Patients & Methods |
FRAMEWORK AND SETTING
In October 1994, the primary authors (R.H., M.H.) started a Christian charity medical clinic called Beulah Land Natural Medicine Clinic in an impoverished area in southern Illinois. The primary modality of treatment offered was Hackett-Hemwall dextrose Prolotherapy for pain control. Dextrose was selected as the main ingredient in the Prolotherapy solution because it is the most common proliferant used in Prolotherapy, is readily available, inexpensive (compared to other proliferants), and has a high safety profile.29 The clinic met every three months until July 2005. All treatments were given free of charge.
PATIENTS
Patients who received Prolotherapy for their unresolved foot and toe pain in the years 2002 to 2005 were called by telephone and interviewed by a data collector (D.P.) who had no prior knowledge of Prolotherapy. General inclusion criteria were an age of at least 18 years, having an unresolved foot or toe pain condition that typically responds to Prolotherapy, and a willingness to undergo at least four Prolotherapy sessions, unless the pain remitted with fewer Prolotherapy sessions. The foot, for purposes of this study, included the area in front of the ankle (cuneiform, navicular) to the metatarsals, metatarsal heads and phalanges. It did not include the heel (calcaneous) or ankle (tibia and fibula). Conditions that typically respond to Prolotherapy include metatarsalgia, degenerative arthritis, as well as tendon and ligament injuries of the foot.
INTERVENTIONS
The Hackett-Hemwall technique of Prolotherapy was used. Each patient received 10 to 30 injections of a 15% dextrose, 0.2% lidocaine solution with a total of 6 to 40 cc of solution used per foot and toe. Injections were given into and around the areas on the foot that were painful and/or tender to touch. The typical areas injected each with 0.5 to 1cc of solution can be seen in Figure 1. Tender areas injected included the metatarsal joints, metatarsal, cuneiforms, and navicular bones, as well as ligament and tendon attachments on the foot. In regard to toe pain, the metatarsophalangeal joints, the proximal interphalangeal joints and the proximal interphalangeal joints were injected if painful and/or tender to the touch. If applicable, the patients were asked to decrease or stop pain medications and therapies they were using, as much as the pain would allow.
| Figure 1. Typical Prolotherapy injection sites for Hackett-Hemwall dextrose Prolotherapy of the foot. |
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OUTCOMES
D.P. was the sole person obtaining the patient information during the telephone interviews. The patients were asked a series of questions about their pain and previous treatments before starting Prolotherapy. Their response to Prolotherapy was also detailed with an emphasis on the effect Prolotherapy had on their need for subsequent pain treatments and their quality of life. Specifically, patients were asked questions concerning length of pain, pain intensity, stiffness, number of physicians seen and medications taken, quality of life concerns, psychological factors and whether the response to Prolotherapy continued after the Prolotherapy session stopped.
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