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Injection therapy in podiatric practice




Were you thinking “can a podiatrist inject into a persons foot, ankle, or knee well, the answer is a “yes”. If you are interested in how injectables in podiatric practice can play an important part in your management, please read on. Do you experience from ingrown toenails, chronic musculoskeletal pain (bunions, osteoarthritis in foot/ankle/knees, morton’s neuroma, patella tendinopathy, bursitis, synovitis, torn ligaments, shin splints, muscle strains, heel pain (plantar fasciopathy), ankle instability/pain from previous ankle injury, achilles or other painful foot, ankle and knee joints). I am going to give you a better understanding of how injectables can be brought into your management of your current complaint.


There are a few injectables a podiatrist can practice in their day to day clinic.

Local Anaesthesia

Ingrown toenails Acute or chronic ingrown toenails are very problematic to the patient and cause a great deal of

discomfort when putting shoes on or walking. This is when a podiatrist will perform a partial nail avulsion surgery, meaning the inside, outside or both nail sections are removed. The traumatic toenail

Retronychia(nail grows on top of other nail)/Onychmycosis (fungal nail) This is when a total nail avulsion is performed to remove the traumatised toenail. Both these procedures require a podiatrist to inject a local anaesthetic into the base of the toe to numb it.



Nerve block

This requires blocking off either or potentially both the tibial, superficial peroneal, saphenous and

sural nerve block of the foot/ankle nerves. This is done by knowing where the nerves traverse through the knee, ankle and foot regions. In addition, this can be a good diagnostic tool a podiatrist can utilise.




Prolotherapy

Prolotherapy was designed by a surgeon in the United States George Hackett in the 1930s-1950s to treat chronic pain. Prolotherapy is a nonsurgical regenerative injection technique that introduces small amounts of an irritant solution to the site of painful and degenerated tendon insertions (entheses), joints, ligaments, and in adjacent joint spaces during several treatment sessions to promote growth of normal cells and tissues. Irritant solutions most often contain dextrose (d-glucose), a natural form of glucose normally found in the body.. The most common prolotherapy agent used in clinical practice is dextrose, with concentrations ranging from 12.5% to 25%.20 Dextrose is considered to be an ideal proliferant because it is water soluble, a normal constituent of blood chemistry, and can be injected safely into multiple areas and in large quanties.


Classic Hackett Prolotherapy


This procedure is 12.5%-25% glucose with anaethestic solution which is injected into the damaged tissue. This stimulates a cascade of events that promote healing of the soft tissues.

Prolotherapy works by the same process that the human body naturally uses to stimulate the body’s healing system, a process called inflammation. The technique involves the injection of a proliferant (a mild irritant solution) that causes an inflammatory response which “turns on” the healing process. The growth of new ligament and tendon tissue is then stimulated. The ligaments and tendons produced after prolotherapy appear much the same as normal tissues, except that they are thicker, stronger, and contain fibers of varying thickness, testifying to the new and ongoing creation of tissue.

Lyftogt’s Perineurial Prolotherapy

John Lyftogt's perineural prolotherapy otherwise known as P.I.T is an exciting and innovative advancement in regenerative medicine. It uses 5% glucose injection just under the skin with a small fine needle where no local anaesthesia is required that treats pain, inflammation and damaged tissues. Based on Hilton's Law "the nerve that supplies sensation to the joint also supplies sensation to the skin over that joint and the muscles that move that joint". This suggests if a nerve is irritated that supplies the skin over a joint it may affect (cause pain and change function) in the joint or muscles around that joint.



Platelet Rich Plasma PRP


Platelets are small colourless, disc shaped cell fragments lack a nucleus that are found in blood and play an important role in clot formation. There are growth factors derived from platelets that are responsible for soft tissue repair, bone regeneration, development of new blood vessels and stimulation of wound healing.


This procedure does require removal of one's own blood, getting the blood into a centrifuge for separation of blood segments, therefore, GP referral, having a sterile lab equipment is required.


*All podiatrists undertaken prolotherapy or prp injections should be trained



Endorsement of scheduled medicines


A podiatrist can do an extra 12 months (150 hours) training with an endorsed podiatrist/podiatric surgeon or GP to gain their endorsement of scheduled medicines. This means a podiatrist can act on with dialogue with the patient’s GP. For example, a patient attends the clinic with chronic plantar fasciitis and conservative treatment hasn’t worked and endorsed podiatrist can do cortisone injections, instead of referring back to a radiologist or another specialist. It can be done straight away given symptomatic relief instead of potentially waiting a few days or weeks which delays the treatment needed.


We hope you have found the above information helpful. If you need any further information or wish to make an appointment with one of our podiatrists, we would love to help you.


We are located at 108 Bridport St, Albert Park Vic 3206, or you can call us on 03 8648 7678. Alternatively, you can click on the book now button below and it will take you to our online booking page.







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