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VP advice please

Discussion in 'General Issues and Discussion Forum' started by Sammi, Oct 27, 2011.

  1. Sammi

    Sammi Member

    Members do not see these Ads. Sign Up.

    I have just seen a very despondent lady with a painful verruca on her plantar calcaneal area. There is one main VP with two small satellites. I saw her for the first time 2 weeks ago and debrided alot of overlying callus - there was underlying macerated tissue which I put down to the long standing nature of her problem and the fact that she had tried some home treatments. I dressed and padded it and it felt more comfortable.

    Two weeks later it's painful again , with less callus but still this underlying maceration.

    I am reluctant to treat aggressively due to her having a Lupus type connective tissue disorder - she isn't on any meds and neuro-vasc supply is good.

    I've given her all the blurb on verrucae and the fact that there are no guarantees on any treatments.

    Other than pressure relief can anybody suggest anything else?

    Has anyone seen anything similar ?

    I'd value any feedback

    Thank you
  2. blinda

    blinda MVP

    Hi Sammi,

    Do you know which home treatments your patient used? If it was sal acid there is a risk that overuse can cause tissue breakdown so deep that an abscess is formed. If this is the case, it will have to be drained and appropriate AB cover arranged. Did the skin feel `spongy`?

  3. Sammi

    Sammi Member

    Hi Bel ,

    Thanks for your reply.

    She did use Sal acid based treatment - Bazuka - tho she is not sure which strength.
    I wouldnt say it feels spongy but there does appear to be a kind of bulkiness when the surrounding area is palpated. I did originally put the maceration down to overuse of treatment so there may well be something else going on. There doesnt appear to be any heat or redness otherwise.
    I can debride some of the macerated tissue and see if any pus is released and arrange AB cover however I suspect any abscess is very deep seated and probably a little outside my comfort zone. How would you establish drainage?

    Thanks :)
  4. blinda

    blinda MVP

    Hi Sammi,

    As she is still in pain after just 2 weeks of callus reduction and the skin is still macerated and feels `bulky`, I would err on the side of caution and assume underlying breakdown. This can track quite deep into the tissues, so evidence of pus cannot always be seen.

    If you do not feel comfortable with safely lancing the area yourself, you should refer her to her GP for incision and drainage. They can also prescribe anti-biotic cover if required. There`s no shame in refering on, you could be preventing spread of infection which the pt will thank you for.

    ...And tell her to quit with the acid, nasty stuff if not used correctly, IMHO

  5. did these guys use it Correctly ?

  6. blinda

    blinda MVP



    Love the new avatar, Mike ;)
  7. Sammi

    Sammi Member

    Thanks so much :)
  8. G Flanagan

    G Flanagan Active Member

    Or alternatively you could refer the patient on to another Podiatrist in the area who is confident (and skilled) with this type of intervention.
  9. blinda

    blinda MVP

    Indeed. Keep it `in house` if you can. Networking and referal pathways with other pods is always preferable.
  10. Sammi

    Sammi Member

    Hi there ,

    I'm confident and skilled to debride and lance any obvious abcess / breakdown. If its really deep seated and requires more invasive intervention then I'll refer on. I work in diabetes so am used to aggressive debridement however I must remember that this lady can feel everything I do!!!!

  11. G Flanagan

    G Flanagan Active Member

    Hi Sammi.

    I certainly wasn't saying you didn't have the skills / competence. I was making a more generalised statement about referring on to colleagues rather than straight to GP's. I hijacked your thread to do this, for which i am sorry.

    However now you mention your concerns with the patient being able to feel it, it could possibly be time to refer to someone who can do ankle blocks.

    Or even better, break down those old brick walls in Podiatry and actually invite a colleague to your practice to perform the ankle block and you do the I & D. However I think teamwork in private practice might be pushing the boundaries a bit too far at this stage
  12. Sammi

    Sammi Member

    No apology necessary - I understand what you were getting at. It's hard with text sometimes as i've found out when attempting humour!!Still getting to grips with forum etiquette too!
    Am new into private practice so am still trying to network with other local pods - I'm all for promoting our profession.

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