Achilles Tendon High-Volume Image-Guided Injection (HVIGI)
A painful problem…a powerful solution!
Achilles Tendinopathy (which used to get called tendinitis) is an overload injury where the tendon is not healing/adapting fast enough to keep up with the stresses placed upon on it. This leads to changes in the tendon’s structure and a reduction in it’s ability to handle the stresses placed on it.
As we always preach, the fundamentals of getting an achilles tendon better are a) reduce the loads/stresses on it that are making it irritable/painful and then b) apply the principle gradually exposing the tendon to load again through a methodical exercise programme. But what happens when it doesn’t work out? Where do you go when you just can’t get going with your exercise programme because the pain is holding you back?
Our Podiatry team share your frustration. We have seen this situation time and time again. But we are also super excited to share something with you that we believe to be a genuine game-changer in treating this problem. For the first time, in any clinic in the Scottish Borders, we bring you: High volume image guided injection (HVIGI) therapy.
The cycle of pain in Achilles Tendinopathy.
To understand why HVIGI therapy might be for you it helps to first understand a little bit of what’s going on behind the scenes with your tendon and therefore how one of the major obstacles in achilles tendinopathy can be overcome by adopting this pioneering technique.
Beneath the achilles tendon lies a area of fat tissue that we call “Kager’s fat pad” which is rich with blood vessels and nerves. As achilles tendinopathy progresses, it is very common for new nerves and blood vessels from this fat pad to spread and grow into the achilles tendon in a process called “neovascularisation”. And here we hit the problem!
As we get increasing ingrowth of these very sensitive neovessels we are faced with the conundrum of trying to load/exercise a tendon that is just downright sore and stuck in a very difficult cycle.
Put simply, HVIVI therapy aims to break this painful cycle.
Breaking the cycle.
Once the problem of neovascularisation has been determined (using our in-house diagnostic ultrasound system) and we know you are medically fit to proceed, we can offer HVIGI therapy.
The procedure involves a single injection between achilles tendon and the Kager’s fat pad that lies deep to it. The “image guided” part of HVIGI therapy is the use of ultrasound. This is done throughout the procedure so the needle inside can be seen as we inject - this is essential to ensure a safe, accurate and painless as possible injection.
On the point of pain (a natural concern to have) we have not found patients to struggle at all! This is partly due to the order we prefer to follow: firstly we introduce local anaesthetic which rapidly numbs the area for the remaining steps, secondly we inject a high-volume (hence the name!) of sterile saline water and a tiny dose of steroid to finish.
Pain relief and localised anti-inflammatory effects from the anaesthetic and steroid are helpful but crucial to all this is the high volume of fluid which strips the tendon and fat pad away from each other, separating the painful nerves and blood vessels that otherwise prove so challenging to conquer.
This combination and technique has been well researched and is similar to that employed by some of the UK’s leading Podiatric and Orthopaedic surgeons.
Getting you back on your feet.
Aftercare with HVIG therapy is simple but important. You must not drive on the day of the procedure and are asked to avoid any strenuous activity for 2 weeks post-procedure. This means avoiding any running, hopping, jumping, basically anything where the tendon would be asked to work hard and fast. Your exercise programme prescribed by your Podiatrist will also be put on hold for this short period.
But then…the magic happens!
Patients often report enormous pain relief before the 2 week period is complete however the goal now is to crack on with our rehab. programme (which may include in not only a much less painful condition but in a much more sustainable and achievable way. Our Podiatry team will continue to work closely with you and monitor your progress to with the aim of achieving a full and complete recovery.
Combined with our expertise in providing existing treatments for achilles tendinopathy like our in-house and lab-made custom foot orthoses, and our gait retaining services, we believe HVIGI therapy is the missing piece of the puzzle for many suffering with a painful achilles tendon.
We are proud to continue bringing new and pioneering treatments and services to the Scottish Borders and delighted to be the first clinic here to offer this service to our patients. As always, we are here to help and if you have any further questions about this or other services we offer, please don’t hesitate to get in touch with the details below.
Guide Prices
£295 per achilles, including all aspects of the procedure, ultrasound scan and follow-up appointment.