Plantar Injection

Support for this idea was obtained when rats were treated intraperitoneally with phenylquinone (an irritant which causes writhing) 30 min prior to sub-plantar injection of kaolin. There was marked inhibition of swelling usually... 

There are 3 known plasma kinins, namely the nonapeptide bradykinin or kallidin-9 [154, 157, 158, 363, 364, 473, 523], lysyl-bradykinin or kaUidin-10 [499,665] and methionyl-lysyl-bradykinin [155,159,556]. These pharmacologically active polypeptides behave simlarily, although quantitative differences exist between them [141, 156, 412]. Bradykinin increases vascular permeability in the rat after intradermal injection [82,107,167,633] and also after sub-plantar injection into the paw [110, 210, 389, 601], and as such plasma kinins are potential mediators of the anaphylactoid oedema. 

Rupture of the plantar fascia induced by glucocorticoids has usually been reported in athletes. However, a case of spontaneous degenerative rupture has been reported in a 72-year-old man who had received four glucocorticoid injections over 1 year for plantar fasciitis (SEDA-21, 418) (277). 

These injections can likewise enable patients to wear and use orthotic devices more effectively. Injection into the triceps surae musculature can improve the fit and function of an ankle-foot orthosis by preventing excessive plantar flexor spasticity from pistoning the foot out of the orthosis.49 Injections into severely spastic muscles can also increase patient comfort and ability to perform ADL and hygiene activities. Consider, for example, the patient with severe upper extremity flexor spasticity following a CVA. Local injection of botulinum toxin into the affected muscles may enable the patient to extend his or her elbow, wrist, and fingers, thereby allowing better hand cleansing, ability to dress, decreased pain, and so forth.7... 

Fig. 2. Antinociceptive effects of intraplantar BEO in the capsaicin test. BEO was injected into the plantar surface of the hindpaw 10 min prior to injection of capsaicin (50 ng/paw). Jojoba oil was used as a control, which was without affecting the capsaicin-induced nociceptive response. Data are means + S.E.M. in — 10 mice per group). p < 0.001, p < 0.01 when compared with Jojoba oil-treated controls by Dunnett s test.

Several techniques have been used to produce the reaction, but basically the arthritic syndrome can be elicited by injecting killed mycobacteria in mineral oil into the plantar surface of the foot or intradermally into the tail. From the tenth day onwards the joints of one or all of the feet gradually become inflamed and are painful, particularly when pressure is applied other inflammatory lesions occur in the ears, tail and lungs. These reactions are present in a severe form up to about the thirtieth day, after which they begin to subside . The degree of inflammation can be assessed visually or by measuring the swelling with a micrometer. 

Morton s neuroma is a plantar digital neuroma of the third branch of the median plantar nerve on the foot resulting in a burning pain of the foot. The injection relieves the burning and pain, but it does cause edema and pain at the injection site. Elevating the foot and applying ice will address the acute discomfort associated vrith the injection. 

A woman stopped taking iproniazid 50 mg twice daily and about a day and a half later became restless and incoherent almost immediately after being given pethidine 100 mg for chest pain. She was comatose within 20 minutes. An hour after receiving the injection she was flushed, sweating and showed Cheyne-Stokes respiration. Her pupils were dilated and unreactive. Deep reflexes could not be initiated and plantar reflexes were extensor. Her pulse rate was 82 bpm and blood pressure 156/110 mmHg. She was reusable within 10 minutes of receiving an intravenous injection of prednisolone hemisuccinate 25 mg. A very similar reaction was described in another patient. ... 

Nociception pain perception can be measured in rodents by a variety of procedures whereby aversive stimulation is applied externally either by heat or electrical stimulation to the tail or paws (tail flick, hot plate, plantar test) or internally by injection into the peritoneum of chemicals (acetic acid, phenylbenzoquinone). Inflammation pain can also be induced by injecting chemicals (carrageenan, formalin) into the paws. More complex approaches induce neuropathic pain by surgical lesions, usually to the sciatic or spinal nerve. For safety pharmacology purposes, usually only the simpler procedures are used. For example, with the hot plate test [18] the animal is placed onto a heated metal plate (54°C) within a vertical cylinder, and the latency to licking its front paws is measured over a short period. 

Zelen CM, Poka A, Andrews J. Prospective randomized, blinded, comparative study of injectable micronized dehydrated amniotic/chorionic membrane allograft for plantar fasciitis a feasibility study. Foot Ankle Int 2013 34 1332-9. 

Hanselman A, Tidwell J, Santrock R. Cryopreserved human amniotic membrane injection for plantar fasciitis a randomized, controlled, double-blind pilot study. Foot Ankle Int 2015 34 151-8. 

The fascia may be painful in any of iis parts and it is common to have patients report pain of the plantar surface of their foot whenever they walk or perform specific tasks, such as going up on their toes or heels. A patieni may use a heel cushion with or without a hole in the center for relief of the pain. Localized steroid injection into the region will relieve the pain. Properly fitting shoes are a necessity as is the use of osteopathic manipulative treatment directed to freeing motion of the bones of the foot and stretching hypertonic muscles of the calf as well as the fascia itself Exercises to increase foot flexibility and stretching of the calf muscles and Achilles tendon are important. 

Finally, an investigation of the effectiveness of ulfrasound-guided corticosteroid injection for the treatment of plantar facilities was conducted by a randomised investigator- and participant-blinded, placebo-controlled trial 82 people with a clinical and ultrasoxmd diagnosis of planfar fasciitis unrelated to systemic inflammatory disease were examined. The participants were randomly allocated to ultrasound-guided injection of the plantar fascia with either 1 ml of 4 mg/ml dexamefhasone sodium phosphate (experimental group) or 1 ml normal saline (placebo) [70 -]. 

Before injection, fhe participants were given an ultrasound-guided posterior tibial nerve block with 2% lidocaine. Primary outcomes were pain, as measured by the foot health status questionnaire (0-100 point scale), and plantar fascia thickness, measured by ultrasoxmd at 4, 8, and 12 weeks. Reduction in pain at 4 weeks favoured the dexa-methasone group by 10.9 points, Between-group differences for pain scores af 8 and 12 weeks were not statistically significant. Plantar fascia thickness measured at 4 weeks favoured the dexamethasone group by -0.35 mm. At 8... 

The number needed to treat with dexamethasone for one successful outcome for pain at 4 weeks was 2.93. There were no reported adverse events associated with the intervention. It could, therefore, be concluded that a single, ultrasoxmd-guided dexamethasone injection is a safe and effective short-term treatment for plantar fasciitis. It provides greater pain relief than placebo at 4 weeks and reduces abnormal swelling of the plantar fascia for up to 3 months. However, clinicians offering this treatment should also note that significant pain relief did not continue beyond 4 weeks. 

McMillan AM, Landorf KB, Gilheany MF, Bird AR, Morrow AD, Menz HB. Ultrasound guided corticosteroid injection for plantar facilities randomized controlled trial. BMJ 2012 344 7589 (online). 

A new case of a plantar fascia calcification as sequela of CS injection in the treatment of a plantar fasciitis has been published [34 ]. A 72-year-old woman with severe plantar fasciitis who received a therapeutic CS injection developed a small calcified lump under the skin which subsequently caused ulceration and infection. 

Fox TP, Oliver G, Wek C, Hester T. Plantar fascia calcification a sequelae of corticosteroid injection in the treatment of recalcitrant plantar fasciitis. BMJ Case Rep 2013 2013. http //dx.doi.org/10.1136/bcr-2013-200303. pii bcr2013200303. 

US has a definite role in the management of plantar fasciitis by guiding local injection of steroids (Kane et al. 1998 Tsai et al. 2000b, 2006), extracorporeal shock-wave therapy (Hyer et al. 2005b), or needle fasciotomy (Folman et al. 2005). For steroid injection, both posterior and anterior approaches can be used to direct the needle tip inside the thickened portion of the fascia. Similar to other authors, we prefer to select a posterior approach to inject the plantar fascia (Kane et al. 1998 Tsai et al. 2000). The patient lies prone with the affected foot resting on a triangular pillow to... 

Kamel M, Kotob H (2000) High-frequency ultrasonographic findings in plantar fasciitis and assessment of local steroid injection. J Rheumatol 27 2139-2141 Kane D, Greaney T, Bresnihan B et al (1998) Ultrasound guided... 

Tsai WC, Wang CL, Tang FT et al (2000b) Treatment of proximal plantar fasciitis with ultrasound-guided steroid injection. Arch Phys Med Rehabil 81 1416-1421... 

Tsai WC, Hsu CC, Chen CP et al (2006) Plantar fasciitis treated with local steroid injection comparison between sonographic and palpation guidance. J Clin Ultrasound 34 12-16... 

Injection of steroids in patients with painful plantar fasciitis is performed with the foot hanging over the examination bed. The transducer is placed in a sagittal plane just caudal to the attachment of the fascia to the calcaneus. Then, a 21 gauge needle is inserted from the posterior edge of the probe and directed toward the thickened origin of the fascia. The needle should traverse the fascia, as it leaves its origin from the calcaneus, to inject on its deep surface. 

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