Foot pain stinks, plain and simply. When you have a foot or ankle problem that is difficult to treat, or if you are concerned about adverse side-effects of systemically administered medications, compounding might provide the right solution for you.Working together with prescribers like podiatrists and their patients, Davis Islands Pharmacy and Compounding Lab provides innovative solutions to challenging medical situations involving the feet. We can create customized formulations containing the most appropriate ingredients in the best vehicle to efficiently deliver the needed drug to the affected area.
Commonly prescribed podiatric medications aim to relieve pain, reduce inflammation, and relax muscles. Such medications often come with undesirable side effects, such as drowsiness. However, when these medications are administered transdermally directly to the foot, the therapeutic benefit can be enhanced while the risk negative side effects has been shown to reduce significantly.
A common example seen in the world of podiatry involves the drug ketoprofen. Research has shown that when applied topically, ketoprofen provides a high local concentration of the drug below the site of application, while decreasing systemic exposure and significantly reducing the risk of adverse side effect such as gastrointestinal upset or stomach bleeding. When properly compounded into an appropriate base, studies showed an 100-fold increase in tissue concentrations of ketoprofen below the application site when compared to systemic concentrations. Furthermore, with compounding, muscle relaxants are frequently added to transdermal bases which minimize the risk of drowsiness and increase the effectiveness of treatment.
Athlete’s foot and onychomycosis (fungal nail) are common problems seen by podietrists. Research points to ibuprofen, alone or in combination with azoles, as a practical solution to treating candidosis. When applied topically, ibuprofen takes advantage of the drug’s antifungal and anti-inflammatory properties. With compounding, various medications that work well together are synergistically combined in a simple solution for antifungal therapy.
According to the Medical Journal “Drug Topics”, “Chemical (using 40% urea) or surgical removal of the nail, combined with topical agents and oral agents, may be necessary in some nondermatophytic fungal infections. For those patients who cannot take or are reluctant to take an oral medication, an antifungal agent (e.g., terbinafine HCl) can be prepared in a pharmaceutical grade DMSO and applied topically… topical medications can be very useful in delivering the drug directly to the problem area. Also, topical medications usually have a lower adverse drug-reaction profile and are not prone to drug-drug interactions, as are systemic medications, if used properly”.
Urea plasters have been shown to be effective for non-surgical removal of traumatized, dystrophic, or diseased nails, and may even be superior to surgical excision. The use of urea plasters can be much less costly, several nails can be treated in one session, and the procedure is essentially painless. Due to the reduced risk of infection or hemorrhage, the procedure is ideal for treating diabetic patients and other with vascular insufficiency and peripheral neuropathy.
Traumatic wounds and pressure sores may heal more quickly if treated topically with phenytoin, which is used orally for anti-seizure therapy. Medications which improve capillary blood flow can be added to a compounded medication to enhance circulation at the wound margins and promote healing of the injured area.
Dry skin and calluses can be treated with topical application of moisturizers such as silicone or urea. At Davis Islands Pharmacy, we utilize specialized equipment, such as an ointment mill, that allows us to compound formulations containing significantly higher concentrations of urea than can be prepared using traditional methods.
In addition to dry skin and calluses, plantar fasciitis and warts are two common ailments treated by podiatrists that can be helped with customized compounded medications.
The root of a patient’s foot pain is not always in the exact location they think it is. Pain sensations follow a nervous pathway along an entire dermatome, from the trigger point to where the sensation is perceived. Trigger point application may be a useful solution when pain medications are administered transdermally, and is especially useful when treating neuropathic pain of the foot.
Numerous compatible medications can be combined through compounding into a single dosage form, providing patients with easier experience when it comes to administration and adherence. What’s more, synergistic effects can also be achieved when certain medications are used in combination. In other words, the end product can oftentimes be more effective than the sum of the individual parts.
Penetrant enhancers can be added to further improve the extent of absorption of topically applied medications targeting foot ailments.
Iontophoresis facilitates delivery of medications into the tissue beneath the skin on the foot 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 been used to successfully treat plantar hyperhidrosis, as well.
Phonophoresis is a technique that combines topical drug therapy with ultrasound to achieve therapeutic drug concentrations in muscles and other tissues beneath the skin on the foot. Ultrasound gels can be formulated specially to contain medications like anti-inflammatories and/or anesthetics, depending on the need of the patient and podiatrist.