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PT, iontophoresis...has anyone had good luck w/ this?

Posted by Carmel M on 9/21/01 at 15:38 (061189)

I finally started PT last Friday. The therapist did ultrasound, electrical stimulation and then she used a machine like a TENS unit with ice wrapped on my foot (10 minutes for that last one.) And finally before I go they put an iontophoresis patch on my heel that is to remain there for 24 hours.

I've only had two sessions of this and am scheduled for at least two more. I've also been wearing my night splint. I took back that awful purple plastic piece of junk...it turns out they received the wrong one and the guys checking in merchandise didn't even look at it before they called me to say it was in. They got the right one ordered and I've worn it twice.

Today I asked the therapist how long it took to see esults (if in fact there are any results TO see) and he said it usually takes three sessions of the ion patch.

Has anyone had good luck with this approach, and how long did it take?

Thanks,
Carmel

Re: Wow....

Carmen H on 9/21/01 at 16:31 (061192)

You have quite a bit of stuff goin on on those tootsies of yours! I am wondering if you are going to be able to tell WHAT works with everything they are doing.
Do you just have PF?
I have had the Ion. and the ultrasound before for other muscular problems...the ion worked miracles on my shoulder but you're talking about a totally different injury.
24 hr patch? i have only had one on for about 25 minutes in a high dose so I can't help you there either.
Gosh I am not much help. I'm sorry.
I would wear the night splint EVERY night though. THAT I CAN tell you helped me in the stetching process. Do you havea stretching program?
Stretching is the BEST thing I have done so far.

Re: Wow....

Carmel M on 9/21/01 at 17:26 (061198)

Hi Carmen,

As far as I can tell, it's only PF. That was the original diagnosis over two years ago. The insertional pain on the bottom of my heel seems to be getting better, but I have pain on the edge of my heel, ALL the way around. So I'm wondering if there is something else going on. The last time I saw my pod he didn't seem to concerned yet. And my physical therapist is aware of the 'new' pain.

I've only had the new night splint for two days, but I plan to wear it every night.

I don't have a stretching program because my tendons and muscles are not tight. My pod and PT said my dorsiflexion is good and the muscles are not tight.

Thanks for your reply! I guess I'll see what happens next and hope it is 'the answer!'

Carmel

Re: PT, iontophoresis...has anyone had good luck w/ this?

Ed Davis, DPM on 9/21/01 at 18:38 (061207)

Iontophoresis involves the use of an electric current to diffuse drugs across intact skin to the area of inflammation. Commonly used drugs include dexamethasone phosphate, a type of steroid and lidocaine, a local anesthetic. The depth of penetration of the drug is very limited. I tend to use iontophoresis on achilles tendinitis because the tendon is fairly close to the skin. Thicker skin and fatty tissue on the bottom of the foot will significantly limit the effectiveness of iontophoresis applied to that area. Occasionally, I will apply iontophoresis to the thin skin over the inside of the heel in order to maximize the amount of drug going into the tissues.
Ed

Re: PT, iontophoresis...has anyone had good luck w/ this?

Carmel M on 9/21/01 at 19:08 (061210)

Dr. Ed,
Thanks for responding to my post. When I see my physical therapist on Monday, I will ask if he could put the patch on the side of my heel. It certainly makes sense that not much of the medication would get through the fat pad and thicker skin on the bottom of my foot.

Thanks again.
Carmel

Re: PT, iontophoresis...has anyone had good luck w/ this?

paula on 9/21/01 at 20:21 (061214)

my pt put the patch at the heelspur, right above it and it took away pain from pf on bottom of foot as well as tendonitits. dr ed, you back here? whoopeee! in that case, what are the dangers of cortisone delivered this way? one pt says virtually none, other pt scared to death of cortisone. and while i'm at it, any other things i can do for my recurrent horrendous tendinosis (tendonitis, whatever)/

Re: PT, iontophoresis...CARMEL

Donna M on 9/21/01 at 22:44 (061223)

Carmel, yours sounds like mine! I think I've told you that before! lol There are so many here I have a hard time keeping everybody straight!

Mine is also better, but I have to say the edge isn't near as painful as it was. (I better whisper that!!)

If your Pod ever tells you why the edge could be so sore, let me know if you don't mind!! I've got to find another pod cause all mine says is left is surgery~~and I'll not go that route anytime soon!!!

Good luck and hope you have a pain free weekend!!
Donna

GOD BLESS AMERICA

Re: Hi Donna

Carmel M on 9/22/01 at 08:45 (061238)

I thought we had the same symptoms. When I mentioned the 'edge' hurting he said 'maybe achilles tendonitis' but that doesn't make much sense to me. Because why would it hurt all the way around?! In my mind I'm thinking worse case scenario...stress fracture! Here's why I think that: My right leg is longer than the left (which is why only the right heel hurts), I've had three cortisone shots so maybe the fat pad has deteriorated a little, and I wear very hard custom orthotics.

I've decided if this round of PT doesn't work, I'm going to request an MRI to see what is going on.

Some other things to consider which have me baffled...my achilles tendon is not tight, nor are my muscles tight, I have very good dorsiflexion and range of motion.

Anyway, let me know what you think and what (if anything) your doc or pt has said about the edge pain...and I'll keep in touch. Maybe together we can get this figured out!!

Take care,
Carmel

Re: PT, iontophoresis...has anyone had good luck w/ this?

Ed Davis, DPM on 9/22/01 at 14:29 (061272)

Paula:

There are two reasons that iontophoresis is safer than cortisone shots:
1) lower amount of 'cortisone' that gets into the tissues and 2)only non-repository steroids are used such as dexamethasone phosphate. Such forms of cortisone have primarily anti-inflammatory effects but without the danger of potential tendon ruptures seen with repository steroids. (check archives for my prior post discussing the different types of 'cortisone').

Is your pain in the achilles as well as the plantar fascia?
Ed

Re: PT, iontophoresis...has anyone had good luck w/ this?

paula on 9/22/01 at 17:27 (061294)

thanks for that answer ed. pain in both places but different types of pain. the achilles tendon and sides of ankles feel like a million micro tears kinda close to the skin. at it's worse it is like a vise of pain around my ankles and achilles tendon. sharp pain in a zillion places. the plantar fasciitis pain is different like stepping on a stone all the time or maybe a small sledge hammer on one spot each foot. but the pf pain feels bearable and the tondonitis feels horrible and gets worse every time there's a flare. it's the one scaring me, making me think i'll never get out of this mess.

Re: PT, iontophoresis...has anyone had good luck w/ this?

Ed Davis, DPM on 9/24/01 at 12:40 (061423)

What other treatments are you having currently? I would view iontophoresis as an adjunctive treatment as opposed to a major treatment. How good is your ankle dorsiflexion range of motion? With your knee straight, pull your foot backward--how far does it go back past 90 degrees to the leg?
How long have symptoms been going on?
Ed

Re: PT, iontophoresis...has anyone had good luck w/ this?

paula on 9/24/01 at 15:18 (061439)

dorsiflexion stinks. been working on it for a year getting nowhere cause stretching that way makes tendonitis flare bad. i was looking into a dynasplint, ever hear of it. it's a spring loaded thing you wear for hours every day and it stretches your ankle slow over time. more sophisticated than a nite splint supposedly. been going on for more than a year now. any other ideas? would appreciate cause this is hell.

Re: PT, iontophoresis...has anyone had good luck w/ this?

Ed Davis, DPM on 9/24/01 at 20:01 (061464)

night splints are one of the best modalities for increasing ankle dorsiflexion because they do the right thing: provide a long, low intensity stretch. The reason why your stretching may flare tendinitis is because it is done with too much intensity. The goal is to provide a very gentle stretch but to hold that stretch for as long as possible--night splints provide a way to do this. I often use the N'Ice and Stretch listed by Scott because it is a very comforatable device--comfort is important since it is generally used at night.

What other treatments have you had?
Ed

Re: PT, iontophoresis...has anyone had good luck w/ this?

paula on 9/25/01 at 08:32 (061500)

i just bought a night splint but it is too small. i think it was you who said you mostly use smalls and larges. i got a medium. your post has motivated me to get the right size immediately and give it a try. thanks again.

Re: question for dr ed or king solomon

paula on 9/25/01 at 08:59 (061501)

sorry this is so long. a pod and an orthotist are tugging on each foot, insisting that their orthotic is the one i should get. before they pull me in half i thought i'd get your ideas. i presented the mueller and the arizona brace idea to all my docs, therapists, orthotists. no enthusiasm at all from them and no willingness to read the literature i brought. my physiatrist wants me to get an afo that goes up the back of leg with a sorta hinge at the ankel (i'm currently in wheelchair and havnt walked in a year. they have corrected my muscle wasting disease but my feet and ankles got pttd in the process). my p t yells no, no, an afo will wreak havoc with my very tight achilles tendon cause it will force me to striaghten out my leg in a way i cannot yet. she wants me to get a ucbl orthotic. my physiatrist yells no , no, you desperately need ankle support and besides, an arizona or mueller can't be used in a pool and that's where he wants me to start walking again. another pod who used to be an athletic coach suggested waterproof taping by him till i'm in good enough shape for an arizona. al other med professionals are absolutely against the taping but never say why. another pod says a series of orthotics with plastizote are needed cause my adult aquired flatfoot is so bad that he has to start out correcting it a little and then as it improves make another orthotic and so forth. i will do anything to walk again. i will pay anyghing as well. but i have a closet full of orthotics that don't work and life saving all but gone. i need to make some right decisions now. maybe i need one thing for a pool another for dry land. sorry this is so long.

Re: Wow....

Carmen H on 9/21/01 at 16:31 (061192)

You have quite a bit of stuff goin on on those tootsies of yours! I am wondering if you are going to be able to tell WHAT works with everything they are doing.
Do you just have PF?
I have had the Ion. and the ultrasound before for other muscular problems...the ion worked miracles on my shoulder but you're talking about a totally different injury.
24 hr patch? i have only had one on for about 25 minutes in a high dose so I can't help you there either.
Gosh I am not much help. I'm sorry.
I would wear the night splint EVERY night though. THAT I CAN tell you helped me in the stetching process. Do you havea stretching program?
Stretching is the BEST thing I have done so far.

Re: Wow....

Carmel M on 9/21/01 at 17:26 (061198)

Hi Carmen,

As far as I can tell, it's only PF. That was the original diagnosis over two years ago. The insertional pain on the bottom of my heel seems to be getting better, but I have pain on the edge of my heel, ALL the way around. So I'm wondering if there is something else going on. The last time I saw my pod he didn't seem to concerned yet. And my physical therapist is aware of the 'new' pain.

I've only had the new night splint for two days, but I plan to wear it every night.

I don't have a stretching program because my tendons and muscles are not tight. My pod and PT said my dorsiflexion is good and the muscles are not tight.

Thanks for your reply! I guess I'll see what happens next and hope it is 'the answer!'

Carmel

Re: PT, iontophoresis...has anyone had good luck w/ this?

Ed Davis, DPM on 9/21/01 at 18:38 (061207)

Iontophoresis involves the use of an electric current to diffuse drugs across intact skin to the area of inflammation. Commonly used drugs include dexamethasone phosphate, a type of steroid and lidocaine, a local anesthetic. The depth of penetration of the drug is very limited. I tend to use iontophoresis on achilles tendinitis because the tendon is fairly close to the skin. Thicker skin and fatty tissue on the bottom of the foot will significantly limit the effectiveness of iontophoresis applied to that area. Occasionally, I will apply iontophoresis to the thin skin over the inside of the heel in order to maximize the amount of drug going into the tissues.
Ed

Re: PT, iontophoresis...has anyone had good luck w/ this?

Carmel M on 9/21/01 at 19:08 (061210)

Dr. Ed,
Thanks for responding to my post. When I see my physical therapist on Monday, I will ask if he could put the patch on the side of my heel. It certainly makes sense that not much of the medication would get through the fat pad and thicker skin on the bottom of my foot.

Thanks again.
Carmel

Re: PT, iontophoresis...has anyone had good luck w/ this?

paula on 9/21/01 at 20:21 (061214)

my pt put the patch at the heelspur, right above it and it took away pain from pf on bottom of foot as well as tendonitits. dr ed, you back here? whoopeee! in that case, what are the dangers of cortisone delivered this way? one pt says virtually none, other pt scared to death of cortisone. and while i'm at it, any other things i can do for my recurrent horrendous tendinosis (tendonitis, whatever)/

Re: PT, iontophoresis...CARMEL

Donna M on 9/21/01 at 22:44 (061223)

Carmel, yours sounds like mine! I think I've told you that before! lol There are so many here I have a hard time keeping everybody straight!

Mine is also better, but I have to say the edge isn't near as painful as it was. (I better whisper that!!)

If your Pod ever tells you why the edge could be so sore, let me know if you don't mind!! I've got to find another pod cause all mine says is left is surgery~~and I'll not go that route anytime soon!!!

Good luck and hope you have a pain free weekend!!
Donna

GOD BLESS AMERICA

Re: Hi Donna

Carmel M on 9/22/01 at 08:45 (061238)

I thought we had the same symptoms. When I mentioned the 'edge' hurting he said 'maybe achilles tendonitis' but that doesn't make much sense to me. Because why would it hurt all the way around?! In my mind I'm thinking worse case scenario...stress fracture! Here's why I think that: My right leg is longer than the left (which is why only the right heel hurts), I've had three cortisone shots so maybe the fat pad has deteriorated a little, and I wear very hard custom orthotics.

I've decided if this round of PT doesn't work, I'm going to request an MRI to see what is going on.

Some other things to consider which have me baffled...my achilles tendon is not tight, nor are my muscles tight, I have very good dorsiflexion and range of motion.

Anyway, let me know what you think and what (if anything) your doc or pt has said about the edge pain...and I'll keep in touch. Maybe together we can get this figured out!!

Take care,
Carmel

Re: PT, iontophoresis...has anyone had good luck w/ this?

Ed Davis, DPM on 9/22/01 at 14:29 (061272)

Paula:

There are two reasons that iontophoresis is safer than cortisone shots:
1) lower amount of 'cortisone' that gets into the tissues and 2)only non-repository steroids are used such as dexamethasone phosphate. Such forms of cortisone have primarily anti-inflammatory effects but without the danger of potential tendon ruptures seen with repository steroids. (check archives for my prior post discussing the different types of 'cortisone').

Is your pain in the achilles as well as the plantar fascia?
Ed

Re: PT, iontophoresis...has anyone had good luck w/ this?

paula on 9/22/01 at 17:27 (061294)

thanks for that answer ed. pain in both places but different types of pain. the achilles tendon and sides of ankles feel like a million micro tears kinda close to the skin. at it's worse it is like a vise of pain around my ankles and achilles tendon. sharp pain in a zillion places. the plantar fasciitis pain is different like stepping on a stone all the time or maybe a small sledge hammer on one spot each foot. but the pf pain feels bearable and the tondonitis feels horrible and gets worse every time there's a flare. it's the one scaring me, making me think i'll never get out of this mess.

Re: PT, iontophoresis...has anyone had good luck w/ this?

Ed Davis, DPM on 9/24/01 at 12:40 (061423)

What other treatments are you having currently? I would view iontophoresis as an adjunctive treatment as opposed to a major treatment. How good is your ankle dorsiflexion range of motion? With your knee straight, pull your foot backward--how far does it go back past 90 degrees to the leg?
How long have symptoms been going on?
Ed

Re: PT, iontophoresis...has anyone had good luck w/ this?

paula on 9/24/01 at 15:18 (061439)

dorsiflexion stinks. been working on it for a year getting nowhere cause stretching that way makes tendonitis flare bad. i was looking into a dynasplint, ever hear of it. it's a spring loaded thing you wear for hours every day and it stretches your ankle slow over time. more sophisticated than a nite splint supposedly. been going on for more than a year now. any other ideas? would appreciate cause this is hell.

Re: PT, iontophoresis...has anyone had good luck w/ this?

Ed Davis, DPM on 9/24/01 at 20:01 (061464)

night splints are one of the best modalities for increasing ankle dorsiflexion because they do the right thing: provide a long, low intensity stretch. The reason why your stretching may flare tendinitis is because it is done with too much intensity. The goal is to provide a very gentle stretch but to hold that stretch for as long as possible--night splints provide a way to do this. I often use the N'Ice and Stretch listed by Scott because it is a very comforatable device--comfort is important since it is generally used at night.

What other treatments have you had?
Ed

Re: PT, iontophoresis...has anyone had good luck w/ this?

paula on 9/25/01 at 08:32 (061500)

i just bought a night splint but it is too small. i think it was you who said you mostly use smalls and larges. i got a medium. your post has motivated me to get the right size immediately and give it a try. thanks again.

Re: question for dr ed or king solomon

paula on 9/25/01 at 08:59 (061501)

sorry this is so long. a pod and an orthotist are tugging on each foot, insisting that their orthotic is the one i should get. before they pull me in half i thought i'd get your ideas. i presented the mueller and the arizona brace idea to all my docs, therapists, orthotists. no enthusiasm at all from them and no willingness to read the literature i brought. my physiatrist wants me to get an afo that goes up the back of leg with a sorta hinge at the ankel (i'm currently in wheelchair and havnt walked in a year. they have corrected my muscle wasting disease but my feet and ankles got pttd in the process). my p t yells no, no, an afo will wreak havoc with my very tight achilles tendon cause it will force me to striaghten out my leg in a way i cannot yet. she wants me to get a ucbl orthotic. my physiatrist yells no , no, you desperately need ankle support and besides, an arizona or mueller can't be used in a pool and that's where he wants me to start walking again. another pod who used to be an athletic coach suggested waterproof taping by him till i'm in good enough shape for an arizona. al other med professionals are absolutely against the taping but never say why. another pod says a series of orthotics with plastizote are needed cause my adult aquired flatfoot is so bad that he has to start out correcting it a little and then as it improves make another orthotic and so forth. i will do anything to walk again. i will pay anyghing as well. but i have a closet full of orthotics that don't work and life saving all but gone. i need to make some right decisions now. maybe i need one thing for a pool another for dry land. sorry this is so long.