Alternative treatments for foot pain | Prolotherapy
Prolotherapy: Alternative treatment for foot pain
Perhaps no activity, sports or work, puts as much pressure and demand on the feet as dancing does. If you can show improvement in dancers than you can reasonably expect a high level of success in foot problems in other patients.
In this article we will examine treatment options and the research behind Prolotherapy for foot pain. See our main page, Prolotherapy for foot pain for more information.
Writing in the The Journal of Orthopaedic and Sports Physical Therapy doctors reported on a case where Prolotherapy injections successfully treated a dancer who had suffered from foot instability due to the excessive force she was placing on her metatarsophalangeal joints (the foot area formed by the metatarsal and phalangeal bones of the toes).
In their case presentation the doctors reported that the 33-year-old dancer with insidious onset (meaning slowly developing and without symptoms) of the medial arch and second and third metatarsophalangeal joint pain had imaging studies revealing:
- osteoarthritis of the first metatarsophalangeal joint,
- second metatarsophalangeal joint calcification,
- capsulitis (ligament inflammation),
- and plantar plate rupture (ligament tear), leading to a diagnosis of instability.
The dancer underwent a treatment program that included taping, padding, physical therapy, a series of prolotherapy injections, and activity modification.
One year after discharge, the dancer reported pain-free dancing with no taping or padding.(1)
Ligaments of the toes and feet – the cause of foot pain and instability
In the case study above the stress of dancing severely compromised the structures of the foot and caused degenerative conditions throughout the foot.
In 2012, Ross Hauser, MD and Wayne A. Feister, DO published findings in the Foot and Ankle Online Journal from the International Foot and Ankle Foundation.
In this research the doctors examined the foot for hallux valgus, a precursor to bunions, and hallux rigidus, stiffness in the big toe and associated ligament laxity known to cause these problems.
In this study, twelve patients were treated with a series of Prolotherapy injections to stimulate the regeneration of tendons and ligaments and to promote the repair of articular cartilage. Upon completion of three-to-six therapy sessions, eleven of twelve patients had a favorable outcome—the relief of symptoms—with an average of four treatments.(2)
One year earlier in 2011, health professionals here at Caring Medical published their findings on alternative treatments for foot pain. The main treatment tested was Prolotherapy. Here is what Ross Hauser, MD and colleagues published in the Journal of Prolotherapy:
The goal of the observation study was to test the effectiveness in patients using comprehensive dextrose Prolotherapy treatments on foot and toe pain. Patients were chosen who were given a varied diagnoses as to the cause of their foot pain. Some of the most common are hallux rigidus (stiff big toe) and hammer toes. Prolotherapy is an injection treatment used to initiate a healing response in injured connective tissues such as tendons and ligaments, common in painful foot and toe conditions.
- Nineteen patients who had been in pain an average of 54 months were treated quarterly with Prolotherapy. This included eight patients who were told by their medical doctor(s) that there were no other treatment options for their pain.
- Patients were contacted an average of 18 months following their last Prolotherapy session and asked questions regarding their levels of pain, physical and psychological symptoms, as well as activities of daily living, before and after their last Prolotherapy treatment.
- In these 19 patients, all 100% had improvements of their pain and stiffness.
- Eighty-four percent experienced 50% or more pain relief.
Prolotherapy helped the patients make large improvements in walking and exercise ability, as well as produced decreased levels of anxiety and depression.
- One-hundred percent of patients said Prolotherapy changed their lives for the better.(3)
Prolotherapy for Metatarsalgia and Tarsal Tunnel Syndrome
- Please see our companion article for questions on Morton’s Neuroma.
Doctors writing in the medical journal Foot and Ankle Clinics noted: “The traditional open surgical options for the treatment of metatarsalgia and lesser toe deformities are limited and often result in unintentional stiffness.”(4)
Metatarsalgia is an umbrella term and not the name of an actual injury. It can be pain in the ball of the foot with or without inflammation. Sometimes the diagnosis is isolated down to Tarsal Tunnel Syndrome.
Tarsal Tunnel Syndrome is very similar to Carpal Tunnel Syndrome. The tibial nerve runs in a canal on the inside of the foot called the tarsal tunnel. When the tibial nerve gets pinched here, it is called Tarsal Tunnel Syndrome. The symptoms described for this syndrome include pain in the ankle, arch, toes, or heel.
Recent research found that one of the many reasons Tarsal Tunnel Syndrome treatment fails is lack of an accurate diagnosis or lack of understanding or appreciation of the actual anatomy involved.(5)
Dancers again. Most research however points to simple wear and tear as the main culprit, and to demonstrate this in the extreme doctors writing in the medical journal Medical problems of performing artists, looking at female professional flamenco dancers and found that the evidence for high heels or other shoe problems as cause of their chronic foot pain were not as common as chronic repetitive trauma suffered during the practice of footwork dancing.(6)
In the journal Foot & ankle specialist Dr. Valerie L. Schade wrote that advanced metatarsalgia can lead to conditions of Avascular necrosis (bone death) of the second metatarsal head. Conservative treatment includes nonsteroidal anti-inflammatory medication, reduced activity, padding, orthotics, and immobilization. When conservative treatments fail, a wide variety of surgical procedures exist; however, the optimal procedure is unknown.(7)
The pain associated with plantar fasciitis is usually described as pinpoint or knife-like pain in the heel pad. Pain is usually worse in the morning, when the plantar fascia is stiff, cold, or tensed. The pain is caused when the damaged tissue is stretched, so when the person begins to bear weight on the foot, the pain level is very high, but lessens as he/she continues to walk/run, presumably as the plantar fascia becomes more flexible. The pain typically originates very gradually; starting only with pain at the beginning of exercise. However, without appropriate treatment; even walking becomes too painful.
Plantar fasciitis can occur for any number of reasons, most having their root in simple overuse. The pain is a result of the weakness of the plantar fascia, which then inflames. Please see our article on Plantar fasciitis and Plantar Fasciopathy for a more detailed discussion on these problems.
A heel spur forms because the plantar fascia is barely connected. Thus, the heel spur is not the cause of the pain, but rather the result of plantar fasciitis. By administering Prolotherapy, the spur-producing process stops. This idea is applicable to any osteoarthritis process in the body. Prolotherapy stops every arthritis-producing processes because it corrects the root of the problem, which is tendon, ligament, and fascia weakness. Prolotherapy has corrected many a foot problem that would otherwise have had to have surgery that is often unsuccessful.
The toes of the feet are held together in part by capsular ligaments. These ligaments keep the toes pointed straight. Capsulitis is an inflammation of these ligaments.
Turf toe is a very common condition among football players, as well as other “turf” sports. Turf toe is, simply, a sprain of the ligament of the great toe.
Turf toe may cause severe and chronic pain. If there is an injury to the MPJ, it can lead to prolonged disability, because the MPJ joint is vital to walking. This is the joint involved in the push-off phase of walking and running. If untreated, turf toe can cause hallux rigidus, or an immobile joint in the great toe. Other long-term injuries include painful arthritis and bunions.
In the Journal of foot and ankle surgery, doctors write: Surgical treatment of moderate hallux rigidus remains controversial and the optimal surgical technique has yet to be defined.(8)
Bunions, also referred to as hallux valgus or hallux abducto valgus, and hammertoes (hallux malleus), are two common diagnoses for toe pain whose etiologies can be related to the structures of the forefoot. A multitude of diagnoses can be arrived at for foot/toe pain, though many times the underlying problem, a weakness or injury in the ligaments, tendons or cartilage, is the culprit. For a more detailed discussion on Bunion pain and Prolotherapy.
Runners and dancers are most likely to suffer from sesamoiditis, but really anyone can experience this type of pain in the big toe. It occurs in the ball of the foot as the sesamoid bones become irritated. Like the kneecap, the sesamoid bones act as a pulley. Unlike the kneecap, the sesamoid bones are tiny bones that run along the tendon to the big toe. As they become irritated, they can cause inflammation in the tendon in which they reside. Standard treatment for sesamoiditis include rest, ice and special shoe pads. Unresolved sesamoiditis pain involves removing the sesamoid bones. See our article on Sesamoiditis Pain Treatment
1. Ojofeitimi S, Bronner S, Becica L. Conservative Management of Second Metatarsophalangeal Joint Instability in a Professional Dancer: A Case Report. J Orthop Sports Phys Ther. 2016 Feb;46(2):114-23. [Google Scholar]
2. Hauser RA, Feister WA, Dextrose Prolotherapy with Human Growth Hormone to Treat Chronic First Metatarsophalangeal Joint Pain. The Foot and Ankle Online Journal 5 (9): 1 [Google Scholar]
3. Hauser RA, Hauser MA, Cukla JK. A retrospective observational study on Hackett-Hemwall Dextrose Prolotherapy for unresolved foot and toe pain at an outpatient charity clinic in rural Illinois. J Prolotherapy. 2011;3:543-51. [Google Scholar]
4. Redfern DJ, Vernois J. Percutaneous Surgery for Metatarsalgia and the Lesser Toes. Foot Ankle Clin. 2016 Sep;21(3):527-50. [Google Scholar]
5. Gould JS.Recurrent tarsal tunnel syndrome. Foot Ankle Clin. 2014 Sep;19(3):451-67. doi: 10.1016/j.fcl.2014.06.015. Epub 2014 Jul 12. [Google Scholar]
6. Castillo-López JM, Vargas-Macías A, Domínguez-Maldonado G, Lafuente-Sotillos G, Ramos-Ortega J, Palomo-Toucedo IC, Reina-Bueno M, Munuera-Martínez PV. Metatarsal pain and plantar hyperkeratosis in the forefeet of female professional flamenco dancers. Med Probl Perform Art. 2014 Dec;29(4):193-7.2. [Google Scholar]
8. Schade VL. Surgical Management of Freiberg’s Infraction: A Systematic Review. Foot Ankle Spec. 2015 May 19. [Google Scholar]
9. Slullitel G, López V, Seletti M, Calvi JP, Bartolucci C, Pinton G. Joint Preserving Procedure for Moderate Hallux Rigidus: Does the Metatarsal Index Really Matter?. The Journal of Foot and Ankle Surgery. 2016 Dec 31;55(6):1143-7. [Google Scholar]