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VP treatment in private practice

Discussion in 'General Issues and Discussion Forum' started by Sammi, Jul 14, 2011.

  1. Sammi

    Sammi Member

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    Hello everyone

    I'm venturing into private practice (from scratch)and deciding on which VP treatments to offer. Having been working for the NHS we stopped treating them a long time ago.

    Am used to all the spiel regarding no treatment / home treatments. But thinking more about using Salicylic acid and cryotherapy (separately!)- needling isnt an option until I brush up my post tib anaesthesia!

    I've come across cryospary 59 (with poor reviews), cryoalfa ( more costly) and cryosuccess (expensive). Obviously with just starting out I'm reluctant to pay out too much initially.

    I'd appreciate any feedback / advice etc

    Thank you

  2. lucycool

    lucycool Active Member

    I use silver nitrate, sal acid and needling.. I'd be interested in peoples opinions on cryo too as I think I've seen the same info as you and it seemed out of the question..

    As for tib blocks etc, I can recommend the foot and ankle injection site book available on amazon.. great and has a DVD!

    Good Luck!

  3. Sammi

    Sammi Member

    Thats really helpful Lucy - I can use sal acid & silver nitrate in the meantime. Will definately look the book up. Needling appears to be the way forward at the moment - I expect have you had good results then ?

    What is a reasonable rate for this procedure please ?
  4. davidh

    davidh Podiatry Arena Veteran


    A word of caution. You need to do some practice with your injection techniques, preferably supervised by someone who knows what they are doing, and you need to at the very least sit in with someone to observe needling 1st-hand.

    Once competent you can look at fee scales for the procedure.

    If (and it's not such a big if nowadays as it once was) your needling goes wrong, it will not look good in Court when you are asked by the claimant's barrister where you were taught needling and you reply " I read it on an internet forum":eek:.

  5. davidh

    davidh Podiatry Arena Veteran


    My advice is to check that out only when you are competent in both injection technique and needling technique and are confident that you know when needling is appropriate to use.

    The threat of litigation is never too far away with invasive procedures.

  6. LuckyLisfranc

    LuckyLisfranc Well-Known Member

    Can someone please point me to any evidence outside of the anecdotes on Podiatry Arena that say that 'needling' is an efficacious and recognised intervention for warts?

    I am both intrigued and slightly concerned by the enthusiasm for this technqiue, when it appears to have no basis in any literature I have ever read.

  7. Sammi

    Sammi Member

    Yes , I totally agree. I'm not the type to rush into anything without being fully proficient - working for the NHS where everything is evidence based has made me very wary. Perhaps my response came back as a little casual!!!

    I'm just in the process of finding out what other private pods are offering. I originally was going to steer clear of VPs altogether however it appears that there is still a demand for treatment.

    I appreciate your replies. I'm still getting to grips with forum etiquette too ;)
  8. blinda

    blinda MVP

    Hi Lucky,

    There is no evidence, yet. I am currently working on some research, but it`s a long-haul trip.

    I share Davidh`s concern in that some practitioners (and this includes GPs. Yes, some are reading the Arena and having a `stab at it` themselves) are not competent in either (or both) injection and needling technique. They are `having a go`without first finding a mentor in appropriate injection technique nor observing a practitioner who has successfully utilised the needling treatment. I have had more than a few patients referred to me, either by their GP or another pod, after unsuccessful and very painful experiences of needling VPs.

    Unfortunately, recent podiatry graduates are, in the main, only taught digital ring blocks and then awarded a certificate for use of LA anywhere on the lower limb!:bang: I would advise these pods, with an interest in needling, to seek out a mentor to supervise local infiltration and tib block techniques.

  9. Barbthepod

    Barbthepod Member

    Hi Sammi

    I attended a very good theoretical and practical verrucae surgery workshop in Tamworth (UK) last Sunday, which incorporated hands on treatment techniques in liquid nitrogen cryosurgery, electro-surgery and included mentoring in tib block techniques and local infiltration on patients in current treatment.

    Have a look at MasterClass Presentations Ltd for more details... http://www.masterlearner.co.uk/ then the side bar verrucae surgery. They also run courses on advanced anaesthesia.


  10. davidh

    davidh Podiatry Arena Veteran

    Double-posted. I thought my 1st post had disappeared but it's come back:confused: - oops.
  11. Don ESWT

    Don ESWT Active Member

    To all,
    After 20 years of using 66% sal and Mono:- the one off application and removal after 5 days results in a intact wart sometime 10-15mm diameter and up to 5-10mm deep. size does vary and age of patient has no boundary.

    Oh by the way my father brought the same method from Scotland to Australia in 1947
    Up until 2009 we had 62 year of solid results using the same method.
    You cannot double bind the treatment of planter warts
    You will not find any study paper on which is the best way to treat this virus It is a mongrel virus which has been around since Adam was a pup.
    Clean skin is not a barrier to the virus, it is the mother of all opportunistic pathogens to inhabit the upper 3 layer of the skin.
    Incubation time is from 1 month to 18 months
    survives -25 degrees C to 55 degrees C
    The virus is approximately 1 millionth of a millimetre in diameter
    It complicates the skin surrounding blood vessels but will not penetrate into the lower dermal layers. It just wants to survive where it can cause the most discomfort.

    Always willing to share pictures only need your email

    Donald Iain Scott

    Living in Grafton NSW - Working in Wollongong
    Just a short commute
  12. Sammi

    Sammi Member

    I have really appreciated everyones replies , it's really helped me to have a good think!Having now read through various articles , links and posts from the past few years I have decided to go with sal acid based treatment for the time being and see how I get on.

    Thanks again all :D
  13. dsfeet

    dsfeet Active Member

    In the past i have used sal acid and silver nitrate all with some success, failures as well. curettage for the large persistant warts.ref these to pod surgeon.
    the last 12 months i've been using cyrotherapy , the small kits -89degrees . have found that success rate has increased , treatment consults are less , treatment time very quick
    the kits cost $ 600 +, not cheap. Main aim for this response is to say BEWARE. Often the little small part/ noozle that needs autoclaving has its issues. it blocks,the lever not working etc etc
    IT requires a B class sterilizer to prevent this from occurring . something they DON"T mention when they sell the kit, only when difficulties occur, and your brought spares , lost treatment times etc
    We now have to take ours to the hospital for autoclaving, time consming, when all other autoclaving is done inhouse.
  14. Tim Foran

    Tim Foran Active Member

    Do yourself a favour a buy a dewar for liquid nitrogen. If you don't want to buy the spray canister as well, just use a disposable foam cup with a cotton tip. You can control the freeze much more precisely and the pressure from the cotton tip tends to penetrate better.

  15. Yeah there is.

    There's the original Falcor paper in japma, which I admit is pretty old.

    But there was a case series in Podiatry Now a few months back!

    I'll try to find the reference.
  16. blinda

    blinda MVP

    Sorry, I thought Lucky wanted `evidence` :rolleyes:;)

    Bad tempered,
  17. akibs

    akibs Member

    Hi Sammi
    Just wanted to include my experiences here with treating VPs in private practice. Silver Nitrate only seems to be effective on early VPs or children. I used to use Salicylic Acid and still recommend to patients that they have the option of using an OTC sal acid prep whilst supported by me, but to be honest by the time most patients come to see us they've tried most things including Sal acid preps. The majority of the patients want a structured treatment plan with clear success rates. After several years of trying to avoid it due to the cost I decided to invest in a liquid nitrogen dewar. Whilst expensive it adds another useful and effective treatment option for patients. It took me a while to be able to afford to have LN2 but I wouldn't be without it now. ideally having a range of effective treatment options means you can tailor your treatment to the VP and the patient.
    Almost forgot to say I bought and tried nearly every other 'freeze' treatment available from Podiatry suppliers and found them to be a waste of time. Hope that helps..
  18. dsfeet

    dsfeet Active Member

    looks like might have to invest in the Dewar liquid nitrogen option, is there experience needed for its use?
    Not to unhappy with the small cyro unit , except the hassles of the b class autoclave, and agree all othe freeze units i've used in the past are a waste of space, money and effort.
    Can someone give details of where to purchase the Dewar unit and approx cost to purchase and use?
  19. Well there's different grades of evidence ;-).

    Nothing wrong with a case series. It's not an rct but it's better than nowt!
  20. Sammi

    Sammi Member

    Thanks akibs, thats really helpful. I'll look at possibly putting a cryo purchase into my business plan - am currently finding out how all those little extra expenses are adding up! Fingers crossed for a successful acorn! ;)
  21. blinda

    blinda MVP

    Forgive me, Herr Isaacs. Please accept my sincere apple-ogies. Yeah, OK. My first published paper was also a case series....:eek:

    But, I reckon we can still do better....
  22. And a very fine case series it was too ;)
  23. healthyfeet

    healthyfeet Active Member

    I still find Saturated Monochloracetic acid the best for most vps! I've been using it regularly for 25 years. Be warned though, it can cause skin breakdown, so you need to select suitable patients and VPs, and give advice re. sos and possible reactions. Sometimes i use cryotherapy or switch to AgNO3 once the vp is superficial enough!

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