Prolotherapy

Prolotherapy, short for “proliferative therapy,” is a medical treatment that involves injecting a solution (usually a dextrose-based solution) into ligaments, tendons, or other connective tissues to stimulate the body’s natural healing response. The goal of prolotherapy is to strengthen and stabilize these tissues by inducing inflammation and encouraging the growth of new collagen fibers.

Prolotherapy is sometimes used solely, or often in combination with other adjunct therapies ( bracing, rehabilitation, etc) for treatment of musculoskeletal pain and injuries, including those affecting the foot and ankle. In the context of foot and ankle issues, prolotherapy might be considered for conditions such as ligament sprains, chronic ankle instability, plantar fasciitis, Achilles tendonitis, and other soft tissue injuries.

Here’s how the prolotherapy process  works:

1. Assessment: A thorough evaluation of the foot and ankle is performed to determine the underlying cause of pain or instability. This  involve physical examinations, medical history review, and possibly imaging studies.
2. Injection: During the prolotherapy procedure, a solution containing dextrose (a type of sugar) is injected into the affected ligaments, tendons, or joints. The injection causes controlled inflammation at the site, which is believed to trigger the body’s natural healing response.
3. Inflammation and Healing: The controlled inflammation caused by the injection is intended to stimulate the body to send healing cells to the area, promoting tissue repair and the production of new collagen fibers. This can lead to increased strength and stability in the treated tissues.
4. Recovery: After the procedure, patients might experience some discomfort and inflammation as the healing process takes place. Over time, the treated area should gradually become stronger and more stable, reducing pain and improving function.

Here at Cheltenham Podiatry, we provide a personal approach based on your specific needs. There are two types of Prolotherapy used here at the clinic.

Classic prolotherapy and the Lyftogt technique. These techniques involve injecting dextrose (sugar) solutions into tissues to stimulate healing and reduce pain. Here’s an overview of each:

1. Classic Prolotherapy: Classic prolotherapy, also known as traditional or standard prolotherapy, involves injecting a solution (usually a sterile dextrose-based solution, 15-25%) into ligaments, tendons, joints and other connective tissues at or near the site of pain or injury. The goal is to create controlled inflammation, which stimulates the body’s natural healing process. Over time, this process is believed to lead to tissue repair, strengthening, and increased stability. Often used for pain relief and Improved function in arthritis, or to heal damaged ligaments and tendons. Often these injections maybe ultrasound guided for more accurate placement.
2. Lyftogt Technique: The technique is different to the classic prolotherapy. Developed by Dr. John Lyftogt. This technique focuses on targeting nerve endings within the connective tissues, rather than just the structural components like ligaments and tendons. In this technique, a very low concentration of sterile glucose 5% buffered solution (dextrose) is used as the injectable solution. The injections are directed towards specific points where nerve endings are sensitive or painful. The goal is to reduce neurogenic inflammation and promote pain relief by affecting the nervous system’s response to pain signals.

The Lyftogt technique is often referred to as “neural prolotherapy” due to its emphasis on addressing nerve-related pain and inflammation. It’s thought to work by resetting nerve signals and restoring normal nerve function in the affected areas.

Both classic prolotherapy and the Lyftogt technique aim to promote tissue healing and pain relief through different mechanisms. The choice between these techniques may depend on factors such as the nature of the condition, the patient’s response to treatment. Cheltenham Podiatrists are experts in this field, with our lead podiatrist Jacqueline teaching  the techniques to other podiatrists.

Classic prolotherapy is a treatment option that is sometimes considered for various foot and leg conditions, particularly those involving chronic pain, instability, or soft tissue injuries. It aims to stimulate the body’s natural healing processes by promoting tissue repair and strengthening. Here are some foot and leg conditions that may be treated with classic prolotherapy:

1. Chronic Ankle Instability: Classic prolotherapy may be used for patients with chronic ankle instability due to repeated ankle sprains. Injections are typically targeted at the ligaments surrounding the ankle joint to improve stability.
2. Plantar Fasciitis: Prolotherapy may be considered for plantar fasciitis, a condition characterized by heel pain. Injections are usually directed at the plantar fascia to promote healing and reduce inflammation.
3. Achilles Tendonitis: Achilles tendonitis involves inflammation of the Achilles tendon, which connects the calf muscles to the heel bone. Prolotherapy injections may target the Achilles tendon to encourage healing.
4. Tendon and Ligament Injuries: Various tendon and ligament injuries in the foot and leg, such as those affecting the posterior tibial tendon or peroneal tendons, may be candidates for prolotherapy to facilitate healing and reduce pain.
5. Osteoarthritis: In cases of osteoarthritis in the foot or ankle, prolotherapy might be considered as a complementary treatment to help manage pain and improve joint function.
6. Joint Instability: Conditions that cause joint instability in the foot or leg, such as ligament laxity, may benefit from prolotherapy injections to strengthen the affected ligaments.
7. Shin Splints: Prolotherapy has been explored as a potential treatment for chronic exertional compartment syndrome (shin splints). It aims to address the soft tissue inflammation and pain associated with this condition.

Lyftogt perineural therapy targets the nerve endings that are sensitive or painful, known as valleix points. It has been used for various foot and leg conditions that involve chronic pain and nerve-related issues. Some conditions that might be considered for Lyftogt perineural therapy include:

1. 1. Plantar Fasciitis: This condition involves inflammation of the plantar fascia, which causes heel pain. Lyftogt perineural therapy may target nerve endings around the heel area to reduce pain and inflammation.
   2. Neuropathy: Peripheral neuropathy, which can affect the feet and legs, involves damage to the peripheral nerves and can result in pain, tingling, and numbness. Lyftogt perineural therapy may be used to alleviate these symptoms by addressing nerve-related issues.
   3. Chronic Regional Pain Syndrome (CRPS): CRPS is a complex and painful condition that can affect any part of the body, including the legs and feet. Lyftogt perineural therapy may be considered as a component of a comprehensive treatment plan to manage pain and improve function.
   4. Tarsal Tunnel Syndrome: Similar to carpal tunnel syndrome but affecting the foot, tarsal tunnel syndrome involves compression of the tibial nerve. Lyftogt perineural therapy may be used to address nerve-related pain in this condition. This can be done with ultrasound guidance on some occasions.
   5. Morton’s Neuroma: This is a painful condition that involves thickening of the tissue around one of the nerves leading to the toes. Lyftogt perineural therapy may be explored to reduce pain and discomfort associated with Morton’s neuroma.
   6. Nerve Entrapment Syndromes: Various nerve entrapment syndromes can affect the lower extremities. Lyftogt perineural therapy may be considered to address pain and discomfort related to these conditions.
   7. Post-Surgical Pain: In some cases, patients may experience chronic pain following foot or leg surgery. Lyftogt perineural therapy could be explored as a treatment option to alleviate this pain
   8. Tarsal Tunnel Syndrome: Prolotherapy injections may be considered for tarsal tunnel syndrome, a condition similar to carpal tunnel syndrome but affecting the foot. This is often done under ultrasound guidance , otherwise known as deep hydro dissection, to baths the damaged nerve in the dextrose solution to normalise its function and release any constriction from surrounding structures. 

If you have a pain condition, that is not resolving, please book an assessment to see if these techniques are suitable a option to solve your pain.