Prolotherapy – Foot & Ankle

What is prolotherapy?

Prolotherapy involves injecting a solution into or around a painful or injured musculoskeletal structure.

The most commonly used solution is dextrose, a form of glucose.

Depending on the condition being treated, the solution may be injected around:

• tendons
• tendon attachments
• ligaments
• plantar fascia
• selected joints; or
• other soft-tissue structures.

The exact treatment area and injection technique depend on your diagnosis.

How does prolotherapy work?

Prolotherapy is thought to work differently from treatments designed simply to numb pain or suppress inflammation.

The dextrose solution creates a controlled local stimulus within the treated tissue.

This is thought to influence biological processes involved in:

• tissue healing and adaptation
• cellular activity
• local repair responses
• collagen and connective-tissue processes; and
• pain modulation.

The aim is to encourage a healing and adaptive response within the treated area, rather than simply provide temporary pain relief.

Research into the precise biological mechanisms continues, and the response can vary according to the tissue and condition being treated.

Why has prolotherapy been recommended?

Prolotherapy may be considered for selected persistent foot and ankle conditions, including:

• plantar fasciopathy / persistent heel pain
• selected tendon problems
• selected ligament-related problems
• persistent pain around tendon or ligament attachments
• selected painful or degenerative joints; and
• other chronic musculoskeletal conditions where prolotherapy is considered clinically appropriate.

It may be particularly considered when symptoms have persisted despite appropriate conservative treatment or when your podiatrist believes an injection treatment aimed at stimulating a local tissue response may be appropriate.

Not every painful tendon, ligament or joint is suitable for prolotherapy.

Your podiatrist will have considered your diagnosis, clinical findings, previous treatment, medical history and individual circumstances before recommending treatment.

Why do we use ultrasound guidance?

At The Podiatry Clinic, ultrasound guidance is normally used where appropriate for foot and ankle prolotherapy injections.

Ultrasound allows your podiatrist to visualise many of the relevant structures beneath the skin and accurately identify the area being treated.

It can also help guide the needle towards the intended treatment area while avoiding important surrounding structures.

The injection can therefore be planned according to your individual anatomy and diagnosis.

What happens during the procedure?

Before proceeding, your podiatrist will confirm the area being treated, review relevant medical information and discuss the procedure with you.

You will have an opportunity to ask questions before providing consent.

The skin is cleaned using an appropriate antiseptic solution.

Where appropriate, ultrasound is used to identify the treatment area and guide the procedure.

A sterile needle is then carefully introduced and the prolotherapy solution is administered into or around the intended structure.

Depending on your treatment, more than one injection point may be required to appropriately treat the affected area.

A small dressing may be applied afterwards.

The injections themselves normally take a relatively short time, although your appointment allows time for assessment, preparation and appropriate aftercare advice.

What does prolotherapy feel like?

You will feel the needle entering the skin and may experience:

• stinging
• pressure
• aching; or
• temporary discomfort

as the solution is administered.

Some treatment areas are naturally more sensitive than others.

You may also experience a feeling of aching or fullness within the treated area following the procedure.

Your podiatrist will explain what to expect according to the structure being treated.

How many treatments will I need?

The number of prolotherapy treatments required varies according to:

• your diagnosis
• the tissue being treated
• how long the problem has been present
• the severity of the condition
• your response to treatment; and
• your overall rehabilitation plan.

Some patients may require a single treatment, while others may benefit from a course of injections spaced over time.

Your response will be reviewed before further treatment is recommended.

Prolotherapy is not normally repeated simply according to a fixed schedule without considering how you have responded.

What results can I expect?

Dextrose prolotherapy has been studied for a range of musculoskeletal conditions.

There is encouraging clinical evidence for its use in selected persistent tendon and fascia conditions, including chronic plantar fasciopathy, with research demonstrating improvements in pain and function in appropriately selected patients.

Evidence for some other foot and ankle conditions is more limited, and treatment protocols vary between studies.

The response also differs between individuals.

Some patients experience a meaningful reduction in pain and improvement in function, while others experience a smaller response or little benefit.

Your podiatrist will therefore recommend prolotherapy according to your particular diagnosis and clinical findings, rather than assuming that every musculoskeletal condition will respond in the same way.

Improvement cannot be guaranteed.

When should I expect improvement?

Prolotherapy is not intended to provide an immediate cure.

Because the treatment is designed to stimulate a biological response, improvement may develop gradually over the following weeks.

Some patients may experience temporary soreness before noticing improvement.

For persistent tendon, ligament and fascia problems, recovery and tissue adaptation also take time.

Your progress should therefore be considered alongside your function, rehabilitation and ability to gradually return to activity rather than simply how the area feels immediately after injection.

What happens after treatment?

You will normally be able to walk following your appointment, although this depends on the area treated.

It is common for the treated area to temporarily feel:

• sore
• aching
• tender
• mildly swollen; or
• more sensitive than usual.

A temporary increase in your usual symptoms can occur following treatment.

Your podiatrist may recommend temporarily reducing strenuous or high-impact activity depending on the structure that has been treated.

You will then normally be encouraged to gradually return to appropriate activity and rehabilitation according to the advice provided.

Prolotherapy works best as part of a treatment plan

Prolotherapy should not be viewed as a replacement for rehabilitation where rehabilitation is required.

For tendon, fascia and ligament-related conditions, your treatment plan may also include:

• progressive strengthening and loading
• mobility exercises
• activity modification
• footwear advice
• taping or bracing
• orthotics where appropriate
• gait or pressure analysis
• management of training or occupational load; and
• other treatments where appropriate.

The injection may help create an opportunity for improved symptoms and function, while rehabilitation addresses the capacity of the tissue and factors contributing to the problem.

Following the rehabilitation programme recommended by your podiatrist is therefore an important part of treatment.

What are the potential benefits?

Potential benefits of prolotherapy include:

• targeted treatment to the affected area
• a non-steroid injection option
• potential reduction in persistent pain
• potential improvement in function
• treatment aimed at supporting the body's local healing and adaptive response
• ability to treat selected tendon, ligament, fascia and joint conditions
• ability to combine treatment with rehabilitation; and
• an additional non-surgical option for persistent musculoskeletal conditions.

What are the possible side effects and risks?

Prolotherapy is generally well tolerated when appropriately performed.

Temporary effects can include:

• discomfort during the injection
• soreness or aching afterwards
• temporary increase in symptoms
• mild swelling
• bruising; and
• tenderness around the injection site.

Less common risks associated with injection procedures include:

• bleeding or more significant bruising
• infection
• prolonged increase in pain
• irritation or injury to a nearby nerve
• blood-vessel injury
• injury to surrounding soft tissues; and
• allergic or unexpected reaction to substances used during the procedure.

The precise risks vary according to the location and structure being injected.

Serious complications are uncommon when patients are appropriately assessed and injections are performed using appropriate clinical precautions.

Your podiatrist will discuss any additional risks that are particularly relevant to your treatment area.

Is prolotherapy suitable for everyone?

Prolotherapy is not appropriate for every patient or every musculoskeletal condition.

Your podiatrist will consider factors including:

• your diagnosis
• the tissue being treated
• active infection or recent illness
• infection or skin problems around the injection site
• allergies
• diabetes
• anticoagulant or antiplatelet medication
• pregnancy or breastfeeding
• previous injections or procedures
• previous surgery
• your medications and medical history; and
• other factors that may affect treatment or tissue healing.

Please tell your podiatrist about any significant change in your health or medication before treatment.

Anti-inflammatory medication

Because prolotherapy is intended to stimulate a local biological response, your podiatrist may advise you about the use of anti-inflammatory medication around the time of treatment.

Do not stop any medication prescribed by your GP or another healthcare professional without discussing this with them or your podiatrist first.

If you require pain relief following treatment, ask your podiatrist or pharmacist what is appropriate for you.

What are the alternatives?

Your alternatives depend on your diagnosis.

These may include:

• continued rehabilitation and progressive loading
• activity modification
• footwear changes
• taping or bracing
• orthotics
• medication
• focused or radial shockwave therapy
• Class IV laser therapy
• corticosteroid injection where clinically appropriate
• other injection therapies such as hyaluronic acid or PRP where appropriate
• further imaging
• specialist assessment
• surgery for selected conditions; or
• choosing not to have prolotherapy and continuing with conservative management.

Your podiatrist can explain which alternatives are relevant to your particular condition.

How much does Prolotherapy cost?

Prolotherapy – Foot & Ankle: £295

The fee includes the injection procedure and ultrasound guidance where clinically appropriate.

Your podiatrist will advise whether a single treatment or further treatment may be appropriate according to your response.

When should I contact the clinic?

Some temporary soreness following prolotherapy can be expected.

Please contact the clinic if you develop:

• severe or unexpectedly increasing pain
• significant swelling
• increasing redness or warmth
• discharge from the injection site
• persistent numbness or weakness
• an unexpected loss of function
• symptoms substantially different from your usual condition; or
• anything else that concerns you following treatment.

Seek urgent medical advice

Infection following an injection is uncommon but requires prompt assessment.

Seek urgent medical advice if you develop severe or increasing pain associated with marked swelling, redness or heat, particularly if you also feel unwell or develop a fever.

Seek emergency medical assistance if you develop symptoms of a serious allergic reaction, such as difficulty breathing or significant swelling of the face, lips, tongue or throat.

Your next step

If you have already booked your treatment

Please attend your appointment as arranged.

Make sure we are aware of your current medication, allergies and any significant changes in your medical history.

If you have developed an infection, started antibiotics, become pregnant or there has been another important change in your health, please tell us before treatment.

Your podiatrist will review the procedure with you and answer any questions before you provide consent.

If prolotherapy has been recommended but you have not yet booked

You can book your Prolotherapy – Foot & Ankle appointment when you are ready to proceed.

£295

Important information

This information sheet supports the discussion you have had with your podiatrist and is intended to help you make an informed decision about treatment. It does not replace individual clinical advice.

Dextrose prolotherapy provides a non-steroid injection option for selected persistent musculoskeletal conditions. Research is encouraging for some conditions, particularly persistent plantar fasciopathy, although the strength of evidence varies according to the condition being treated.

The aim of treatment is to support a local biological response that may help reduce pain and improve function. Individual responses vary and improvement cannot be guaranteed.

For many tendon, fascia and ligament conditions, prolotherapy is most appropriately used alongside progressive rehabilitation and management of the factors contributing to the problem.

Before treatment, your podiatrist will confirm that prolotherapy remains appropriate, discuss the relevant benefits, risks and alternatives with you, and provide an opportunity to ask questions before giving your consent.

The Podiatry Clinic