In cases where connective tissue elements such as ligaments, tendons and joints are damaged, the process of stimulating wound healing mechanisms by injection of proliferating solution, repairing and reshaping the tissues in this way is called prolotherapy.
Prolotherapy is a treatment method that provides natural healing. Tissue damage that causes painful conditions can be permanently treated with prolotherapy.
Prolotherapy is the most successful in cases where the healing of tendon and ligament problems after trauma is not sufficient and causes chronic pain.
The purpose of prolotherapy is to stimulate these damaged joints, tendons and ligaments with proliferating solutions to regenerate and reshape, so that the cause of degeneration in the foot and ankle region will be eliminated, and the pain will also disappear.
Today, most of the causes that cause pain in the foot and ankle are due to damage to the joints, tendons and ligaments in this region. If left untreated after damage has occurred, chronic inflammation occurs. After 4-6 weeks, chronic pain due to degeneration begins.
The most common causes of foot and ankle pain; arthritis in the ankle and foot joints, talonavicular necrosis, achilles tendinosis, haglund’s disease, hallux valgus deformity, heel spur (plantar fasciitis), acquired flat feet, morton’s neuroma, recurrent ankle sprains due to hyperelasticity syndrome.
Achilles Tendinosis, Haglund’s disease and partial tendon rupture
Microtraumas caused by repeated traumas caused by activities such as jumping rope, long distance running or tennis cause progressive tendon degeneration in the Achilles tendon. Microtrauma or partial tears cause episodes of sharp and temporary pain localized to the middle of the tendon. Decreased elasticity and mobility with the progression of tendinosis cause disruption. Unless there is a full-thickness rupture, regular prolotherapy treatment gives faster and longer-term results compared to conventional physical therapy applications in healing tendinosis, trigger point and partial rupture.
Arthritis of the Ankle and Toes
Arthritis other than a systemic cause or crystalloid deposition may be due to repetitive trauma, overactivity, or nutritional deficiencies. The time of the pain, its relationship with the movement and the area where it is felt are important. In addition to prolotherapy treatment performed at regular intervals, methods such as physical therapy applications, hyperbaric oxygen therapy, ozone therapy can be applied as supportive.
Hallux Valgus Deformity
Pain and deformity occur in the first toe due to the deformity in the joint area between the metatarsal bone and the finger. It is more common in women with pointed toes and wearing narrow shoes. In addition to the prolotherapy treatment to be carried out at regular intervals, the factors that cause stress on the joint should be eliminated. Here, silicone between the fingers, rollers worn at night can reduce the pain by relieving the surrounding tissue by placing the finger in the right position, and personalized insoles can be used.
Heel Spur (Plantar Fasciitis) and Acquired Flat Foot
Heel Spur (Plantar Fasciitis) is an injury caused by overuse of the heel or sole of the foot (plantar face). Heel spurs are more likely to occur in women, people who are overweight, and those who work in a job that requires walking or standing on firm ground. If the heel spur is not treated, it can turn into a chronic condition and cause foot, knee, hip and back problems over time as it will change the way the person walks.
In Acquired Flat Foot, there is insufficiency of the tibialis posterior tendon, which supports the foot dome and forms the arch of the foot. In these patients, the picture develops gradually, and the patient’s complaints gradually increase over the years. Patients first become aware of the disappearance of the inner arch of the foot, then a decrease in walking distance occurs. Over time, problems such as foot swelling, various bone deformities, and ankle pain are added to the table.
In the treatment of both diseases, shoe modification, special insoles, and protective wristbands can be used in the early stages in addition to the prolotherapy treatment performed at regular intervals. Physical therapy and rehabilitation programs can be added to the treatment.
Ankle Sprain
In ankle sprain, the ligament structures that are responsible for balancing the foot on the inner and outer sides of the ankle are damaged under normal conditions. 90% of ankle sprains are caused by outward rotation and strain of the ankle. The ligament complex on the outer side of the ankle is damaged as a result of this strain, swelling, pain and limitation of movement develop in the ankle.
In 10% of ankle sprains, complaints of instability – recurrent ankle sprains- may develop. As a result of the damage that occurs when the ankle is sprained for the first time, the external lateral ligaments of the ankle are damaged. Ankle instability may occur after multiple ligament injuries, inadequate treatment of the initial sprain, or proprioception disorders.
The problem is usually bilateral in ankle sprains (Hyperelasticity syndrome), which develops due to the excessive elasticity of the ligaments in the body genetically. There is no special trauma in the patient’s history in the occurrence of sprains. Even when the patient is walking on the road, the ankle can easily be sprained. In true ankle instability, the problem is usually unilateral. There is trauma (usually sports injuries) at the onset of the event. Sprains often recur and occur during sports.
In the treatment of ankle sprains, the acute injury period is expected to pass. After a 2-3 week rest period, physical therapy (friction and stretching at first, strengthening exercises with subsequent sessions) can be performed together with prolotherapy treatment.
Principles of prolotherapy treatment:
Pre-treatment: Reducing pain and muscle spasm to control the inflammatory response (protection, rest).
Definitive treatment: Combined with prolotherapy and stretching-strengthening exercises programs until complete recovery during the repair phase and reshaping.
Prolotherapy treatment is an injection method that is tailored to the individual and applied in 15-30 day periods. The injected liquid is not a chemical substance, drug or steroid (cortisone, etc.); A combination of concentrated dextrose and diluted local anesthetic is used. It is ensured that the tissue is reconstructed in its original form in a natural way. One of the most striking aspects of the prolotherapy method is that there is no physical restriction during the treatment and it does not require rest. On the contrary, stretching and strengthening exercises and movements aimed at improving joint range of motion are applied to patients as a complement to prolotherapy treatment.
Unlike the traditional approach, cold application, elevation, compression application, use of non-steroidal painkillers and steroid injections have no place in our practice.
