Multiple puncture techinique for verrucae- how long post-plantar plate tear?

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Hi All,

I'm seeking advice about the safety of using the multiple puncture technique for mosaic verrucae post-plantar plate tear. The verrucae are located on the plantar metatarsal heads at the site of the former tear.

Plantar plate tear was confirmed on ultrasound 8/12 ago. Patient is 40 year old female with no other significant medical history. Patient responded well to regime of icing and taping for several weeks, and footwear modification. Patient now wears orthotics and tolerates these well.

Subjective: C/O stiffness in L/2nd and 3rd MPJs (site of tear). Previously C/O paraesthesia which has resolved. No pain with plantarflexion of digits L/2 and 3. No tenderness at site. Verrucae appeared about 3/12 ago and have not responded to regular duofilm application. Verrucae are painful with lots of WB-activity.

Objective: No significant dorsal subluxation of digits L/2 and 3 when performing Lachman's test. No oedema is present. Mild v-sign between digits L/2-3; this is bilateral and (patient reports) long-standing. Multiple verrucae plantar L/2-3MPJ region.

This might sound daft but I'm curious whether there are any contraindications for performing the multiple puncture technique, or things I should be wary of given the site of the verrucae.

Thanks in advance,
Kristan