Iontophoresis - adverse reaction?

[RolliePollie]

I have been going to physical therapy over the past 3 weeks for tendonitis in my ankle. The PT has used Iontophoresis with Dexamethasone during each visit. The last three appointments, he used a bandaid version powered by a watch battery that you wear for 3-6 hours.

So here is my dilemma. The ankle is much better. A week ago, it was almost 100% better with no pain, swelling was down, etc. But then my entire foot started swelling and I have pain over the top of my foot near my toes and on the bottom of my foot near my heel. The PT thinks I may be having an allergic and/or adverse reaction to the Iontophoresis and he's not going to do it anymore. I'm not having any itching (but maybe the residual Dexamethasone is masking that?), but my foot is puffy and bright pink, and the swelling gets worse if I ice it. I did a little research on the internet and found that Iontophoresis can cause temporary nerve and blood vessel damage. I did get a minor electrical burn from one of the first treatments, so maybe my PT had the power turned up too high? PT's out there...does this sound like an allergic reaction to you? I just do not understand what is going on and I'm really quite frustrated!

[KnottedYet]

Sounds like it's beyond your PT.

Can you get a hold of your doc's office and ask them what they recommend?

Could be a reaction to the material of the bionic bandaid, could be you just had too many ionto treatments and too close together in time. (how many did you have, anyway?)

I don't use ionto anymore, so I don't remember all the precautions and reactions. (I've probably done maybe 2 ionto patients in the last 4 or 5 years. Two clinics I've worked in don't use it at all. It's just not that common around here anymore.) So, I'm sorry, but I'm not much help. Please call your doc if your foot isn't right.

[RolliePollie]

Could be a reaction to the material of the bionic bandaid, could be you just had too many ionto treatments and too close together in time. (how many did you have, anyway?)

I've had 7 ionto treatments over 2 week's time. And the last three were the bandaid version. When he did ionto in the office with the electrodes hooked to the little power thingie, it was stinging and burning SO BAD that I had to have him take it off and give me a break. And the bandaid version supposedly should not sting, but it was stinging for the entire 3-4 hours I had it on. So maybe I just can't tolerate electrical current running throuhg my body?!?! I'm also suspicious of those bandaids, although I'm not allergic to latex. The PT did say that a reaction to ionto would build up over time, kind of like an allergic reaction to anything else. So it seems feasible to me, but then again, I have no clue about this kind of stuff!

Knotted - just out of curiosity, is ionto kind of an "old school" treatment? It seems like it's been the cornerstone of my treatment with this PT. I've never had PT before, so I have no idea what different types of things a PT would do for tendonitis. I am not terribly impressed by this guy in general, so maybe I should try to get a different referral.

Hmmm...the body is such a fascinating machine. I wish I could look inside my foot and see what the heck is going on in there!

[KnottedYet]

I don't know your PT, and I don't know the situation with your tendonitis. So take everything I say with a grain of salt.

If your gut instinct is to find a different PT, I say go with your gut.

7 iontos in 2 weeks is rather unusual in my experience. Continuing when the patient is having an adverse reaction is also rather unusual. (It may prickle or tingle, but it should never sting and burn.)

How is your foot now? Giving your doc's office a call might still be a good idea.

And please don't get any more ionto treatments.

[RolliePollie]

Thanks Knotted...I really like hearing another knowledgeable person's opinion! I hate being a patient who doesn't know anything...I just have to blindly trust the PT to do whatever he thinks we need to do. Not that I'm certain he did anything wrong. I'm sure that he didn't have any bad intentions, but he did kind of blow me off when I complained about the ionto pain and the new foot symptoms. Luckily, I don't have another appointment until after Christmas, so that will give my foot some time to do its own thing. And if it's not better by then, I'll be calling the Dr. and cancelling the PT appointment!

It is better tonight but still doing weird things...like now the pain has moved to another new place and is gone from the old places. I kind of think my foot is possessed. Or maybe I'm just crazy!

[KnottedYet]

What kind of exercises does the PT have you doing? Are you doing a lot of foot/ankle posture exercises in a mirror (to watch the posture)? Are you doing a bunch of very silly looking toe exercises to strengthen your intrinsic muscles? Do you have calf raises in a few different postions to strengthen the extrinsic muscles? Hips have a lot to do with the feet/ankles in women, does he have you doing hip external rotation exercises like clamshells, and hip abduction exercises like side leg raises?

What kind of insoles did he have you buy for your shoes? Did he put wedges on the undersides of the insoles to help align your ankle and foot bones and take stress off the tendons and ligaments? Do the insoles have a deep heel cup?

If he's doing a good job with the rest of it, and just got overenthusiastic about ionto, then maybe I was being too harsh when I said go ahead and get a new PT. But I really think you will be better off if you DON'T get another ionto.

[RolliePollie]

This is really interesting. Knotted - I'm so glad you asked all those questions. Now I am thinking even more that I should seek out a new PT and see what they think. Thank you so much for your replies!

My PT does have me do some stretching/strengthening exercises, but no hip exercises. He is not recommending insoles because he says he considers those a last resort. I am kind of suspicious that this particular PT finds my case quite boring. I've watched him with other patients and he seems more enthusiastic about their treatment. Being a brand new PT, I wonder if he's looking for exciting cases that give him a challenge. Well, I guess maybe I'm giving him a challenge now! Even though I live in a really small town, we do have at least one other PT clinic that I know about. I think next week I'll call the Dr., hopefully go in and get checked out, and then definitely pursue a new PT referral.

My mom is an R.N. and she really thinks I have nerve/blood vessel issues going on. For one thing, my foot is tending to be a different color than the good foot. She thinks the blood vessels are freaking out. I just hope that if this is damage from the ionto, that it's temporary and not permanent. No more ionto or any other electrical treatments for me!

[KnottedYet]

I've watched him with other patients and he seems more enthusiastic about their treatment.

Ummmm, how is it you can watch him with other patients while you're there? Is he treating more than one patient at a time? (that's illegal)

I like using Superfeet insoles, they are cheap ($35) and very easy to wedge to sort of customize the fit. As a person's muscles get stronger they often need less and less wedging, and I can peel the wedges off the Superfeet and trim them down. Sometimes by the end of PT the patient doesn't even need wedges anymore, but they keep using the Superfeet. The nice thing about sturdy neutral insoles is that they also help cue the muscles when to fire. (the bottom of the foot gets more positional info from touching the insoles than from touching a flat surface, for example.) Insoles are usually my first resort, rather than my last. (I have a very good orthotist I can send folks to who need custom orthotics. Those are expensive!)

I'm glad you've got your mom as a resource. Instead of Rudolf's Red Nose for Christmas, you've got the glowing red toes!

[VeloVT]

Hi Sara,
Of course Knot can offer much more valuable information than I can, since I've only experienced ionto as a patient and I have NO medical expertise. But I just wanted to reinforce that you are NOT having a normal reaction to it. I had ionto for about 4-6 weeks last year for peroneal tendinitis from running (tendon that runs behind the ankle and wraps under the foot). The ionto was mildly helpful for me, got rid of the acute "I can't walk for more than 100 yards without limping" pain but didn't return me to running (massage did though, amazingly well).

But, I never had anything more than mild tingling from the treatments. We did twice a week. I think the machine worked on some sort of watt/minute measurement (takes less time at higher wattage, more time at lower wattage) and they would always take 5 minutes adjusting the settings to my comfort. I think my skin must be thick, because they kept asking, ok, do you feel anything now? does it hurt now? and every time they were able to crank it up as high as it would go (they always seemed surprised). Afterwards the therapist would rub a little cream on the areas that the electrodes had contacted. But I never even had redness.

I did have weird systemic reactions that I attribute (perhaps erroneously) to the dexamethasone. On days I had treatments, I would be jittery after the treatment and couldn't sleep at all. I was also off/irritable and it seemed to aggravate acne... I attributed the mood/sleep symptoms (which were pronounced and completely limited to days I had treatments) to the dex because I've had similar experiences other times I've had to take medications with steroids -- but, according to the package inserts anyway, this kind of systemic reaction is supposed to be unusual with ionto (as opposed to steroids taken orally or through injection), so maybe it was coincidence .

Anyhoo you shouldn't be swelling. I hope you are able to find another treatment that works.

[RolliePollie]

Well, I'm all done with PT. But my foot is not completely better. I am a bit puzzled by the whole PT experience. If I ever need PT again, I'll ask for a referral to a different clinic. My PT's final hypothesis about what happened with my foot is that I have some disorder, like Reynaud's, that causes my nerves to react to ice. He now says he doesn't think it was the Ionto. I disagree. I think is was too much Ionto at too high of a level, and I think it messed up the nerves in my foot. Based on Liza's comments about the Dexamethasone, I think I may have been reacting to that as well. I was really grumpy but that could've also been because I was annoyed that my foot was hurting, plus the holidays kind of make me grumpy. So who knows about that. But my face broke out really bad during the couple of weeks I was getting Ionto, and I could've sworn that I just looked puffy in general. Now my skin is back to it's normal level of breaking out and I don't think I look puffy anymore.

I still haven't been back to the Dr. because it is getting progressively better. There is just minor pain that comes and goes, and the swelling is pretty minimal at this point. I'm going to give it one more week and see what happens. I'm planning to go skiing on Wednesday, so that should be a good test. Oh, and I bought Superfeet insoles yesterday, so I'll be trying those out as well.

Knotted, thanks again for your insight on the whole PT thing. I almost hope I need PT again sometime so I can go to someone else and see the difference!

[KnottedYet]

I'm sorry your PT experience wasn't the best.

If your foot doesn't get better, don't hesitate to contact your doc.

If you have any issues with your Superfeet, please contact me. If I can't help solve the problem, I have the name of a rep for the Superfeet company who might be able to help.