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The Treatment of Verrucae Pedis Using Falknor's Needling Method: A Review of 46 Cases

Discussion in 'General Issues and Discussion Forum' started by Kevin Kirby, Apr 2, 2013.

  1. Re: The Treatment of Verrucae Pedis Using Falknor’s Needling Method: A Review of 46 Cases

    Usually 1000mgs/day with the dermatologists .
     
  2. Re: The Treatment of Verrucae Pedis Using Falknor’s Needling Method: A Review of 46 Cases

    Haven't you learned yet? Size doesn't matter.:cool:
     
  3. DTT

    DTT Well-Known Member

    Re: The Treatment of Verrucae Pedis Using Falknor’s Needling Method: A Review of 46 Cases

    Don't tell me you still believe that one Kevin :D

    Cheers
    D;)
     
  4. blinda

    blinda MVP

    Re: The Treatment of Verrucae Pedis Using Falknor’s Needling Method: A Review of 46 Cases

    Yep, what he said. Different degrees of tissue damage will heal, differently.

    I`ve been mulling this one over and tattoos come to mind, as they often do.The majority of tats do not produce scarring, even though multiple pin pricks are administered into the dermis and/or subcutaneous layer and they bleed. However, a very small surgical incision in the same piece of skin heals with a scar. Why? The answer could be in this very interesting paper I found;

    Scar-free healing: from embryonic mechanisms to adult therapeutic intervention

    Ferguson and O’Kane considered the evolutionary context of wound healing, scarring and regeneration and detailed the differences between inappropriate scarring response and the appropriate regeneration (scar-free healing) responses. In part, they stated;

    So, it would appear that pin-point bleeding usually heals with complete tissue regeneration, whereas an incision, no matter how small, usually results in scar formation. This is due to altered signalling mechanisms for healing (inappropriate levels of inflammatory cells and stimulation of granulation tissue and fibroblast activity), brought about by these`subtle alterations to the type of injury`. As Kevin pointed out, poor blunt dissection technique can result in tearing or cutting and subsequent scarring.
     
  5. DTT

    DTT Well-Known Member

    Re: The Treatment of Verrucae Pedis Using Falknor’s Needling Method: A Review of 46 Cases

    Kevin

    Having used many times in my previous life inserted infusion cannula into various parts of the anatomy ( arms usually if they were present at the time) and were in many cases the size of a drain pipe to push the infusion fluid through to replace body fluids.

    I never ever remember any evidence or reported problem of scarring at the point of insertion.

    Now all needles for medical use have a bevelled tip which as far as I am aware is to reduce the incidence of scaring and tissue damage.

    These needles are used TRILLIONS of times throughout the world without a problem

    BUT

    We have to create one in this procedure ( nothing new there generally within the profession :craig:)

    Show me the evidence of the 25 /27 gauge against the 18 gauge for scarring ( Coz I use 27 / 18) and then I can decide as a clinician based on best evidence based medicine the best Tx for my patients.

    Thank you
    Cheers
    D;)

    ps

    Did they pat you on the head when they said " size doesn't matter" ?? :D:D
     
  6. Paul Bowles

    Paul Bowles Well-Known Member

    Re: The Treatment of Verrucae Pedis Using Falknor’s Needling Method: A Review of 46 Cases

    Hi Mark, Yes as I said you can go quite a bit higher. We have always started with a relatively low therapeutic dose and kept it going for 12 weeks+ Personally I am quite happy with 300-350mg daily for VP's
     
  7. Re: The Treatment of Verrucae Pedis Using Falknor’s Needling Method: A Review of 46 Cases


    I don't think it really matters what size needle you use. I've used anything from an 18 gauge to a 27 gauge and they all seem to work just as well. When I used an 18 gauge needle for the procedure, I never saw scarring.

    Don't know what else to tell you.
     
  8. DTT

    DTT Well-Known Member

    Re: The Treatment of Verrucae Pedis Using Falknor’s Needling Method: A Review of 46 Cases

    That's fine Kevin, I was just checking to make sure I wasn't giving out wrong information.

    As I said I use both 18 and 27 gauge depending on the size and position of the lesion so now I'm happy to continue.
    Thanks for the reply
    Cheers
    D;)
     
  9. stevewells

    stevewells Active Member

    Re: The Treatment of Verrucae Pedis Using Falknor’s Needling Method: A Review of 46 Cases

    Been away soaking up the rays in sunny Spain so missed the beginning of this post - just wanted to add my congratulations to you B - great work and outstanding persistence - you deserve everything you get for your hard work - I am grateful (as I am sure most members of the forum are) for your outstanding contributions to the forum especially in the field of Podiatric Dermatology.
    Keep up the good work.

    Steve
     
  10. blinda

    blinda MVP

    Re: The Treatment of Verrucae Pedis Using Falknor’s Needling Method: A Review of 46 Cases

    Thanks, Steve. You played no small part in teaching me good technique in administration of LA...`twas fun;)
     
  11. danc

    danc Welcome New Poster

    Re: The Treatment of Verrucae Pedis Using Falknor’s Needling Method: A Review of 46 Cases

    Congratulations on the research success Belinda, I love the article.

    It just so happens that we have conducted a pilot RCT in Perth WA last year. Hopefully JAPMA will publish ours soon.

    It's great to see more research in this field, hopefully someone out there is working on a large sample RCT as we speak. Cheers.
     
  12. blinda

    blinda MVP

    Re: The Treatment of Verrucae Pedis Using Falknor’s Needling Method: A Review of 46 Cases

    That's great news! I look forward to reading your paper.:drinks

    Bel
     
  13. Kaleidoscope

    Kaleidoscope Active Member

    Re: The Treatment of Verrucae Pedis Using Falknor’s Needling Method: A Review of 46 Cases

    Blinda

    Great paper! Thanks for sharing it with us all. Only sorry I didn't get to help you with the info gathering (doesn't help I'm so far away!)

    Let me know when you have a bumper crop of 'needling' patients and I'll happily come along again! Hope we can also see Steve Wells for that long-awaited 'session' of LA fun soon!

    Keep up the good work!

    Cheers
    Linda
     
  14. blinda

    blinda MVP

    Re: The Treatment of Verrucae Pedis Using Falknor’s Needling Method: A Review of 46 Cases

    Thanks, Linda.

    Actually, you did play a major part in assisting with my original literature search on the subject. You`ll recognise some of the key papers referenced in the final paper.

    I owe you a beer or three too :drinks

    Cheers,
    Bel
     
  15. blinda

    blinda MVP

    Re: The Treatment of Verrucae Pedis Using Falknor’s Needling Method: A Review of 46 Cases


    For those interested, this came up in my alerts today;

    http://www.journalofclinicalvirology.com/article/PIIS1386653213000826/abstract

    Chin, chin :drinks
    Bel
     
  16. Paul Bowles

    Paul Bowles Well-Known Member

    Re: The Treatment of Verrucae Pedis Using Falknor’s Needling Method: A Review of 46 Cases

    Great article Belinda - so this begs the questions - should we be taking a biopsy of these lesions prior to treatment to determine the best course of action?
     
  17. blinda

    blinda MVP

    Re: The Treatment of Verrucae Pedis Using Falknor’s Needling Method: A Review of 46 Cases

    I think diagnosis of HPV sub-type will certainly be the way to go, in the not-too-distant future. At the moment, we have to justify further investigation (even in the case of biopsy, at least in the UK) as to how results will alter/effect treatment intervention. With the available evidence, this isn`t possible. Yet.

    The ideal way to combat HPV infection would be to improve the immune response to the virus so it is specific and directed against early viral proteins. Much research is focusing on the development of a specific antiviral therapy. The most exciting and promising treatments that are appearing on the horizon are the type-specific HPV vaccines. While current research is focused on malignant HPV (HPV16 & HPV18), the same technologies could be applied to the HPV types that cause benign cutaneous warts.

    Bel
     
  18. Paul_UK

    Paul_UK Active Member

    Re: The Treatment of Verrucae Pedis Using Falknor’s Needling Method: A Review of 46 Cases

    Great paper Bel well done!

    On a slight side note, has anyone done or know of any good quality videos of the procedure being done?
     
  19. blinda

    blinda MVP

    Re: The Treatment of Verrucae Pedis Using Falknor’s Needling Method: A Review of 46 Cases

    This is interesting. It discusses the use of adjuvants in HPV vaccines to promote an anti-inflammatory microenvironment by disrupting the various evasion mechanisms of HPV.....:cool:
     

    Attached Files:

  20. W J Liggins

    W J Liggins Well-Known Member

    Re: The Treatment of Verrucae Pedis Using Falknor’s Needling Method: A Review of 46 Cases

    How about a course Bel?

    Cheers

    Bill
     
  21. blinda

    blinda MVP

    Re: The Treatment of Verrucae Pedis Using Falknor’s Needling Method: A Review of 46 Cases

    Hi Bill,

    I`m not sure what the level interest would be, although I have presented our paper to a few branch meetings, which was well received.

    Thing is, the needling procedure is dead easy. It`s literally penetrating to pin-point bleeding on a seleted lesion until there is no further resistance felt. So long as you`re certain the lesion is a VP and the pt is not intolerant to LA, there is very little which can go wrong.

    That said, it would appear the largest hurdle is competence in LA technique....something you would certainly be a dab hand at teaching. I know I`ve mentioned this to you before, maybe we should perform a duet?

    Bel
     
  22. W J Liggins

    W J Liggins Well-Known Member

    Re: The Treatment of Verrucae Pedis Using Falknor’s Needling Method: A Review of 46 Cases

    Always happy to sing with you!

    Cheers

    Bill
     
  23. blinda

    blinda MVP

    Re: The Treatment of Verrucae Pedis Using Falknor’s Needling Method: A Review of 46 Cases

    Another vaccine found to prevent a further 5 sub-types of HPV. Only a matter of time, I reckon, before we have a similar jab available for our benign fellas....


    EUROGIN: Investigational HPV vaccine prevented 97% of cervical, vaginal, and vulvar pre-cancers caused by 5 additional types:

    http://uk.univadis.com/2029/Pages/D...2tlbj48L1VzZXJEZXRhaWxzPg==LVKCCE&BackTo=Home
     
  24. Paul Bowles

    Paul Bowles Well-Known Member

    Re: The Treatment of Verrucae Pedis Using Falknor’s Needling Method: A Review of 46 Cases

    Its not the 97% that will be prevented that worry me - its the 3% that will come into my office saying the vaccine didn't work for them!!! In retrospect it will make our jobs 100% easier for 97% of the population but 100% harder for the left over 3%! Possibly a double edged sword!
     
  25. j1nxst3r

    j1nxst3r Member

    Re: The Treatment of Verrucae Pedis Using Falknor’s Needling Method: A Review of 46 Cases

    Thanks Belinda for a fab piece of work! I'm a 2nd yr Pod student (for my sins) and I used the subject of verrucae for a Poster assignment at my uni. I used journal articles regarding Needling to back up my research and was told by a p/t lecturer that Needling was NOT a technique I should be concerned with...

    Now I'm definitely going to ignore.. that little 'pearl of wisdom'.

    Mike

    PS I do find your dermatology very very interesting.. even if I don't fully understand it yet :D
     
  26. W J Liggins

    W J Liggins Well-Known Member

    Re: The Treatment of Verrucae Pedis Using Falknor’s Needling Method: A Review of 46 Cases

    I beg to differ.

    There is no such thing as a stupid question, and as a student, you should be concerned with everything relating to pod. (unless, of course it is an area which will be taught later).

    Keep the faith

    Bill Liggins
     
  27. blinda

    blinda MVP

    Re: The Treatment of Verrucae Pedis Using Falknor’s Needling Method: A Review of 46 Cases

    Thanks, Mike.
    I'm glad you found our paper of interest. As an undergraduate your tutors will demand an evidenced based justification of any treatment plan. Whilst there may not have been a plethora of controlled trials to demonstrate the efficacy of needling VPs, the evidence is growing. Maybe you could respectfully ask your tutor why they gave you such as advice?
    Enjoy your studies, :drinks
    Cheers,
    Bel
     
  28. Re: The Treatment of Verrucae Pedis Using Falknor’s Needling Method: A Review of 46 Cases

    Mike:

    About four weeks ago, I needled one verrucae plantaris (vp) out of 3 large vps in a 10 year old girl with her right plantar foot. After 2 weeks, the one vp needled is 90% gone, and the two I didn't needle are now about 50% gone (she said they have been itching quite a bit this last week). The mother and the patient think I am great since they have been trying to treat these painful lesions with other therapies for 6 months with no results. She says she's telling all her friends about my treatment.

    I know that this is yet another anecdote, but this is the kind of response I see on a regular basis in the patients whose vps I treat with the needling approach. Something to consider telling your "wise" instructor about.

    BTW, welcome to Podiatry Arena.:welcome:
     
  29. j1nxst3r

    j1nxst3r Member

    Re: The Treatment of Verrucae Pedis Using Falknor’s Needling Method: A Review of 46 Cases

    Hi Kevin,

    Many thanks for your swift reply! I am certainly encouraged that your having positive responses to the needling treatment :D I have 3 VP's which have been my constant (annoying) companion for around 5-8 yrs and which i'm almost giving up on getting rid of.

    I'd certainly put myself forward to be a test subject at uni in order to show the technique if it were offered to us students..

    But it's definitely a technique I'll look into learning and use in my own practice.

    Kind Regards,

    Mike

    Oh and thanks too for the hearty welcome! :good::santa:
     
  30. blinda

    blinda MVP

    Re: The Treatment of Verrucae Pedis Using Falknor’s Needling Method: A Review of 46 Cases

    If anyone knows of a pod who `needles` in the Banbury area, please PM or email me.

    Cheers,
    Bel
     
  31. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Re: The Treatment of Verrucae Pedis Using Falknor’s Needling Method: A Review of 46 Cases

    Treating plantar warts: utilising natural immunity to induce wart regression
    Hashmi, Farina; Bristow, Ivan
    Dermatological Nursing, Volume 13, Number 1, March 2014 , pp. 42-45(4)
     
  32. Re: The Treatment of Verrucae Pedis Using Falknor’s Needling Method: A Review of 46 Cases

    Is this an updated version of the paper cited in the original post? If so, can someone send or upload a full copy please?
     
  33. dyfoot

    dyfoot Active Member

    Re: The Treatment of Verrucae Pedis Using Falknor’s Needling Method: A Review of 46 Cases

    I have only tried this technique 3 times so far with 2 resolutions, but there was quite a delay.
     
  34. Ian Linane

    Ian Linane Well-Known Member

    Re: The Treatment of Verrucae Pedis Using Falknor’s Needling Method: A Review of 46 Cases

    Similarly I would appreciate a copy if possible: ianlinane@gmail.com
     
  35. blinda

    blinda MVP

    Re: The Treatment of Verrucae Pedis Using Falknor’s Needling Method: A Review of 46 Cases

    Unfortunately, this paper is not Open Access....but check your inboxes ;)
     
  36. Re: The Treatment of Verrucae Pedis Using Falknor’s Needling Method: A Review of 46 Cases

    Bel

    Thanks for the papers - is this your second version? Is there a follow-up on the clinical results?

    Cheers :drinks
     
  37. DaveJames

    DaveJames Active Member

    Re: The Treatment of Verrucae Pedis Using Falknor’s Needling Method: A Review of 46 Cases

    Bel,

    Please could I be cheeky and get a copy too? Thanks in advance. :drinks

    Dave :)
     
  38. Tim VS

    Tim VS Active Member

    Re: The Treatment of Verrucae Pedis Using Falknor’s Needling Method: A Review of 46 Cases

    Me too please Bel if you don't mind :)

    Cheers

    Tim
     
  39. blinda

    blinda MVP

    Re: The Treatment of Verrucae Pedis Using Falknor’s Needling Method: A Review of 46 Cases

    No, I`m not an author of this paper. I was unaware of its publication until recently from an alert that I was cited in Google Scholar.

    Good to see Farina is in agreement with my research of current literature on possible mode of action in localised immune responses and how the virus evades immune detection.

    No follow-up from me, I`m afraid. Private practice severely restricts undertaking of clinical research.
     
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