This information about neural prolotherapy for feet relates to treatment for irritated nerves. You can find information related to prolotherapy for ligaments, tendons and joints here.
The idea behind Neural Prolotherapy it essentially this. An injury of some sort damages one of the body’s tissue. Following this, the nerves that supply the damaged tissue becomes irritated. This irritation can continue long after the original injury has settled and can affect the nerve higher or lower than the injury. The outcome of an irritated nerve can include pain, swelling, altered reflexes and muscle spasm.
Nerve fibres contain a large amount of connective tissue. They are subject to strains and injury like any other tissue. A sharp ‘yank’ on a nerve, for example at the outside of an ankle during a sprain, can affect its function for a long time. This may be due to the the physical organisation of the ‘supply services’ that support the nerve bundles.
The structure of a nerve is a bit similar to a tube of plastic electrical conduit. The fibres of the nerve run inside, with the connective tissue packing out the volume. The ‘tube’ is the epi-neural sheath. Around the outside of the sheath run the blood vessels and the tiny nerves that supply the nerve itself. These micro-structures are called the nervi nervorum.
Chronic Constriction Injury
The mechanism of just how the nerve is injured is a bit mysterious. At this time, it is currently thought to involve a Chronic Constriction Injury (CCI). Nerves commonly pass from one area to another through a hole of some sort, or around a corner or under some other structure. This happens in many, many places. If irritation and swelling enlarges the nerve inside these passage ways which have a fixed diameter, it can cause a ‘strangulation’ of the nerve. As the blood supply and nerves run around the outside of the nerve bundle, they are most prone to this compression and strangulation. This may result in malnourishment of the nerve. This in turn limits healing of the nerve itself and sometimes the tissues that the impaired nerve services.
What is injected during Neural Prolotherapy?
For peripheral cutaneous nerves, the infiltrate is a 5 % (weak) glucose solution. This is a sterile liquid of 95% water and 5% glucose. It is hypotonic and extracted immediately before injection from a sterile bag. The solution within the bags is intended for use intravenously (I.V.) It is vitally important that substances administered by the I.V. route are sterile and safe which reinforces the idea of this sterile glucose and water mixture being a harmless substance. Neural prolotherapy uses sub-cutaneous injections, that is, just beneath the skin. Neural prolotherapy does not intended to deliver the injection into a blood vessel.
Possible effects of Neural Prolotherapy
Anabolic effect (repair) on connective tissue
Reduction in number of neovessels
Reduced cross section of tendon in tendinosis ie tighter bundles of muscle fibres
Reduced tendon oedema / swelling
Improved architecture of collagen in tendons ie more orderly bunches of connective tissue
Which Nerves are injected during neural prolotherapy?
This depends entirely on the location of the pain. A knowledge of nerve anatomy is required to determine which nerve is likely to be supplying the painful area. These nerves then carry the pain impulses back to the brain. The nerves will be palpated along their course and painful trigger points are marked. A normal nerve does not have the painful spots to touch that we find in affected nerves.
How is Neural Prolotherapy for Feet Performed?
The weak glucose solution is introduced using a very fine needle just below the skin. As the injections are superficial, they are not particularly painful. There may be a series of five to ten spots done to follow the nerve until it reaches the constriction point. Stronger glucose solutions used in soft tissue prolotherapy can be irritating. At this weak 5% strength, the solution itself is not and so local anaesthetic is usually not used. Often, the injections will relieve the pain very quickly when the correct area is targeted. It isn’t unusual for people to be free of the original discomfort before leaving the clinic. This improvement fades initially and a series of three to six treatments is usually envisaged.
What can Neural Prolotherapy be used for?
- Calf muscle strain
- Shin splints
- Medial/lateral ankle pain
- Achilles’ Tendon Injury
- ‘Cuboid syndrome’
- Morton’s neuroma
- ‘Bunion pain’
- Plantar fascia syndrome
- Heel pain especially where not responsive to standard treatment
- Knee pain
- ITB syndrome
- Pes Anserinus syndrome
- Jumpers knee
- Runners knee
- Infra/supra patellar tendinopathy
- Osteoarthritic pain
What are the risks of Neural Prolotherapy?
This treatment has been used extensively in the field of sports medicine. At the time of writing, no serious side effects had been reported. For the most part, the main risk is if the clinician has chosen the wrong treatment to address your condition. If this is the case, the treatment will fail and the series of injections will not prove useful. On the upside, it is extremely unlikely that any harm will come from the therapy. The podiatrist will discuss the risks and rewards in your specific circumstances. They will answer questions to help you to decide if this is an option you wish to explore.