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VP help pls

Discussion in 'General Issues and Discussion Forum' started by lucycool, Jun 22, 2011.

  1. lucycool

    lucycool Active Member


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    Hi,
    I have a 30yrs old pt coming in today with about 12- 14 VPs of differing sizes on both feet which he has had for 2+ years and am planning to needle them today using a tibial block.

    He has a large (2-3cm and sticks out at least 1cm) VP on his achiles insertion point which is the one causing him the most pain/ discomfort/ problems with shoes etc.. (which he thought was just callous!)

    My worry is that that area won't be knocked out with tib block and that I can't do a local around it due to achiles - or even needling that area may damage the achiles. Am I right?

    I've got 5 hours to make a decision and at this point I'm going to leave it, but since that is the one that causes the most pain, it seems rubbish to do nothing.

    Help/ advice very gratefully recieved!!

    Lucy
     
  2. blinda

    blinda MVP

    Hi Lucy,

    I certainly wouldnt needle anywhere near the achilles tendon. Last thing you want is to be inducing inflammation in that area, IMO. I don`t always needle the most painful lesion, yet still obtain good results for multiple VP.

    Cheers,
    Bel
     
  3. lucycool

    lucycool Active Member

    Hi Bel,

    Thanks for the quick response. So from your experience, that one should hopefully go if I just do the others? It seems to be the case with the other pts i have, I just want to check!

    Thanks!

    Lucy
     
  4. I know nothing personally (only what Ive read )about needling but as Bel suggests leave this one alone - treat the others and if the immune response happens it might disappear as well.

    but when the patient comes in explain the possible side effects of needling the Achilles area and explain what you hope to occur immune response etc and pad the Achilles Vp to reduce shoewear pressure - ie cut for VP from some felt it will make him more comfortable and you can get on a treat the VP´s without causing any problems
     
  5. blinda

    blinda MVP

    Yep, in my experience, needling just one VP often produces a cascade effect i.e.the other VP`s (and hand warts) will also resolve.

    I have, on a couple of occasions, had to perform a second needling as not all lesions resolved, although all did reduce in size. Interestingly, I have had more success with needling mosaic and multiple VPs than large singular ones, which is not what was suggested in the recent case series in Pod Now.

    Cheers,
    Bel
     
  6. puppysaurus6

    puppysaurus6 Welcome New Poster

    I have to agree with the majority . I havnt performed needling my self but would be reluctant to inject so close to the achilles. I would concentrate on the other Vps and I expect if you can remove them successfully, the main VP may subside. I would consider treating it today but by other means ie, debridement,' topical treatments, cryo, so that you feel you've started treatment and it is'nt a wasted journey. Good luck

    Kind regards
    Emma
     
  7. blinda

    blinda MVP

    Hi Emma,

    The beauty of needling is that you don`t `remove` VP`s, your immune system is stimulated to recognise the virus, then build the necessary anti-bodies to rid the entire body of the infection which is otherwise undetected.

    I wouldn`t treat a VP presenting on the achiles tendon with anything other than reduction of callus and deflection as Mark suggested ;)
     
  8. lucycool

    lucycool Active Member

    Hi,
    I was just about to say that - is there any point in treating the VPs with anything if you are needling others? Seems a bit pointless?

    Thanks for all your advice, I like that I'm on the right track! The Pod Arena Rocks!

    Lucy
     
  9. blinda

    blinda MVP

    Personally, I will only needle one lesion even if there are many. If the others are painful I`ll just reduce the callus.

    Cheers,
    Bel
     
  10. fishpod

    fishpod Well-Known Member

    i would not cryo over the achilles tendon cos if it goes wrong damages the tendon or sheath you will be in deep poo, stick to needling the others. ps never forget they will go away on their own anyway.
     
  11. daisyboi

    daisyboi Active Member

    Personally I really struggle with the repeated assertion that VP will self resolve if left. I have seen VP that are often in excess of ten years old. I just wonder what other people's experience of this is and what evidence exists to back this statement up.
     
  12. fishpod

    fishpod Well-Known Member

    my golf buddy showed me his daughters vp as large as a 1pence coin 3rd week in march it was quite prominent isaid i would treat it end of april after retun from my annual leave saw the girl on friday june 17th at her wedding and said hey dont you wont me to do your wart she showed me her foot a miracle the wart was gone ps after 30 years experience i have seen this alot its not new or anecdotal. regards fishpod ps if you dont need the fee and dont treat them they will go but not many will pass up the chance of anice little earner . i treat virtually no vps and refuse to treat children as most effective therapy ie cryo and electrocautery involve a certain amount of pain which frightens young patients ps if it dont hurt dont treat it.i treat 6000 pts per year so see lots of vps self resolve
     
  13. daisyboi

    daisyboi Active Member

    Yes I agree that SOME VP self-resolve and I have no problem with that idea. The question I am asking is do we have any idea of what percentage and are there any predictors as to which lesions will self resolve. This is not an approach that we have to any other foot problem so why do we suddenly adopt it enmasse for VP? is it because its in the best interests of the patient or is it in fact because our results are poor and we find them difficult to treat effectively? Would we adopt a wait and see approach for onychocryptosis? Why not? I suspect the evidence is just as good. I have seen patients who have allowed such nails to grow rather than treat them and they have improved. Not many I admit but I have seen it. Therefor, given that it is not unusual to find a ten year old VP how can we be sure that self-resolution is the norm and the ten year old VP the exception rather than the other way around?
     
  14. fishpod

    fishpod Well-Known Member

    hi i have no idea of the percentage and can think of no predictors as to which lesions will resolve. we adopt the approach en masse in the nhs because the 1st port of call for most wart lesions is the gp surgery cos its free if they treated all the warts the nhs would grind to ahalt so the gp gives em ascript for a salacylic acid based prep tells em to use it 6 months if it goes great if not they may try cryo electrocautery in adults older kids ,so a private chiropodist may be the 3rd port of call for the patients who want to get rid of thier vp and they mighthave had it for some time vps dont kill anybody so thats why the nhs does not worry about them much. ps most of my local dermatologists will bollock u if they get referals for plantar warts the medical profession rely onself resolution u need to reassure the patient thats all.
     
  15. W J Liggins

    W J Liggins Well-Known Member

    Hi Daisy

    I suggest that onychocryptosis is a rather different pathology. A wart is a viral infection and therefore the immune system will deal with it, sooner or later (I think that your question is valid, because we simply have not collected the evidence). O'cryptosis is a reactive tissue hyperplasia which may or may not have a superimposed infection; we therefore have a duty to treat the condition if requested to do. I have a treasured photograph of a patient who allowed 'nature to take its course'. The granulomas from the nail folds met in the centre of the nail and coalesced, then became organised with the result that he now has 'normal' epithelium across the nail and just cuts the nail as it 'peeps out from under'. The three other points are that VPs are mainly painless (if not under a WB area) and are highly unlikely to become exacerbated or to be subject to superimposed pathology. Such is not the case with o'cryptosis.

    All the best

    Bill
     
  16. nick_700

    nick_700 Active Member

    SL378220.JPG

    Dear Daisy

    This is a good reason to not allow onychocryptosis to progress unchecked (refer to attached photo - the worst case of onychocryptosis I have ever/will ever see). I realise you were not implying to leave this condition untreated, only making a point.

    Regarding leaving VPs, I would love to see some data regarding self resolution. Personally I have seen too many patients who have large mosiac veruccae that have been present for in excess of 20 years to be convinced that ALL VPs will self resolve. Clearly some do however.

    Lucy
    Sorry I have never needled VPs so can't help, have used other topical agents in the past as immune modifiers (DCP - diphencyprone) however have ceased using it due to questions about carcinogenicity. Works a treat, however asbestos was a great insulator too I guess...

    Does anybody have any data on the effectiveness of needling VPs?
     
  17. SarahR

    SarahR Active Member

    I would love to see bill's photo too. Is it possible to post it?
    Sarah
     
  18. daisyboi

    daisyboi Active Member

    Hi Nick, thanks for the posting and fascinating photo. Your quite correct, I am in no way suggesting that we should leave onychocryptosis!! I am suggesting that we should not leave VP. As far as I can make out VP are not supposed to be on the feet and if a patient is sufficiently motivated to attend a clinic then they are obviously bothered by the presence of the lesion. I think we should assume that every VP is going to last ten years plus unless we can confidently predict otherwise, hence the request for research data. I have just photographed and treated a VP using dry needling for the first time. It sounds like many clinicians are experiencing good results from this therapy and so it may be a better option than repeating painful procedures on a frequent basis.
     
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