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Neurovascular HD Rx

Discussion in 'General Issues and Discussion Forum' started by Blue123, Feb 7, 2010.

  1. Blue123

    Blue123 Active Member

    Members do not see these Ads. Sign Up.

    I recently read an article in Podiatry Now, im sure most of you have seen it also, about the treatment of Verruca using compeed blister packs which the author had used and claimed had been their most successful VP treatment to date. For those of you that did not see it, the protocol for treatment was debridement and simply to apply the compeed and leave in place for as long as possible i.e 2-3 weeks. On review after this period the properties of the compeed would donate moisture and hence allow for controlled maceration of the verruca (given the compeed was applied correctly). As a result the affected tissue could be debrided much more effectively and hence be 'destroyed'.

    Within the article the author suggested this technique could be applied to the rx of fibrous, painful corns.

    I deal with a patient that suffers from an extremely painful hd overlying the 4th MTPJ, the cause being a rugby incident where a boot stud came through the sole of the boot into the area of the foot in question. Briefly 35 years later this is still having a huge impact on the patients quality of life and they have had routine podiatric care every 5weeks to relieve their pain. After a year under my care of routine treatment, at this point this not including enucleation as the patient wont allow it, involving light debridedment and scf pmps with cut out i read this article and thought it was worth a go. We have discussed enucleation under LA, orthoses and electrosurgery but due to other medical history and finances these are not viable.

    After the first application of compeed there showed minimal effect, we are now 2months into the process and suprisingly to myself we have made a major breakthrough. Using painscales linked with time intervals for pain we are getting positive results and although enucleation is still not possible the tissue is being debrided more effectively each visit.

    I now intend to adopt this approach with a handful of other carefully selected patients and will keep you updated.

    Has anyone else used this or similar methods? Results please?

  2. Admin2

    Admin2 Administrator Staff Member

  3. sam_wallwork

    sam_wallwork Active Member


    Dont suppose you have a link to the article? or if you know which Podiatry Now edition it was in.


  4. Blue123

    Blue123 Active Member

    Have searched online for a link and cannot find...will attempt to locate the article for you promptly
  5. Mark_M

    Mark_M Active Member

    I use a similar technique with 'heel balm' type creams.
    I have the patient apply it generously and apply an occlusive dressing.

    I have used this for IPK's (intractable plantar keratoma) and found it allows for better ennucleation. In the long term with regular treatment, the size and depth is reduced.
  6. laurafoot532

    laurafoot532 Welcome New Poster

    My first post, so bear with me.

    I have been in private practice for 25 years, for such conditions that are exquisitely painful I always use marigold therapy, please "google" this for more info. 4 initial treatments, using a cavity felt pad to put the marigold mass in situ, and thereafter the patient applying marigold oil and tincture to the lesion after discharge normally clears up said problem. It completely eradicates the scar tissue, vascular and nerve involvement.

    I did a years study at the Royal Homeopathic Hospital Great Ormond street and have a recognised Society qualification LF Hom ( Pod ). There is alot of information out there for those that are interested to add another string to their bow. 30 c of Acid Nit is a good homeopathic remedy, but there are so many others.

    Hope this helps,

    I have also worked with my local vet who specialises with greyhounds who have same problems with great results, better than amputating the poor dogs digits, which is what some vets do!

  7. smith2010rgs

    smith2010rgs Welcome New Poster

    Hi My first post too. Only a quickie, but I have had good results using a small piece of Granuflex over the lesion for a couple of days. Similarl results to the Compeed, as it macerates the lesion allowing debridement. GP not too happy prescibing it for this though
  8. footankle.ca

    footankle.ca Welcome New Poster

    I have commonly used 70% sal acid in a petroleum base inserted into a 3mm SCF pad with aperture. Then I occlude the lesion with waterproof tape for a period of 3 days. The patient then returns for debridement and enucleation. This patient had such a large and painful corn along the plantolateral portion of his foot that enucleation was not an option. This procedure made the process easier and much less painful.

    The corn has gotten much smaller, less painful and the patient needs not come in as often. The patient manages the corn by wearing orthotics, that had been modified and specially made for this cause. "Crocks" like shoes that I have excavated for the lesion for around the house or when wearing orthotics is not possible. Basically, he doesn't go bare-foot.

    No, I have the patient simple apply an over-the-counter medicated corn pad 2 days prior to the office visit.

    This has been working for us, however I am going to try a similar treatment plan using Uremol 40. We'll see.

  9. twirly

    twirly Well-Known Member


    I have had some success with treating very sensitive lesions using a product called Salu from a British supplier called Hilary Supplies

    I tape a small piece of non adherent dressing over the lesion prior to treatment & drip some Salu solution onto the dressing. Leave in place while treating any other areas & debriding the lesion after around 5 mins is less painful. Do not use on any open areas though as the patient will cry. :empathy:

    Salu contents: Alkaline solution, Potassium Hydroxide, Styrene/PVP - Copolymer.

    Also great in softening O/P.


  10. LuckyLisfranc

    LuckyLisfranc Well-Known Member

    Dare I ask a couple of questions....

    1. What is a neurovascular corn, and what does it look like? I don't think I have ever seen one in over 16 years.

    2. If these things exists, what it there cause?

    3. If the cause is mechanical, like all other corns we see - then why are we talking about topical therapies? What exactly do they achieve, except for some softening of the lesion.

  11. Ros the Pod

    Ros the Pod Active Member

    I second your post. I have not seen one either. If you get a response, please would you forward onto me, and oblige. Many thanks.
  12. sspod2001

    sspod2001 Active Member

    Firstly i'm not too sure as to the diagnosis of Nerve involvement in HD's as the previous posts asks, more likely that the tissue has become fibrosed due to the constant high pressures over long periods which causes hypersensitivity. (can also be seen in very thick long standing callous) however vascular involvement is without question. A more experienced collegue (seems to have been around when podiatry first started :) who also lectured at various universities claimed to have great results using the carbolitic Phenol applied over the lesion for 1-2 mins.

    I have since tried this on several patients with long standing fibrous HD's, some of whom would never allow a podiatrist to attempt enucleation every time they returned for debridement, every 4 weeks in some cases! along with substantial SCF pressure relief initially then progressing onto custom foot orthoses with the same deflective pressure relief with fantastic results. so much so that these patients would then ask for the phenol application each time.

    hope this helps
  13. tom.laughland

    tom.laughland Member

    Has anyone been able to locate the article that is talked about in the first post? I have looked but have been unable to find it anywhere.

  14. tom.laughland

    tom.laughland Member

    Blue 123 is this the article in question?

    PodiatryNow November 2009, E J Franklin. Clinical Experience. VP treatment using occlusive
    hydrocolloid therapy. An over-the-counter remedy

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