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Treatment advice to needle or not?

Discussion in 'General Issues and Discussion Forum' started by twirly, May 2, 2010.

  1. twirly

    twirly Well-Known Member


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    Dear colleagues,

    12 year old male presented with verruca left 1st plantar metatarsal area.

    2 cm diameter. 10 weeks duration. Very painful.

    Patient in excellent health.

    Patients doctor has previously cryo'd the lesion which has had little effect. Other than to make it even more painful.

    The problem: Usually I would offer to 'needle' the lesion. However, this young man is a key player for a football teams academy league.

    He is shortly due (end of week) to play another academy team in Milan.

    I initially debrided the lesion to reduce pressure over the lesion & advised deflective padding.

    Still very painful.

    Would value your opinions RE: Best advice/ treatment to offer this patient.

    Would needling a week prior to an important match be likely to impede this player?

    Many thanks,

    Mandy.
     
  2. Hi Mandy,

    Here my option without the experience of needling.

    1 the kid is 12 missing 1 game is not going to end his career. ( whatever the parents or kid think)
    2 if you can´t make him comfortable enough to play with your padding as you started, then the kid is going to be in pain one or the other?

    3 what is the weeks after looking like for the kid. ie very busy or not as many important games?

    So with your experence in needling if you needle on monday Morning will the pain be less, the same or more?

    If the kid has a few busy weeks after and the answer to question above most likely was same or maybe less - with the advice that the pain levels have a chance to be more to the parents and child then I would treat.

    If the kid has less important matches- maybe one he can miss, make as comfortable as possible for "the big match" start treatment after.

    As well as padding maybe some thing that can numb the painful area maybe an option as well- like a numbning spray.

    From my reading of the needling thread it seems recovery is pretty quick as well painfree, but if the VP is painful now it probably be painful after as well so the padding etc will be required anyway. The next question will healing time be longer after needling and playing football?

    Maybe, I once had a paitinet without my knowledge till after play football the day after a double sided PNA. He said it was painfull but less painful than before, but healing time was twice as long and he missed 2 matches after.

    So I´m not sure if I help much cause I can´t say Ive needled 1000 VP´s and .... , but maybe my post helps ?

    but I would think that if the weeks after are not as important pad, numb, reduce load on the area anyway you can get the job done after.
     
  3. twirly

    twirly Well-Known Member

    Many thanks Michael,

    I will respond more fully later (your post is helpful)

    :drinks

    Regards,

    Mandy
     
  4. Mandy:

    48 hours after debriding the verrucae and performing the needling procedure, he should be painfree. And regarding his soccer (i.e. football) game, adrenaline is a great pain killer. You could probably needle it during the game, without anesthetic and he wouldn't feel a thing.;)
     
  5. DTT

    DTT Well-Known Member

    Hi Twirls

    IMHO NO !!
    We do not get any (or have not had to date) ANY needling patient complain of post operative pain after 24 hours ( a slight bruised feeling by some the next day) but after that comfort compared to before the Tx.

    Frankly if he is going to make top flight football he will have to get used to playing with discomfort :eek:.

    Several years ago I provided podiatry services for a premier league football team .

    It taught me a very real lesson coz I thought these guys were a load of pansies that acted injury ....

    I promise they are NOT !! I have witnessed players with injuries I couldn't believe could carry on but did :eek:

    Let this fella go to Milan with at worst slight soreness with the proviso he comes back to you on his return for appraisal.

    That should do the trick:D

    Cheers Hun
    D;)
     
    Last edited: May 2, 2010
  6. twirly

    twirly Well-Known Member

    Many, many thanks,

    I will call the patients mum in morning & offer a bank holiday Monday appointment. to allow time for any discomfort to settle 'pre-match.

    Was awake at 3am today pondering options......................

    Wouldn't want to impact on a flourishing star before they even begin. ;)

    Regards,

    Mandy.
     
  7. DTT

    DTT Well-Known Member

    Ooopsie
     
    Last edited: May 2, 2010
  8. DTT

    DTT Well-Known Member

    Twirls

    Make it Tuesday and enjoy your Bank holiday weekend with your family !! it will make no difference;)

    I was awake then too, but mine was with wind ( bloody Metformin automatic entry to the GB farting championships !!!:eek: )

    Enjoy your rest,let a strong healthy 12 yo get on with his life with your help;)

    Oh yes you would ..... by making him pain free and happy ;)

    Get on with it girl :drinks

    Cheers
    D;)
     
  9. Dear She who Twirls,

    What was the outcome of the sleepless nights and is the next (insert name of whatever football player you want making too much money) getting the needle ? Will be intesting as you will be keeping a close eye on recovery time.
     
  10. twirly

    twirly Well-Known Member

    Good day to you too Mr Weber, Sir,

    I discussed treatment with patient yesterday & took the decision to allow the patients father to read into 'Needling' here on Podiatry Arena. This I think will allow him to be confident in making an informed decision should he want the lesion needled in the future.

    I have further debrided the lesion, made a stunning (if I say so myself) removable scf/f/w plantar met' pad with aperture to lesion. Also provided dad with spare padding to practice his scissor technique. ;)

    Hopefully they will win in Milan (although their adult 1st team were defeated at the weekends match & now face relegation).............:sinking:

    Should I needle the lesion in future I promise to post pre & post op' photos.

    Many thanks to everyone for all their help. I really appreciate it.

    :drinks

    Regards,

    She wot twirls on occasion :D

    PS.
    That would have to be Ronaldo. Strikes me as a nasty, conceited, cheat but hey! I don't understand the game anyhow :eek:

    Surely someone that good at diving should have gone for swimming not footy? :rolleyes:
     
  11. DTT

    DTT Well-Known Member

  12. Simon read this thread. This is where it all started for Podiatry Arena. There is nearly 400 posts for you to read lots of pictures to show the results. Enjoy

    http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=25720
     
  13. The old posting at the same time trick, no chance of Zuse/Simon getting lost then.
     
  14. cjpod

    cjpod Member

    Advice anyone,
    12 year old boy type 1 diabetic, multiple plantar vps both painful and embarrasing.
    is needling a good idea?
     
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