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Posts for: January, 2015

January 09, 2015
Category: F.Y.I.

Sclerosing Injections are a series of injections often used to treat a painful Morton's Neuroma in the foot.  A Morton's Neuroma is a nerve inflammation or neuritis that occurs when a nerve on the bottom of the foot, usually between the third and fourth toes, becomes compressed or otherwise irritated and enlarges.  It is NOT a tumor, despite the name given to it many years ago by Dr. Morton.  Pain and numbness starting in the ball of the foot and radiating into the toes is a common symptom, and it often becomes worse as the nerve becomes more inflamed or enlarged.  There are several ways to treat neuromas, with surgery being done less and less often.

 Steroid (cortisone) injecions and orthotic devices are probably used in the majority of cases first, especially if padding and changes in shoes do not help.  Unlike steroid injections which are given to shrink the nerve, often temporarily, sclerosing injections are given to cause a chemical neurolysis of the nerve, basically making the nerve no longer work.  While nothing is successful 100% if the time, a series of sclerosing injections, often between 3 and 7 of them spaced 10 to 14 days apart, is often very helpful in reducing and often eliminating the pain, numbness, burning, and tingling of a neuroma.

  Typically, a very small amount of the medication, often less than 1.0cc, is infiltrated directly into or on the nerve.  It is helpful to use ULTRASONIC GUIDANCE for this treatment to be sure the medication is right at or in the nerve.  With steroid injections, a larger amount of fluid is injected near the nerve, so that the medication "bathes" the nerve.  It is more important with a sclerosing injection to give the medication right at or behind the bifurcation (the y-shaped area where the nerve splits into two branches). 

A very small needle can be used for this, usually smaller than that used for a steroid injection, as long acting steroid medications are "thicker" and are not easily administered through a very thin needle.  The procedure takes only a few minutes, and the patient is helpful in communicating with the doctor when she feels the doctor is "getting close to the nerve."  Sharp, electrical shock type pains, which are relatively brief, will tell the patient the needle is very close to the nerve.  The medication is given in that spot, and then the procedure is over.

  The sclerosing mixture used is often a mixture of absolute alcohol, Marcaine (a long acting anesthetic), and epinephrine.  In the U.S., it is common to use a 4% solution, but in europe, where the procedure has been done for a much longer period of time, high concentrations of the medication are used.  This increases the effectiveness, and may reduce the number of injections needed, but it does carry some risk of "burning" the skin.  I, personally, have found that a 10% mixture works well in a majority of cases, and have had no untoward effects with that strength.  I have heard of mixtures as high as 20% being used in Europe, with a high success rate, but also a sometimes unacceptable rate of side effects.  In any case, the sclerosing injections are usually given every 10-14 days until the patient sees a nearly complete resolution of symptoms.  I have found, in my practice, that anywhere from 3 to 7 are needed.  We usually then evaluate the patient several weeks to a few months later, to be sure there is no recurrence.

Dr. Richard S. Eby

(423) 622-2663

January 04, 2015
Category: Uncategorized

Plantar fasciitis and Achilles Tendonitis are two of the most common painful problems that affect the foot and ankle.  While there are MANY conservative treatment options for both conditions, many conservative treatments give TEMPORARY and/or PARTIAL results.  The use of high energy pulses to treat heel pain is NOT a new phenomenon.  In that late 1990's, and early 2000's, SHOCKWAVE THERAPY became a very effective and somewhat popular way to treat these problems, especially Plantar Fasciitis, which is extremely common, and for which surgical intervention often reveals unpredictable results.  Shockwave Therapy became less and less popular as the cost of these treatments were often as high as $2000 per treatment, and usually NOT covered under traditional health insurance.  In the past few years, less expensive and more portable units to transfer kinetic energy into the body have come on the horizon.  RADIAL PULSE THERAPY delivers high energy pulses for 1.Efficient energy transfer to effect muscle tone. 2.Treatment of muscle aches and pain. 3. Increasing localized blood circulation.  One of the radial pulse therapy units is marketed under the name "EnPuls."  While it can be used for back pain and upper extremity complaints as well, my expertise with this unit is in foot and ankle pathology.  I, specifically, have found this unit very helpful in the treatment of PLANTAR FASCIITIS and ACHILLES TENDONITIS with or without heel spur and bursitis.  Usually about five treatments are needed, spaced about 7-10 days apart, to give significant and lasting relief.  Unlike traditional shockwave treatment, there is NO need for anesthesia, either local or general.  The treatment is not painful, but may be slightly uncomfortable, especially over bony prominences such as the back of the heel.  Additionally, there is some improvement in heel pain, almost immediately.  While it still may take a few days to see a marked reduction in symptoms, the pain in the heel typically does not increase for a few days or weeks, as has occurred in many with traditional shockwave therapy.  Like traditional shockwave therapy, the patient should NOT consume oral anti-inflammatory medication (prescription or over the counter meds - including aspirin, Ibuprofen, or naproxen) for a period of time after the treatment(s).   In those cases where other conservative treatments have not been effective, Radial Pulse Therapy with the enPuls (Zimmer Medizin systems) has been a welcome addition treating heel pain, and can often eliminate the need for surgery.


Richard S. Eby, DPM

(423) 622-2663


January 01, 2015
Category: Nail Treatments

BigNews.Biz - Apr 16,2013 - Chattanooga, TN, 17-APR-2013 - Dr. Richard Eby DPM, Chattanooga podiatrist, is pleased to announce that locals no longer have to put up with the pain and inconvenience of ingrown toenails. Ingrown toenails (onychocryptosis) are a commonly occurring issue usually found in the teenage years and beyond. The causes are found in improper trimming, poorly designed shoes and excessive sweating of the feet (hyperhidrosis).

According to Dr. Eby, speaking in a recent interview, "Ingrown toenails are usually caused by trimming toenails too short, particularly on the sides of the big toes. They may also be caused by shoe pressure (from shoes that are too tight or short), injury, fungus infection, heredity, or poor foot structure. Ingrown toenails occur when the corners or sides of the toenail dig into the skin, often causing infection."

"A common ailment", he continues, "ingrown toenails can be painful. Ingrown toenails start out hard, swollen, and tender. Left untreated, they may become sore, red, and infected and the skin may start to grow over the ingrown toenail."

Initially, the condition begins with pain in the specific nail. As the problem worsens, there may be drainage, difficulty walking and infection. This can be a particular difficulty with diabetic patients.

Prevention is the best way to avoid suffering the need for surgical therapy. Common therapy which can be begun at home, which will prevent many of the cases includes soaking the feet in warm soapy water several times daily. Advanced cases where infection is present may require antibiotics, but only at the instruction of the podiatrist.

Learn more about the prevention and care of ingrown toenails by visiting the web pages at today. Members of the press and individuals who have further questions about the details in this press notice are encouraged to contact Dr. Richard Eby DPM, Chattanooga podiatrist, at the location described below.

Contact Person Name: Dr. Richard Eby DPM
Address: 3603 Ringgold Road, Chattanooga, TN, 37347
Contact Phone Number: (423) 622-2664