Ankle and Foot

Foot Pain Prolotherapy

In a new paper on treatment guidelines, researchers suggested that 10% of the population can be effected by Plantar Fasciitis, so it is clearly a major problem for doctors to deal with.

The underlying cause involves microtrauma to the plantar fascia, specifically at its insertion point on the calcaneus (heel bone) where the soft tissue attaches to bone. Successful management of plantar fasciitis is typically achieved with the conservative  therapy approaches.1

There are many conservative treatments that can provide relief from chronic severe plantar fasciitis. A new paper examining these options suggest several therapies including rest, physical therapy, stretching, and change in footwear, arch supports, orthotics, night splints, anti-inflammatory agents, and surgery. Almost all patients respond to conservative nonsurgical therapy.2

However, in some cases chronic severe plantar fasciitis does not respond and the patient remains with pain and mobility issues.

Treating The Patient With Chronic Severe Plantar Fasciitis

Two research papers examined a comparison between Platelet Rich Plasma (PRP)  and cortisone steroid injections – the prefered treatment for reducing the inflammation of the fascia to the heel bone.

At 12 months, PRP is significantly more effective than Steroid, making it better and more durable than cortisone injection.

In the most recent paper, doctors found “PRP is as effective as Steroid injection at achieving symptom relief at 3 and 6 months after injection, for the treatment of plantar fasciitis but unlike Steroid, its effect does not wear off with time. At 12 months, PRP is significantly more effective than Steroid, making it better and more durable than cortisone injection.”3

This researched followed an earlier paper presented at the 2012 Annual Meeting of the American Academy of Orthopaedic Surgeons which concluded that platelet-rich plasma (PRP) was a  more effective than cortisone for chronic severe plantar fasciitis.4

Morton’s Neuroma

The American Orthopaedic Foot and Ankle Society describes Morton’s Neuroma as feeling like you are “walking on a marble,” and you have persistent pain in the ball of your foot. A neuroma is a benign tumor of a nerve. Morton’s neuroma is not actually a tumor, but a thickening of the tissue that surrounds the digital nerve leading to the toes.

Doctors at the Department of Trauma & Orthopaedic Surgery, Scarborough General Hospital published their review on the diagnosis and management of Morton’s neuroma. In it they call Morton’s neuroma a common condition mainly affecting middle aged women. There are many reasons that can cause Neuroma including chronic repetitive trauma, ischemia (loss of blood supply), entrapment (Nerve compression syndrome), and intermetatarsal bursitis.

They note that the current nonoperative treatment strategies include shoe-wear modifications, custom made orthoses, and injections of local anesthetic agents, sclerosing agents (which can include Prolotherapy and Platelet Rich Plasma), and steroids. Operative management options primarily involve either nerve decompression or neurectomy.5

Many patients come into the office having been misdiagnosed with Morton’s neuroma. This condition affects the toe area, and is caused by nerves getting entangled at the base of the foot or in between the toes. Most often the problems associated with Morton’s neuroma are actually symptoms of metatarsalgia, which is a simple inflammation of the same area. Metatarsalgia has also been very successfully treated with PRP foot injections.

The use of ultrasound guided injections in problems of the Morton’s Neuroma

Doctors at the University Hospitals of Leicester in England explored whether it was better to use ultrasound guided cortisone injections when offering foot pain treatments, than not using the ultrasound guidance. What they were looking for was if the ultrasound improved the cortisone treatments.

What they found was that in dealing with foot anatomy, their study showed that ultrasound guidance did not demonstrably improve the efficacy of corticosteroid injections in patients with Morton’s Neuroma. Secondly a trained clinician who understands the forefoot anatomy may perform an injection without ultrasound guidance with good and safe results.6

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