Mark’s clinical research historically has been in terms of injection techniques for chronic heel pain with a condition commonly known as plantar fasciitis.  The research thesis was looking at the efficacy of using a local anaesthetic as a potential treatment of this chronic soft tissue injury and the results were comparable with the existing literature looking at the use of cortico steroids for the same patient group. 

One of the side issues to the study was in terms of developing a more user friendly injection technique for patients undergoing this potentially very painful procedure.  This involves the use of an ankle block which ensures that the pain of injecting the heel is either minimal or none depending on the success of the ankle block itself.
See video see video Below which clearly shows the use of a tibial block to help facilitate the process of a heel injection.
 


See video see video Below which shows the plantar approach for this condition.

This has certainly allowed a more controlled technique to try and improve the placement of the active ingredient whether that be local anaesthetic or cortico steroid, and also helping in depositing a larger volume of solution which in itself is a potential variable for a successful outcome in terms of injection techniques.

Mark’s other key area of interest in terms of injection techniques is in the use of local anaesthetic as a stimulus to tissue repair.  Much of the literature around tissue repair involves invoking the body’s response to injury.  More often than not, in chronic soft tissue injury the stimulus to repair is often reduced or absent.  

Mark utilises local anaesthetic with a process known as wet needling which involves the infiltration of local anaesthetic into injured tissues. see video Below



After a period of time the tissues are then needled with a 21 or 23 gauge needle to help stir up the tissue repair process.  Although this seems quite damaging to the tissues it does have the potential of initiating acute tissue repair as a means of trying to stir up the body’s repair process in  a chronic tissue injury.  

The use of a controlled injection, ie needling into the tissue certainly is an avenue that we look to use in patients that are not responding to a recognised treatment protocol for much of the Achilles tendon and peroneal type problems that we see.

The area certainly has had support over the last decade and beyond with the use of prolotherapy, and essentially this is a modified version of the same technique applied solely to foot and ankle soft tissue problems. 

These injection techniques are used alongside the majority of the mechanical offload which has been described elsewhere in this overview such as orthotic management and the use of a rehabilitation programme in association with Physiotherapy teams where needed.  These factors together often can improve the patient’s outcome for what may well have been a frustrating period of time either in pain or away from their sporting activities, and really forms a basis for a complete package of care for the majority of foot and ankle problems that we see here within the Foot and Ankle Clinic.