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Bupivacaine for heel pain

Discussion in 'Podiatry Arena Help, Suggestions and Comments' started by Bennepod, Nov 4, 2011.

  1. Bennepod

    Bennepod Active Member

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    I have read the postings on serial Marcaine injections (with and without needling) of the plantar fascia for heel pain (primarily by Bill Liggins). I am interested in knowing if many are using this therapy and with what results. Any tips or pearls or advice on technique and or where further information can be had.

    Many thanks,

    Brendan Bennett
  2. Paul Bowles

    Paul Bowles Well-Known Member

    We did some clinical work in this area back in 2002 and personally I think the injection is the key factor. The agent is not. By inserting a needle into the insertional medial band of the fascia I believe you get a minor transverse fasciotomy type effect causing elongation of the medial band of the plantar fascia - thus reducing the tension. Obviously local anaesthesia, corticosteroid would be beneficial in the short term for pain relief, but would do nothing long term. SOme of my orthopaedic and radiologic colleagues tend to disagree with this concept though.

    I have been keen to get a small ultrasound study going to further examine this. I also believe this may be an explanation as to why corticosteroid does not work for all patients - i.e. the person injecting does not get the fasciotomy style effect due to position/location of injection.

    Interested in anyone elses thoughts....
  3. Peter

    Peter Well-Known Member

    I do US guided steroid injections with fairly good results. I think the key is to bathe the fascia, rather than to inject into it directly, which is difficult anyway due to the pressure
  4. W J Liggins

    W J Liggins Well-Known Member

    I agree with this, in that in my study there was no attempt made to inject into the fascia, but to remain superficial to it. Even with an ankle block some pain is still experienced and certainly post-injection pain occurred in those few cases outside the study that I did (deliberately) penetrate the fascia.

    The mechanism of action remains something of a mystery and I am no longer in a position to have the large cohorts of patients necessary to examine this. So Paul's idea of u/s examination is a good one. I suspect that a formal study using MRI will be necessary to answer the question once and for all, given that bursae and other DDx will need to be ruled out.

    All the best

  5. Bennepod

    Bennepod Active Member

    Thanks for your replies.

    Paul, I have a sonogram. How would you propose such a study. Perhaps if enough of us are interested we could organize a multi centered study?


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