Injection Therapies – Prolotherapy and Perineural Injections in Forest Hill

We use prolotherapy and perineural injection techniques for selected tendon, ligament and nerve-related pain around the foot and ankle, particularly when long-standing problems have not responded to usual care.

Jeremy Lefort has used traditional prolotherapy in podiatry practice since 2007 and completed further training in perineural injection techniques with Dr John Lyftogt in 2010. Our clinic is one of the few podiatry practices in Melbourne to offer both prolotherapy and perineural injections as part of a broader treatment plan.

Types of injection therapy we offer

• Prolotherapy – injections aimed at strengthening and repairing connective tissue such as ligaments and tendons.
• Perineural injections – low-concentration dextrose injections around irritated nerves to help normalise their function.

Injection therapy is rarely a first step. We usually consider it when a clear diagnosis has been made and simpler measures such as load management, footwear changes, exercise programs and orthotic therapy have not been enough on their own.

Prolotherapy

What is prolotherapy?

Prolotherapy is an injection technique used to stimulate the repair of connective tissues, mainly ligaments and tendons. A dextrose (glucose) solution is injected into specific points around the painful structure to trigger a controlled healing response.

Common problems we use injection therapy for

Injection therapies are considered when well-run conservative care has not been enough and imaging or examination supports their use. Examples include:

• Ball of foot pain such as Morton’s neuroma or painful joint capsules
• Big toe joint pain and bunions with significant joint irritation
• Chronic Achilles tendon pain in selected cases
• Complex sports foot and ankle injuries where other options have been exhausted

How does prolotherapy work?

The dextrose solution is strong enough to briefly irritate the target tissue and switch on the body’s normal inflammatory and repair processes. Unlike a new injury, there is no tearing of fibres, but the body still responds by laying down new collagen and gradually tightening and strengthening the area.

How many injections are required?

Most people need a short series of treatments rather than a single injection. As a guide, many cases require around three to five sessions spaced roughly two to three weeks apart, although this varies from person to person.

How long does it take to work?

Connective tissue healing is slow. Tendons and ligaments may take around three months from the start of treatment to repair and remodel. Some improvement may be noticed sooner, but prolotherapy is best viewed as a medium-term approach rather than a quick fix.

What can I expect after a prolotherapy injection?

Immediately after the injection the area is usually numb because the dextrose solution is mixed with a small amount of local anaesthetic. As the anaesthetic wears off, it is common to feel increased soreness for a few days as the inflammatory response is triggered.

Although uncomfortable, this post-injection pain is generally a sign that the desired healing response has begun. Simple pain relief can be discussed, but anti-inflammatory medications are usually avoided as they may interfere with the intended effect. Most people can continue with normal daily activity, with some sensible limits based on the underlying condition and advice from the podiatrist.

Perineural injections

What are perineural injections used for?

Perineural injections are used for nerve-related pain around the foot and ankle. Two conditions we commonly treat this way are:

• Intermetatarsal bursitis
• Morton’s neuroma and related forefoot nerve pain

They can also be helpful where pain feels more generalised (for example across the top of the foot) and there is a mix of nerve irritation, muscle tightness and underlying foot posture issues. In these cases, if the nerve component is not addressed, pain may not fully resolve.

How do perineural injections work?

The body has a dense network of small sensory nerves that can become “overactive” and start producing pain-promoting chemicals, leading to ongoing pain and tissue irritation (neuropathic inflammation).

Low-concentration dextrose (commonly around 5%) is injected around the affected nerve. This has been clinically observed to block certain receptors on the nerve surface, helping to “down-regulate” the nerve and restore more normal behaviour. The injections usually need to be repeated, with benefit building over several treatments.

How are these nerves irritated?

Small sensory nerves pass from the skin to deeper tissues through narrow openings in fascia, muscles and bony tunnels. Tight muscles, altered biomechanics or local crowding can cause constriction and abnormal nerve behaviour. Examples include nerves in the tarsal tunnel at the inside of the ankle or in the intermetatarsal spaces between the long bones of the foot.

Types of perineural injection

• Subcutaneous perineural injection (SPNI): A fine needle is used to place a small volume of dextrose solution just under the skin along the path of the irritated nerve.
• Deep perineural injection (DPNI): A larger volume is injected deeper around the nerve where it is being constricted as it passes through fascia or a tunnel. The injected fluid gently stretches the tissue layers to create more space and reduce pressure on the nerve (a process known as hydrodissection).

What can I expect after perineural injections?

Because we are not trying to trigger a strong inflammatory reaction, there is usually little to no post-injection pain with perineural techniques. SPNI may cause a brief stinging sensation at the injection site that settles within minutes. DPNI can occasionally produce a temporary feeling of fullness in the area as the fluid disperses.

Most people can continue normal daily activities immediately after treatment.

Book an injection therapy assessment

If you have persistent heel, tendon, ligament or nerve-related foot pain that has not responded to usual treatment, injection therapy may be worth discussing as part of a broader plan. We will assess your condition, explain whether prolotherapy, perineural injections or another approach is most appropriate, and outline the likely number of sessions.

You can book an appointment online or call the clinic to arrange a suitable time.

Lefort Podiatry provides prolotherapy and perineural injection therapies for patients from Forest Hill and surrounding suburbs including Blackburn, Nunawading, Mitcham, Box Hill and Doncaster East.