Iontophoresis facilitates delivery of medications into the tissues beneath the skin by electronic transport of ionized drugs in solution. Acetic acid iontophoresis is effective in the treatment of heel pain. Iontophoresis of dexamethasone for plantar fasciitis should be considered when more immediate results are needed. Iontophoresis has also been used to successfully treat plantar hyperhidrosis.

Phonophoresis is a technique that combines topical drug therapy with ultrasound to achieve therapeutic drug concentrations in muscle and other tissues beneath the skin. Ultrasound gels can be formulated to contain medications such as anti-inflammatories and/or anesthetics.

J Am Podiatr Med Assoc. 1999 May;89(5):251-7

Management of heel pain syndrome with acetic acid iontophoresis.

Japour CJ, Vohra R, Vohra PK, Garfunkel L, Chin N.
Department of Surgery, Veterans Affairs Medical Center, Brooklyn, NY 11209, USA.

In order to access the PubMed abstract of this article, visit this website link.

 Am J Sports Med 1997 May-Jun;25(3):312-6
Treatment of plantar fasciitis by iontophoresis of 0.4% dexamethasone. A randomized, double-blind, placebo-controlled study.

Gudeman SD, Eisele SA, Heidt RS Jr, Colosimo AJ, Stroupe AL.
Specialty Centers for Orthopaedic & Rehabilitative Excellence, Indianapolis, Indiana, USA.

In order to access the PubMed abstract of this article, visit this website link.

To avoid the risks of COX-2 inhibitors, our pharmacy can compound topically applied NSAIDs such as ibuprofen and ketoprofen. Topical NSAIDs have a safety profile which is superior to oral formulations. Topical NSAID administration offers the advantage of local, enhanced delivery to painful sites with a reduced incidence of systemic adverse effects.

Topical preparations can be customized to contain a combination of medications to meet the specific needs of each patient.

Topical NSAIDs for Acute Pain

“Topical non-steroidal anti-inflammatory drugs have a lower incidence of gastrointestinal adverse effects than the same drugs when they are taken orally. The low incidence of systemic adverse effects for topical NSAIDs probably results from the much lower plasma concentration from similar doses applied topically to those administered orally. Topical application of ibuprofen resulted in measurable tissue concentrations in deep tissue compartments, more than enough to inhibit inflammatory enzymes.”1 Topical NSAIDs have not been associated with renal failure.2

1BMJ. 1995 Jul 1;311(6996):22-6

Topical non-steroidal anti-inflammatory drugs and admission to hospital for upper gastrointestinal bleeding and perforation: a record linkage case-control study.
Evans JM, McMahon AD, McGilchrist MM, White G, Murray FE, McDevitt DG, MacDonald TM.
Department of Clinical Pharmacology, Ninewells Hospital and Medical School, Dundee.

Free full text article available at bmj.com:

http://bmj.bmjjournals.com/cgi/content/full/311/6996/22

2QJM 1995;88:551–557

In order to access the PubMed abstract of this article, visit this website link.

The following article concludes: “Topical non-steroidal anti-inflammatory drugs are effective in relieving pain in acute and chronic conditions.”

BMJ. 1998 Jan 31;316(7128):333-8

Quantitative systematic review of topically applied non-steroidal anti-inflammatory drugs.
Moore RA, Tramer MR, Carroll D, Wiffen PJ, McQuay HJ.
University of Oxford, Oxford Radcliffe Hospital, Headington, UK

In order to access the PubMed abstract of this article, visit this website link.

Free full text article available at bmj.com:
http://bmj.bmjjournals.com/cgi/content/full/316/7128/333

 The following article reports “The systemic concentrations of ketoprofen have also been found to be 100 fold lower compared to tissue concentrations below the application site in patients undergoing knee joint surgery. Topically applied ketoprofen thus provides high local concentration below the site of application but lower systemic exposure.”

Pharm Res. 1996 Jan;13(1):168-72

Percutaneous absorption of ketoprofen from different anatomical sites in man.
Shah AK, Wei G, Lanman RC, Bhargava VO, Weir SJ.

Pfizer Inc., Central Research Division, Groton, Connecticut 06340

In order to access the PubMed abstract of this article, visit this website link.

Transdermal therapy to decrease side effects

Medications that relieve pain, reduce inflammation, and relax muscles can have side effects that are detrimental to athletic performance, such as drowsiness. However, when these medications are administered transdermally, the therapeutic benefit can be enhanced while significantly reducing the risk of adverse effects.

For example, research has shown that topically applied ketoprofen provides a high local concentration of drug below the site of application but decreases systemic exposure and significantly reduces the risk of gastrointestinal upset or bleeding. When properly compounded into an appropriate base, tissue concentrations of ketoprofen were found to be 100-fold greater below the application site (knee) compared to systemic concentrations. Muscle relaxants can be similarly prepared to minimize the risk of drowsiness.