, and treatment decisions require an appropriate clinical evaluation, including an in-person examination when indicated.
Candidacy is determined on ultrasound, not over the phone. Bring your imaging and get an honest answer about your hip in one visit.