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For the Doctors

Posted by BrianJ on 3/08/04 at 14:35 (146461)

Have any of the doctors tried topical nitroglycerin (cream or patches) as a treatment for chronic PF? It has proven effective for other chronic tendinopathies such as tennis elbow, and I was wondering if it might be worth a shot. Any thoughts?

Re: For the Doctors

Dr. David S. Wander on 3/08/04 at 16:26 (146471)

No, it's something that I haven't tried. Nitroglycerin is a potent vasodilator, meaning the blood vessels 'open up' more allowing increased blood flow. This can have significant interactions with other medications and medical conditions. I am not aware of any documented use of nitroglycerin as being 'proven effective for other chronic tendinopathies.....' If you have articles or a link for my review I'd be very interested in seeing any literature on the subject. If the use has been anecdotal, it is still a new concept to me and can be dangerous. If it is legitimate and in the literature, fill me in and I'll read the articles and give by opinion.

Re: For the Doctors

BrianJ on 3/08/04 at 16:35 (146473)

Dr. Wander --

The article I'm referring to is titled 'Topical Nitric Oxide Application in the Treatment of Chronic Extensor Tendinosis at the Elbow: A Randomized, Double-Blinded, Placebo-controlled Clinical Trial.' It's in the American Journal of Sports Medicine, Nov.-Dec., 2003, by Justin Paoloni. I would value your thoughts on the subject. Thanks.

Re: For the Doctors

Dr. David S. Wander on 3/08/04 at 16:41 (146474)

Brian,

Thanks. Additionally, I did a search and found some information about the use of nitro for shoulder pain. The use of nitro reported that it appeared to decrease pain levels, but the details of the study were vague. I will look at the article in AJSM and let you know what I think.

Re: nitric oxide link

scottr on 3/08/04 at 22:14 (146493)

here's the article to which brian refers:
http://www.findarticles.com/cf_0/m0918/6_31/111502063/p1/article.jhtml

Re: For the Doctors

Ed Davis, DPM on 3/09/04 at 00:00 (146500)

Can be very effective for Raynauds disease and underprescribed for that -- a disease causing cold sensitivity in the toes and fingers. The impication for tendinopathies is increase the circulation to the area in order to help effect a cure. Does it cause increase in circulation to persist long enough? Could it cause a sufficient increase in cutaneous circulation to enhance absorbtion of topical ibuprofen? One caution: excess absorbtion of the cream can cause headaches.
Ed

Re: For the Doctors

Dr. Z on 3/09/04 at 10:46 (146526)

Ed

I use ths for Raynauds all the time. Very effective. Headaches sometime are a problem

Re: For the Doctors

BrianJ on 3/09/04 at 10:56 (146532)

I am not a doctor, but it seems logical that local circulation is a prime consideration in PF healing. Given the extreme distal position of the feet, and the fact that chronic PF causes most people to curtail their exercise regimen, increasing circulation to the injury site is important, isn't it?

Re: For the Doctors

Ed Davis, DPM on 3/10/04 at 22:56 (146650)

Brian:
It is, but there are so many ways that can be done, it is not clear that that will suffice, but is worth a try. Intractable PF is a tissue quality issue, that is, there is an area of the fascia that is diseased --- too thick, scar tissue, loss of elasticity, poor circulation due to lack of blood vessel formation within the substance of the tissue itself. The thickness and scar tissue provide a barrier for the body to lay down new blood vessels within the diseased tissue.
Ed