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The following is a short list of conditions that are common in podiatric medicine and respond to treatment with FORTEX:

1. BURSITIS
2. HALLUX ABDUCTO-VALGUS
3. TENDIDITIS
4. CONTUSION
5. POST-OP CARE
6. ANTERIOR TIBIAL CREST PAIN
7. HALLUX RIGIDUS
8. CAPSULITIS
9. ACUTE GOUT ATTACK
10. CLOSED FRACTURE

For acute pain, Fortex may be administered topically up to four (4) times daily. For milder discomfort, apply Fortex as directed or once daily. Then application every other day, will continue to provide relief from mild pain or discomfort. Eventually a course of once weekly applications can provide long-term relief from symptoms.

The use of Fortex does not change the way that you practice medicine or surgery, it is another adjunct to the armamentarium for the management of musculoskeletal pain. By adding Fortex to the patient's treatment protocol, you supplement their care with a product that is effective and long lasting.

One to two capfuls that are added directly to the skin at joints, to muscle insertions or origins, or added to your soak or bath water, is all that one would apply to an area the size of two times the area of the surface of the palm of the hand. Rub the oil thoroughly over the skin surface and over area(s) of deep pain.

Here are some suggested treatment protocols for the following conditions that you may help to supplement your patient's standard of care. As you realize the effectiveness of Fortex, you may expand your uses for Fortex.

BURSITIS
Bursitis, whether located at the 1st metatarsal phalangeal joint or anywhere in the foot, can be treated in a similar manner as indicated above. As an alternative or as an adjunct to elective procedures, applications of Fortex can provide symptomatic relief. Direct applications to the skin over the area of the swollen bursae usually begins to provide relief usually within 45 minutes to 1 hour after application. Fortex can be used in conjunction with other forms of therapies such as oral NSAID's, or with steroid injections. One of the immediate benefits of using Fortex is rubbing the topical solution on the painful area. This form of massage also provides mild symptomatic relief. If the area of pain is to tender to massage, then a 20 minute foot soak in warm water is recommended. Add four (4) capfuls of Fortex directly to the soak water and swirl the water with the affected foot and begin soaking.

HALLUX ABDUCTO-VALGUS
Fortex works well with many forms of joint pain because of its ability to penetrate deep to the joint space. There is no substitution for surgical correction if indicated, however with or without surgery, Fortex can be used to treat this deformity.

Pre-Operatively, Fortex can be applied directly to the 1st metatarsal phalangeal joint (MPJ) and gently rubbed-in over a period of 1 to 1.5 minutes. Use 3 - 4 applications per day. Soaking as directed above is also recommended in substitution for one of the applications per day.

Post-Operatively, Fortex is ideal for post-op pain and scar (cicatrix) tissue. Fortex is best used post-operatively after the sutures have been removed and the surgical wound is closed with no areas of drainage or dehiscence. Fortex can be rubbed in and a post-operative dressing would then be applied over the Fortex.

TENDINITIS
Tendinitis is a very difficult condition to treat because of the varuous dynamics of etiologies for tendon pain. Whether the tendon is subluxed, strained, in mechanical disadvantage, overused contracted, undergoing collagen vascular changes, etc. The resulting pain from these conditions can respond, in varying degrees, to the uses for Fortex.

Application of Fortex along the tendon's course and at the myotendenous junction will help to relieve conditions like Achilles tendinitis, Peroneal tendinitis, Anterior and Posterior Tibiialis tendinitis and extensor or flexor digital tendinitis/capsulitis. Three copious applications of the rubbing oil to these aforementioned surfaces will provide ling lsating and adequate relief after 1 hour with gradual reduction of the symptoms over a 2 - 3 day period. Please remember that Fortex is not a cure-all and that the use of this product will provide relief. As a physician who understands the dynamics of the etiologies of tendidntis, one must also suppliment the therapy with strappings, splintage, orthoses, stretching exercises or other therapies pertinent to the relief of the symptoms.

CONTUSION
Blunt traumaaffecting deeper soft tissues and bone seems to be one of the reasons which Fortex was developed. One can not deny the effects of massage upon such an injury. Proper massage can help to reduce soft tissue congestion and relieve lymphatic glands of debris and help to restore circulation to its beneficial wxygenating levels, thus speeding the healing effect. Since Fortex Rubbing Oil is designed to be applied topically, the massage effects along with the deep penetration provided by the medical grade peanut oil, will help to provide fast acting relief for this symptomatic condition. As previously indicated, applications of Fortex will be adequate when applied according to the package insert. Applications of Fortex prior to using a steam bath can help to reduce the need for additional applications of the product since raising skin temperature or increasing activity by way of exercise increases the bioavailability of the product more rapidly to the tissues. Therefore, the use of steam or warm water soaks is a tremendous adjunct to the Fortex therapeutic effect.

POST-OPERATIVE CARE
Fortex may be used as a therapeutic adjunct for post-op pain from one week to tend days post-op. Apply the rubbing oil after the sutures have been removed. Then apply the post-operative dressings as usual. Continue to apply the Fortex as directed to minimize inflammation and scar pain. Do not apply Fortex to open wounds and it is not for internal uses. Application of Fortex to mucous membranes and open wounds would provide considerable discomfort in the form of a burning sensation.

Continued use of Fortex for post-op care provides for your patient an excellent alternative to taking oral NSAID's. With this consideration, Fortex can provide patients with long lasting relief of their mild to moderate post-operative pain. The use of oral NSAID's and analgesics are handy to provide an added systemic effect for relief of more moderate to severe pain. The use of Fortex therefore can lower the side effects and dependencies encountered with the use of long term analgesics especially those with codeine and hydrocodone.

ANTERIOR TIBIAL CREST PAIN
Overuse syndromes and sports pain from running and exercises can produce micro tears and stress fractures along the anterior tibia. Micro increases in the anterior compartment pressures associated with exercises and muscle hypertrophy can also produce pain. Proper identification and diagnosis of each condition is paramount when developing your treatment plan. Whether you are planning physical modalities, orthoses, surgery, casting, stretching or strengthening exercises, the earlier you apply Fortex the faster you are speeding relief to your patient. If you have a true compartment syndrome, this medical surgical emergency has to be recognized. When stress fractures are the etiology of the presenting condition, Fortes is indicated. Muscle strains and tears along the tibial crest can be treated immediately with direct applications of Fortex.

HALLUX RIGIDUS
Hallux rigidus is a difficult condition to manage with topical NSAID's. Especially when the best procedure is correction surgically. Pain is not easily reduced by medications such as NSAId's or steroid injections, because of the structural component which produces arthritic changes, fractures around the joint, cartilaginous destruction and bony erosions. The condition responds best in its early stages with injections and with NSAID's and when the 1st MPJ rang of motion is considered Hallux Limitus. Fortex willprovide relief of symptomatic pain temporarily, however the structural changes and persistent range of motion pathology will eventually require surgical intervention. Procedure selection and post-operative results will determine the long term sequellae of the patient's care and prognosis. If an implant is used to change the joint, the eventual ankylosing of the 1st MPJ will reproduce the problem of Hallux limitus/rigidus over time. Follow the package insert directions for maximum results.

CAPSULITIS
Capsulitis is the inflammation affecting the thick fibrous structures surrounding a joint. Capsulitis , brusitis and tendiditis are inflammatory events which can occur either separately or as a combined event at the joint. As with tendinitis and brusitis, capsulitis responds to Fortex because of its deep penetration reaching the joint. Apply as directed to the joint three (3) to four (4) times daily.

ACUTE GOUT ATTACK
Gout is an arthritic event associated with errors in the purine metabolic pathways. The subsequent over production of serum uric acid causes a precipitation of uric acid crystals which deposits into joints. Usually the 1st MPJ is affected among others and often soft tissues and tendons will also be involved. This causes severe pain, swelling, inflammation, and the inability to function during gait on the affected joint.

The early phases of gout are so painful that it is difficult to touchthe affected joint. Patients will often complain that a gentle breeze or sheets from the bed touching the affected area is exquisitely tender. Direct application of Fortex becomes difficult in the acute phase but does provide relief from the early inflammatory changes. Foot soaks in tepid water with Fortex added will start relief to the area. Another adjunct to care of this condition is to immobilize the affected joint to reduce further urate crystal destruction of the joint cartilaginous surfaces.

FRACTURE
Closed fracture id one condition for which Fortex provides very good rapid relief especially when combined with casting or surgical shoe immobilization.. Digital fractures are especially responsive to copious application of Fortex. All application should be as directed with no more than 3 - times a day. One of the applications can be replaced with a foot soak adding Fortex in the soak water. The fracture will not heal faster, however a pain free course of healing provides can cause complications because the patient can believe that the bone has healed. Surgical fractures respond favorably to use of Fortex, including those status post open reduction with internal fixation.

SUMMARY
Direct application of Fortex Rubbing Oil as directed to the wide gamut of podiatric conditions does provide adequate relief for those conditions. Patient compliance is important for any medication to give therapeutic levels thus providing the intended relief. There is a strong wintergreen aroma with application of Fortex Rubbing Oil, and as the product penetrates the skin, the aroma disappears. The texture of Fortex is light and the solution is clear. Fortex not only works for conditions related to the foot, but is useful for sore aching muscles, arthritis and pain in other parts of the body. Fortex is not for oral use and since it is a medical grade peanut oil base, the oil of arachis is broken down to free fatty acids which serve to help block production of PGE2 and TXA2. The 40% Methyl Salicylate converts to Salicylate and blocks COX conversion to PGE2.