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INJECTION TECHNIQUES  

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 corticosteroids for the same patient group. 
 
There are multiple injectables (solutions) that can be injected into a heel such as steroid, local anaesthetic, saline, platlet rich plasma (PRP) and these are aimed at either reducing tissue inflammation or increasing a physiological response into a tissue.  
 
It is key to understand the rationale behind what is being offered in terms of treating a non responsive heel condition.  
 
An injection should be carefully considered and its administration again, be well delivered and combined with other key elements of mechanical management where possible. 
 
There were a number of outcomes from Mark's Masters level thesis, one of which was to deliver a heel injection after performing a tibial block. A tibial block is designed to block any pain from the insertion of a needle directly into the heel and is generally very well tolerated as a precursor to a heel injection. The tibial block is associated with some discomfort. 
 
Through the research process it was clear that although injectables form part of the treatment options for chronic heel pain the injudicious use of injections should be avoided. Mark was involved in the development of a Patient Group Directive (PGD) to allow clinicians to use corticosteroid in the NHS and taught and mentored on the PGD program.  
 
One of the key messages from the PGD was to ensure clinicians do not excessively use injections as the only treatment modality. Mark has worked in dedicated foot & ankle clinics throughout his career, working closely with leaders in the field across Orthopaedics and Sports Medicine and the number of injections we perform per year would be in double digits at most, please exercise caution if you are seeking treatment from practices that are performing hundreds of injections per year 
 
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