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07/28/2010
RESPONSES / COMMENTS (CLINICAL) - PART 1
RE: Multiple Verrucae (Gary Bjarnason, DPM)
From: Multiple Respondents I posted a very similar case in a 15 y/o female several months ago on PM News. After reviewing numerous suggestions, I decided to use 5-FU/SA (2% 5-fluorouracil plus 16% salicylic acid) cream.
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Warts (before and after) 2% 5-fluorouracil plus 16% salicylic acid) cream |
All verruca resolved and she still remains wart-free. It took 3-4 months, but treatment was pain-free, user-friendly, and without side-effects. The product (known as Wartpeel) can be ordered through NuCara Compounding. For more information go to (medcara.com/wartpeel/)
Chris Seuferling, DPM, Portland, OR, cseuferling@comcast.net I recommend off-label cimetidine 25mg/kg/day P.O. in divided doses. Cure rates approximate 85%, with duration of therapy ranging from 3-12 weeks. See prior PM News issues by using the search engine at www.podiatrym.com for references.
Barry Mullen, DPM, Hackettstown, NJ, yazy630@aol.com Try adding oral Cimetidine 30mg/kg for at least a month, possibly longer to your local treatment regimen. In my experience, it helps slow and prevent spreading, and in some cases has even radically accelerated elimination of the lesions. I also like to use Effudex Cream (5-Fluorouracil) topically and under occlusion.
Neil Levin, DPM, Sycamore, IL, DRFEET1@aol.com
Other messages in this thread:
12/12/2012
RESPONSES / COMMENTS (CLINICAL) - PART 1B
RE: Tibial Sesamoid Fracture (Terry Nayfa, DPM)
From: Elliot Udell, DPM
We have had great success in treating fractures of the sesamoids using the Exogen bone stimulator. The trick, however, is to maximally off-load the area in order to allow for healing. To this end, you need to have a good working relationship with the company that makes your custom orthotics and have them design a device that will take weight off of the first met head.
After the orthotic arrives, mark the area of the first met head and have the patient walk on the orthotic to make sure the correction is in the correct location. You may have to supplement even the best-made orthotic with layers of felt. Let the patient know that it may not be the most comfortable device, but unless the weight is off-loaded from the area, healing of the fracture will be impaired.
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com
05/19/2012
RESPONSES / COMMENTS (CLINICAL) - PART 1A
RE: Soft Tissue Mass (Bryan Markinson, DPM)
From: Tip Sullivan, DPM
I felt the need to respond to the last paragraph in Dr. Markinson’s last post regarding a possible malignant soft tissue tumor. Some people who read the statement: “Lastly, if you find yourself seeking advice on the surgical management of a soft tissue mass (that may be malignant) in PM News, I am reasonably sure you may get some great information. But I am positive that the patient could be in better hands.” may feel offended, intimidated, and hesitant to post here. I hope that does not happen.
This forum should be for all of us to share and we should not hesitate to share our interesting cases. I look forward to it every day. We all realize that this is just a forum and not a text book or “the written word”—Everything read here regarding patient care should be taken as “an opinion” not a hard fact - even Dr. Markinson’s posts. As my mama used to say, “There are lots of ways to skin a cat,” and in most cases there are lots of ways to approach the problems we see. I thank Dr. Markinson and all the others who post here and would like to see more cases. As Dr. Markinson says—there is some great info here. There are also some differing opinions - as they say - that is what makes the world go round.
Tip Sullivan, DPM, Jackson, MS, tsdefeet@MSfootcenter.net
04/14/2012
RESPONSES / COMMENTS (CLINICAL) - PART 1
RE: Onychomycosis in a Ten Year Old (Tip Sullivan, DPM)
The query is about using oral Lamisil with a ten year old. I do not own or use a laser, however, this seems to be an ideal situation for its use. My opinion is that the laser is an excellent modality when oral medications are contraindicated or not otherwise documented.
Richard A. Simmons, DPM Rockledge, FL, RASDPM32955@gmail.com
04/06/2012
RESPONSES / COMMENTS (CLINICAL) - PART 1
RE: Titanium Screws and Metal Detectors (Alan Mauser, DPM)
From: Tip Sullivan, DPM
I don’t know how many screws, plates, etc. that I have implanted in 23 years. I can tell you of only two incidences that have occurred regarding metal detectors. One was following a major rear foot reconstruction using two titanium plates and several screws. The patient was a lawyer, and the detector going into the courtroom went off. I was called from the courtroom to confirm the implants. The problem was that the sensitivity of the machine was set too high.
The other case was another major reconstruction in which lots of hardware was used. They used a wand at the airport and could see the scars. There was no problem, just a hassle for the patient. There are small cards (like credit cards) which you can give to patients that they can put in their wallet/purse that gives the implant name, location, your name, and the date of application. Ask your Wright Medical rep for them. I have never had any issue with a single metatarsal osteotomy screw, but certainly I would suspect the metal detector and have it looked at for adjustment before I took someone to surgery to take out a screw.
Tip Sullivan, DPM, Jackson, MS, tsdefeet@MSfootcenter.net
02/10/2012
RESPONSES / COMMENTS (CLINICAL) - PART 1
RE: Atypical Forefoot Pain (Gary Bjarnason, DPM)
From: Art Hatfield, DPM
How about doing a neurological exam with a monofilament to determine if there is a difference in tactile sensation between the affected foot and the normal foot. This may save the expense of an MRI. Several years ago, a high school girl patient complained of left forefoot pain. On the 3rd visit, I was standing in the waiting room when she pulled up in her '60s VW. I asked her about the car and she stated that she used it to do her school paper route. She delivered about 150 papers every A.M.
Since a 1965 VW was my first car, I thought I finally knew the answer to her problem. Sure enough, the small rubber cap that covered the metal clutch pedal was missing. While doing her paper route, her left foot was constantly on the clutch pedal as she slowed and stopped. She replaced the rubber cap for about a dollar, and her problem was solved (much cheaper than an MRI). There is a lot of vibration in a large truck. This can cause neurological pain without the patient actually having a neuroma. Does the accelerator pedal of the big rig have the appropriate pad in place? Is it worn?
My inclination is that this is simply a neuroma. Remember, if it quacks like a duck, walks like a duck and looks like a duck, it's probably a duck.
Art Hatfield, DPM, Long Beach, CA, Afootjob@juno.com
12/26/2011
RESPONSES / COMMENTS (CLINICAL) - PART 1
RE: Partial Non-union Subtalar Joint Arthrodesis (Judd Davis, DPM)
From: Kevin K. Lam, DPM
Yes, that 90% non-union can be the cause of her pain due to micro-motion. There appears to be micro-motion at the screw threads in the calcaneus, with lysis noted. I would remove the screw, resect the non-union to bleeding bone. Most likely, a bone graft will be required; autogenous being the best. Then use two plantar screws for fixation. Add in BMP, external bone stimulation, and NWB for up to 12 wks. Check Vitamin D3 levels and pre-albumin levels too.
To be 100% sure, do a Lidocaine injection into the STJ. After 5 minutes, do your same ROM test to see if the pain is gone, if it is, then revisional fusion is the answer.
Kevin K. Lam, DPM, Naples, FL, KLAMDPM@HOTMAIL.COM
12/22/2011
RESPONSES / COMMENTS (CLINICAL) - PART 1
RE: Chronic Diabetic Ulcer (Kel Sherkin, DPM)
From: Timothy P. Shea, DPM
Diabetic foot ulcers of longer than three months need to be considered senescent and in a state of non-healing. This indicates a high index of suspicion for adjunctive vascular disease and deep bone/joint infection, even if x-rays are negative.
My recommendation for this wound is: MRI if possible to determine bone involvement. Vascular evaluation (preferably by vascular surgeon to determine nature and extent of vascularity available for healing). If needed, do the vascular procedure first. Revisit medical management. Once stable, plan deep surgical extensive debridement of the wound (probably to include the bone and joint. This may require distal amputation). Take deep cultures of the wound for appropriate infection management. Do close monitoring of medical status (commonly out of control blood sugar) .
Post-op plan: leave the wound open unless it can be closed primarily, with all infected tissue removed. Negative pressure wound therapy, off- load foot with cast, weekly debridements, and if possible advanced tissue therapy 2-4 weeks after surgery. Use markers of decrease in square volume (length by width cm.) of the wound by 50% at 4 weeks, 80% at 8 weeks,100% 12-14 weeks.
Be aggressive in wound and medical management. Advise the patient that he is at high risk for loss of limb and life from this type of problem. Follow-up therapy when the wound heals with appropriate footgear and evaluation every month. These are the types of wounds that easily go on to ray resections, transmetatarsal amputations, and then BKAs. Patient compliance will be a major factor in managing this wound.
Timothy P. Shea, DPM, Walnur Creek, CA, tsheapodiatry@yahoo.com
12/22/2011
RESPONSES / COMMENTS (CLINICAL) - PART 1
RE: Orthotic Therapy For Hallux Rigidus (John Scholl, DPM)
From: Keith Gurnick, DPM, Robert S. Schwartz, CPed
The diagnosis of hallux rigidus, by itself, does not necessarily mean that a foot orthotic is indicated. Gait analysis findings and biomechanical measurements would provide additional information to help answer your question. However non-surgical suggestions would include:
1) Suggesting a very stiff-soled shoe with a roomy toe-box.
2) Intra-articular steroid injection to help reduce any joint pain.
3) A full sole carboplast inlay to stiffen up any shoe flexibility.
4) Work or activity modification to reduce propulsive forces across the involved joint.
5) Maybe orthotics.
Keith Gurnick, DPM, Los Angeles, CA, keithgrnk@aol.com
Try a ready-made rocker sole shoe with at least 20 degrees of dorsiflexion at the 1st MTPJ. MBT, Finnamic, PW Minor, and Alden are some of the brands that come to mind. Of course, a rigid rocker can be added to any shoe. If he is wearing a shoe with enough depth to accommodate an orthotic with a Morton’s extension, that is a viable option.
Robert S. Schwartz, CPed, NY, NY, rss@eneslow.com
12/20/2011
RESPONSES / COMMENTS (CLINICAL) - PART 1
RE: Orthotic Therapy For Hallux Rigidus (John Scholl, DPM)
From: Neil B. Levin, DPM
It is a shame, because this appears to be an excellent case (radiographically) for a cheilectomy/decompression 1st metatarsal osteotomy, given the long first metatarsal. If surgery is not an option, however, try putting him in a simple turf toe plate (FOOT MGMT, INC.). It's inexpensive and effective.
Disclosure: I have no financial interest in this company.
Neil B. Levin, DPM, Sycamore, IL, DRFEET1@aol.com
You may want to try a Langer Flexible Allsport (Toprelle) with a Morton's extension made from the shell. It has worked well for some patients in my practice.
Michael J. Schneider, DPM, Denver, CO, podiatristoncall@gmail.com
12/08/2011
RESPONSES / COMMENTS (CLINICAL) - PART 1
RE: Terbinafine Overdose (Eric Edelman, DPM)
From: Jay D Helman, DPM
Terbinafine has a half-life of 2 weeks. Therefore, 2 weeks after last dosing, it's out of the blood and into the skin and nails for the next three months. If patients LFTs are normal, then there is no reason you can't complete the regimen. The only thing Dr. Edelman didn't mention is whether or not he cultured and confirmed that he is treating strictly a dermatophyte. If not, it won't be effective. The reservoir of terbinafine must be sufficient in the nails for the entire clearing process for it to be effective. If it runs out prior to total clearing, the entire nail will re-infect.
Jay D Helman, DPM, Suffern, NY, footdr80@hotmail.com
11/30/2011
RESPONSES / COMMENTS (CLINICAL) - PART 1
RE: Non-Healing Ingrown Toenail (Malignant Melanoma)
From: David Weiss, DPM
I have just treated a 52 y/o WF for a "non-healing" ingrown toenail. She presented to my office with a "paronychia" that had been unsuccessfully managed with three courses of antibiotics by her PCP. Her x-ray showed a mild subungual exostosis. I recommended a nail bed biopsy and an exostosis resection. Her biopsy results revealed a highly invasive malignant melanoma (Clark 5), vertical growth phase. Here is a photo of the toe as she presented.
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Malignant melanoma |
She has now been referred for PET scan, sentinel node biopsy, and amputation of the toe. Considering the presentation and the implications of the diagnosis, I am grateful that we as podiatric surgeons are trained to be suspicious "whenever something does not look or sound right." This is my second malignant melanoma diagnosis in 2 years on the nail bed.
David Weiss, DPM, Richmond, VA, podmed@mac.com
11/19/2011
RESPONSES / COMMENTS (CLINICAL) - PART 1
RE: Wavelengths for Laser Treatment of Onychomycosis (Jeff Kass, DPM)
From Elliot Udell, DPM
We are seeing corporate-sponsored research studies which tend to study small numbers of patients for short periods of time. There are many different companies promoting lasers for onychomycosis and each one will hand you a packet of information showing that their machine and its wavelength is the best. Some have studies backing their devices and others do not.
These machines are very expensive and the treatments are not covered by insurance. As clinicians who have a responsibility to properly inform and advise our patients, we should know if there are any good studies out there showing that the results are long-lasting. To charge a patient a lot of out-of-pocket money for a treatment only to have the problem recur in a year creates a very unhappy patient. Hopefully, there will be some long-term studies on all of these modalities which will address some of these concerns.
Elliot Udell, DPM, Hicksville, NY, Elliotiu@aol.com
11/14/2011
RESPONSES / COMMENTS (CLINICAL) - PART 1
RE: Chronic Wound in Type 1 Diabetic
From: Chris Ferguson, DPM
A chronic wound that doesn't seem to resolve may not be a wound. I would biopsy it to rule out a carcinoma.
Chris Ferguson, DPM, NY, NY, cfergdpm@yahoo.com
10/12/2011
RESPONSES / COMMENTS (CLINICAL) - PART 1
RE: Plating System for Fractured 5th Metatarsal
From: Carlos A Rojas, DPM, Carlos A Rojas, DPM
Which plate to use (particularly for this case) does not seem to me as the major component of your pre-operative planning; the medical and social history together with an uncertain post-operative compliance period seems to me of more concern. The major drawback of this fracture is how distal it is. For plate ostheosynthesis, you need more area for cortical fixation of your distal fragment. I have successfully used small low profile plates from Stryker’s Foot Solution tray from Ascension Orthopedics’ Total Foot System tray. For a distal fracture with a spiral component like this, an alternative suboptimal approach is intramedullary pinning with cerclage wire. I do not recommend a minirail system for this particular fracture pattern. I would also consider an Exogen bone growth stimulator from S&N and would definitely reconsider your original weight-bearing recommendations.
Carlos A Rojas, DPM. Miami, FL, crojavec@yahoo.com
I have to add a different thought process to your fracture management plans. In this patient, I think you should stay away from surgery at almost any cost. A smoking neuropathic DM patient who you know is going to go to work is by definition non-compliant and a high risk for failure. When this fails and is an open bone and hardware case, what will you do then? I would put him in a compression stockinette and a high-top CAM walker boot, and instruct him to have his other shoe sole height modified to be equal in height to the CAM walker. I would also see about putting him in a bone growth simulator daily due to the co-morbidities. Looking at the position of the 5th met, it is a bit radical for where an aggressive tailor's bunion surgery might be, but probably would not be a long-term problem for him. If it were a problem after all is healed and done, then when his health and work responsibilities could be optimized, an elective procedure could be considered. DM, BMI, and smoking cessation counseling should also be part of your treatment plan.
Andrew Levy, DPM, Jupiter, FL, rcpilot48@gmail.com
08/16/2011
RESPONSES / COMMENTS (CLINICAL) - PART 1a
RE: ESWT & NSAIDs (Paul Kesselman, DPM)
From: Lowell Scott Weil, Sr., DPM
Although we have read that NSAIDs will delay healing following ESWT or for that matter surgery, there are NO valid, evidence-based studies that confirm that theoretic assumption. In the two successful FDA studies that we did with ESWT devices, all subjects received post-treatment NSAIDs for two weeks.
In our surgical practice at the Weil Foot & Ankle Institute, virtually ALL surgical patients receive pre-op and 5 days of post-op NSAIDs. Our results with all of our surgeries are consistent with the literature, and our complications such as wound dehiscence and infection are <2 %.
This reminds me of the furor 35 years ago when we began to use 2mg dexamethasone injections into bony operative sites to lessen post-operative pain. Now, more than 40 years later, we continue to use that practice and have not seen any trends toward problems post-op. We did publish a paper on a blinded study comparing dexamethasone to placebo for post-op pain, and the steroid was statistically the winner, with no more adverse events. Note: we do not use any post-op steroid injections in tendon surgeries.
Lowell Scott Weil, Sr., DPM, Des Plaines, IL, Weil4feet@aol.com
05/04/2011
RESPONSES / COMMENTS (CLINICAL) - PART 1
RE: Neuroma Injection Complication? (Ron Werter, DPM)
From: Neil Levin, DPM, Michael M. Rosenblatt, DPM
On very rare occasions, patients will experience a "flare reaction" to the alcohol injections. I typically warn patients prior to an initial alcohol injection that this is a possibility. Usually, these reactions are minor and last for 24 - 48 hours. Occasionally, I have had to place patients on Medrol Dosepak. I do not re-inject these patients and will move on to a different treatment.
Neil Levin, DPM, Sycamore, IL, drfeet1@aol.com
Along with the risks of DVT for which Medrol Dosepak was administered, there is a complication of high doses of cortisone that podiatrists should be aware of. If a patient has a history of alcoholism, esophageal varices, stomach ulcer, etc. the cortisone can precipitate an erosion of the lining of the ulcer and result in an precipitous and fatal hemorrhage, leading to sudden death.
Anyone who prescribes a Medrol Dosepak should closely question...
Editor's note: Dr. Rosenblatt's extended-length letter can be read here.
05/03/2011
RESPONSES / COMMENTS (CLINICAL) - PART 1
RE: Neuroma Injection Complication? (Ron Werter DPM)
From: Michael Forman, DPM, Arnold B. Wolf, DPM
I have had only one post-injection cellulitis (that I know of) in over forty years of practice. It occurred in a woman whom I was treating for a neuroma with local corticosteroid injections. I believe that Dr. Werter's patient did not develop an infection from the alcohol injection, but rather from a superficial seeding of bacteria from the skin. As a matter of fact, I believe alcohol injections have less of a chance of becoming infected than a corticosteroid injection.
This one episode in my practice changed my routine slightly. After scrubbing the injection site with alcohol, I then use a Betadine-soaked cotton tipped applicator on the site. So far so good.
Michael Forman, DPM, Cleveland, OH, im4man@aol.com
As a general rule, I always approach "bilateral neuroma pain" with an increased level of suspicion. If there is a "bilateral/symmetrical" neuropathy, we should be concerned about proximal etiologies for the nerve pain distribution...unless, of course, we have a confirmatory diagnosis (ultrasound, MRI, etc.) of defacto bilateral neuromas. Secondly, I maintain a concern with a "series approach" to alcohol injections to the intermetatarsal spaces. When we introduce what is essentially a strong base (chemically speaking) into the interspace, we must consider what possible "collateral damage" we may be doing to the surrounding tissues (interossei, lumbricales, joint capsule). If there is an adverse affect from the treatment, we should anticipate that possibility and subsequently be prepared to handle the new problem.
Arnold B. Wolf, DPM, Sterling Heights, MI, omnifootcare@prodigy.net
04/16/2011
RESPONSES / COMMENTS (CLINICAL) - PART 1
RE: Uric Acid Crystals, Post-op
From: Tip Sullivan, DPM
I have never had this occur post-op, but it would make sense when one chooses to do a small MIS procedure. I am not a great MIS advocate, but I do use it on occasion. When I use it, I do not put a suture in it, and it usually drains a little. Did you see any gouty material when you did the original procedure? Do you have the patient on any empiric antibiotic? You got what you got - I imagine it could happen to anyone. I would look back at the pre-op x-ray to look for the little mouse bite bone lesions. I would then open this up, and clean out as much gouty material as reasonable (you will never get it all).
I use a mechanical wound lavage system. I might even consider removing some of the the underlying bone if there is any hint of a suspicion and send the "bone" cultures to micro and the material to histopath. I would close it primarily, and would use some antibiotic-impregnated beads (only one or two small ones) if an infection was a concern. I would also discuss this with the patient's primary care physician and suggest chronic maintenance with a xanthine oxidase inhibitor, with a goal of <6mg/dl serum uric acid.
Tip Sullivan, DPM, Jackson, MS, tsdefeet@msfootcenter.net
04/14/2011
RESPONSES / COMMENTS (CLINICAL) - PART 1
RE: Mosaic Wart Treatment (Stephen Merena, DPM)
From: Charles Morelli, DPM, Dwight L. Bates, DPM
Consider oral cimetidine regardless of the patient's age. Yes, it does work better in children, but you have nothing to lose in trying to avoid a treatment that will be uncomfortable for this particular patient. 35mg/kg for 45 days, TID.
The topical I have always used, is either canthranone or cantharadin. They differ slightly, but are basically the same as far as their efficacy. This is a very strong topical med, and needs to be used carefully. Too much can cause a very painful blister, and for children or adults with tender sensitive skin (areas other than the heel or ball of the foot), you need to use less. Apply once after debridement and have the patient return in 10 -14 days. The lesions will have blistered and are easily removed. If some lesion remains, I touch them with silver nitrate and in 10 more days, the patient returns for what is usually a final treatment (usually mechanical debridement with a sanding wheel).
Charles Morelli, DPM, Mamaroneck, NY, Podiodoc@gmail.com
Sweaty feet, hormonal changes as in puberty, and plantar warts go together. If you can keep the warts from becoming worse, you are winning the battle as warts are uncommon in mature people. Control sweating on the plantar surface with topical Drysol or over-the-counter antiperspirant. If that fails, use very dilute formaldehyde topically.
Dwight L. Bates, DPM, Dallas, TX, dlbates04@yahoo.com
04/09/2011
RESPONSES / COMMENTS (CLINICAL) - PART 1a
RE: Chronic Stasis Dermatitis Draining Lymph Fluid (Frank J. DiPalma, DPM)
04/09/2011 Christopher G. Browning, DPM
I have treated hundreds of these stasis dermatitis patients, and I work closely with a local vascular surgeon who performs vein surgeries. We are often asked to manage the lymphedema patients after the procedures, as many have foot and ankle ulcers. Using the following technique, we have almost 100% success.
Make sure this patient does not have mixed arterial/venous problems. Arterial duplex ultrasound is more useful than PVR/segmental pressure (inaccurate reading due to edema). The Unna's boot put out by Henry Schein/Universal (zInc oxide/glycerine, white in color) is superior, in my opinion, because it stretches/gives to some degree and allows even and smooth compression. I would ditch the old pink, rigid-type boots..
Culture the lymph fluid, and expect...
Editor's Note: Dr. Browning's extended-length letter can be read here.
08/11/2010
RESPONSES / COMMENTS (CLINICAL) - PART 1
RE: New Test for Potential Plavix Patients
From: Robert Bijak, DPM I thought I would let that part of the profession that prescribes Plavix (clopidogrel) know of a new test being offered by Quest Diagnostics. It is contingent on the fact that there are 3 types of patient responses to Plavix. First, recall that clopidogrel is changed into the active metabolite in the liver to be effective. As such, the cytochrome P 450 system is utilized. The first type of patient is called the "extensive metabolizer." They convert the drug effectively and should see the best platelet inhibition response. The second type of patient is the "intermediate responder" who has less than optimal platelet inhibition, but does have some benefit. The last group is the "poor responders" who have a genetic defect in the CYP2C19 system, producing no or very little clinical response. The point is that it is now possible and recommended that BEFORE you place your patient on Plavix, you run a blood or saliva test to determine the CYP2C19 variant. If your patient is positive, they should NOT be placed on Plavix because their chance of MI, stroke and other vascular events will be unchanged and give a false sense of treatment. Quest Diagnostics has a blood/saliva test called "Accutype CP" which can determine this genotype. DPMs may score a few points with PCP's and vascular providers when encountering these patients but, most importantly, you would be doing the patient a service. Robert Bijak, DPM, Clarence Center, NY, rbikaj@aol.com
07/30/2010
RESPONSES / COMMENTS (CLINICAL) - PART 1
Query: Painful Erythematous Markings (Harry Cotler, DPM)
From: Thomas Graziano, DPM, MD Dr. Cotler stated that the patient reported that "all labs are normal." What exactly were the labs that were ordered? It would be prudent at least to start with a CBC w/ diff, comprehensive metabolic, and rheumatoid profile. With the limited information presented, it’s difficult to pin it down, but think about erythema nodosum. If that's the case, oral prednisone would be of benefit. You might want to try a week course of it, and then wean it down. Please let the readership know what you find and how she makes out, so that we can all benefit from the case. Thomas Graziano, DPM, MD, Clifton, NJ, TGrazi6236@aol.com
07/29/2010
RESPONSES / COMMENTS (CLINICAL) - PART 1
RE: Multiple Verrucae (Gary Bjarnason, DPM)
From: Multiple Respondents This is a patient who likely is having an issue with a burdened immune system. Look at the epigenome for answers. Diet is the biggest culprit. Get him off of refined carbohydrates, put him on a good probiotic. I would do a work-up for IgG food sensitivities as well as adrenal stress. These patients respond really well to diet changes, immune support, and gentle natural meds that inhibit viral replication. I've done it with adults as well as young people very successfully. In this case, you already see that just attacking the virus at the skin level is not the answer. Bob Kornfeld, DPM, Manhasset, NY, Holfoot153@aol.com My treatment of choice has always been Bleomycin. It is easy to do, consists of one treatment and (given adequate seroconversion of the patient) will result in all the warts on the body (foot and hand) resolving within about 5-6 weeks. If you'd like my treatment method, write to me and I'll send you the .pdf. David Secord, DPM, Corpus Christi, TX, david5603@pol.net For multiple recurrent verrucae, effective treatment in younger patients is Tagamet 400mg and laserformalyde topical solution. If the patient is adult size (110 lbs), I prescribe 3 Tagamet daily and once daily application of laserformaldahyde. I debride them after 3 weeks, and then in 4-6 week increments. It is not perfect, but it does have a significant success rate. Be careful; the laserformaldahyde may cause drying and cracking of the peripheral skin, and application may have to be reduced to every other day. Brian Kiel, DPM, Memphis, TN, Footdok4@gmail.com
07/26/2010
RESPONSES / COMMENTS (CLINICAL) - PART 1
RE: Research on Toning Shoes
From: Kevin A. Kirby, DPM One of the fastest growing segments of the shoe marketplace is the "toning shoe", including MBT (Masai Barefoot Technology), Skecher Shape-Ups, and Reebok EasyTone, to name a few. These shoes typically have a thick rocker sole, have a relatively soft heel wedge and are considered to be a less stable shoe sole design. These shoes retail from about $110 to $250. The marketing claims from the manufacturers of these shoes push the envelope of "truth in advertising", with advertisements claiming that the shoes will help burn more calories, tone up the legs and buttocks, and improve posture. Even though I have a number of patients who have benefitted with reduced foot pain while wearing these shoes, an equal number of my patients have purchased and tried these shoes and found they didn't help them, or even hurt them.
A recent independent scientific study from the American Council on Exercise shows that none of the "fitness shoes" tested helped the subjects burn more calories or exercise muscle groups more intensely than a typical running shoe while walking from 3.0 - 3.5 mph on a treadmill (Porcari J, Greany J, Tepper S, Edmonson B, Foster C, Anders M: Will toning shoes really give you a better body (acefitness.org). This independent study is, to my knowledge, the first research study on these shoes that was not funded by one of the shoe manufacturers.
I hope this research may help the readers of PM News better answer questions from your patients regarding these shoes and the validity of their manufacturer's marketing claims. (acefitness.org/getfit/studies/toningshoes072010.pdf)
Kevin A. Kirby, DPM, Sacramento, CA, kevinakirby@comcast.net
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