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VPs. To treat or not to treat.

Discussion in 'General Issues and Discussion Forum' started by Robertisaacs, Aug 10, 2007.

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    I'd be interested in peoples views on this.

    Our PCT has just made the policy decision to stop treating VP's. Altogether.

    This is the culmination of a move over 8 years going from treat all of them to treat the ones who get refferred, to treat the painful ones, to treat the painful ones on high risk patients, to don't treat at all.

    The rational is that

    A: the treatments are almost universally painful and most VPs are more painful after treatment than before.

    B: Low and unrepeatable success rates with everything bar Aggressive cryo and electrodessication.

    C: They'll go by themselves anyway so whats the point?

    I know several private pods who have patients back every 4 weeks for debridement and a dab of Silver nitrate, sometimes for years! These patients have been led to beleive that if their lesions are not resolving it's because its a Really tough lesion. I struggle to see this as ethical.

    Obviously this is an NHS department but i'd be interested to know how people feel about this from both the public and private sector. Is treating VPs an expensive waste of time or are we missing out on a valuable area of practice?

    Thankyou for your views

    Robert
     
  2. Admin2

    Admin2 Administrator Staff Member

  3. tarik amir

    tarik amir Active Member

    How about treating the ones that are spreading? You see people coming in with several warts that have been present for years and during this time have multiplied. There is no indication that these would resolve on there own. We use nitric acid or curettage and have high success rates with these.
     
  4. Cameron

    Cameron Well-Known Member

    Robert

    >I know several private pods who have patients back every 4 weeks for debridement and a dab of Silver nitrate, sometimes for years! These patients have been led to beleive that if their lesions are not resolving it's because its a Really tough lesion. I struggle to see this as ethical.

    Not sure whether it involves ethics but it may breach morality and would certainly indicate incompetence as the action of silver nitrate solution on the skin is to create precipitation of protein which in the presence of light, turns black. This gives the operator the opportunity to trace the skin striations and identify a circumscribed lesion. It provides an aid to diagnosis but has no medicinal (anti-viral) purpose whatsoever. Neither for that matter would regular reduction of the overlying keratin.

    >Obviously this is an NHS department but i'd be interested to know how people feel about this from both the public and private sector. Is treating VPs an expensive waste of time or are we missing out on a valuable area of practice?

    The answer to both questions is yes.

    toeslayer
     
  5. Nope, we're not doing those either. As you say there is no evidence that these go by themselves, (although i suspect there could be) however there is also no evidence that they don't!

    Agreed. It's a regular source of argument at meetings. I've been arguing the fact that a protein precipitant is different in effect to a caustic for years. The case is not helped by the fact that silver nitrate comes in packets with CAUSTIC written all over it.

    Not sure i agree with you on the regular debridement thing. I've always worked on the basis that aggressive debridement (to the very bloody stage) caused inflammation -> increase in white blood cells -> increased chance of effective immune response. But as you say there is no evidence to support this.

    Regards
    Robert
     
  6. Cameron

    Cameron Well-Known Member

    Robert

    Regular reduction of the keratin layer would have no effect on the stratum spinosum (presumably where the virus is). Reducing bulk may however make the client feel comfortable which is another story, of course. Haemorhaging may then be deatl with by using silver nitrate soln as a stypic.

    I am interested to see what effect (if any) the introduction of innoculation against cervical cancer will have on the clinical incidence of plantar warts.

    Cheers
    toeslayer
     
  7. George Brandy

    George Brandy Active Member

    Robert

    You talk about treatment as being the actual application of a caustic, cryogen or electrodessication. In my opinion this is only one part of the treatment and actually the least important.

    To me the most crucial and fundamental part of any treatment is the explanation by a Healthcare Professional of what the problem is. The Human Papilloma Virus, that causes warts and verrucae, is no exception. I hope that whilst your PCT Podiatrist is no longer going to "treat" the VP they are still going to "treat" the patient and spend time fully explaining HPV. If not however else are we as a profession going to break down the stigma associated with this virus?

    I spend a minimum of 30 minutes with each patient that comes along with a verruca to my practice. During this time the patient learns about the human papilloma virus, its effects on the skin, where it comes from, how it has infected them - each person understands the Etiology, Histology, Pathology, differential diagnosis oh you name it, they understand it whether they have been educated to degree level or left school at 14! If it takes me an hour to explain to a patient, I achieve understanding.

    Once a patient has this understanding, then they can keep a perspective on this innocuous skin lesion and at this point we (not I, but guided by me) discuss reasons for treatment and a suitable method. Usually this is skin debridment to make the patient more comfortable followed by self management. If resolution of the verruca occurs then the patient understands this is an added bonus and is an effect of the immune system not our intervention.

    Robert, if you view application of caustic etc as treating a verruca then you are definitely missing out on an area of valuable practice. You are shifting the problem straight into the hands of other healthcare professionals in the treatment of verruca. Predominately within my locality the treaters of VP's are now the Practice Nurses - who not only treat VP's with cryo but anything that resembles a VP!

    I was a child of the 60's when you had to sit out swimming and PE if you had a verruca. Oh how I looked forward to the examination of my feet by the school PE teacher! You talk to your over 40years of age patients and you will find this stigma is firmly entrenched in their brains even now. Thus the passing on of the VP stigma down the generations. Your challenge, as a Podiatrist, is to help patients over come this stigma and if you successfully achieve this, there may be a long term change in the attitude towards VPs.

    There are not enough Podiatrists (NHS and Private) in this country (UK) that actually sit down with their patients to communicate a thorough understanding of any foot problem to the patient, whether it be a VP or functional problem. Therefore I see no change in the future management of VPs.

    Perhaps our educationalists could be fundamental in changing attitude and perception towards the Human Papilloma Virus?

    GB
     
  8. nicpod1

    nicpod1 Active Member

    Just thought I'd add my view as a private practitioner:

    1) Lots of people request treatment for VPs and they just want to get rid of them (usually for cheap!)

    2) If they are painful, patients benefit from advice on debridement and pressure-relief

    3) When I first see a patient I explain that VPs are a virus and, therefore, treating has extremely variable success rates as it is largely down to their own immune system as there is no anti-viral (unless the cervical cancer vaccine does help)

    4) If patients still want localised treatment after I've explained all of the above, I always combine treatment with advice on taking a supplement called 'Perfectil' which is a 'Skin, Hair & Nail' supplement (which is just a multivitamin really) and which has given good results in most people (I am attempting a case study at present!); plus daily filing and application of 25 % urea cream.

    However, my overall feeling is that VPs are viral and, therefore, the focus should be on the immune system and not blasting the heck out of the skin, but no matter how much I try to put patients off, the majority still want treatment! Go figure!
     
  9. An interesting point not without merit. The plan as it stands is to send refferals for VPs straight back to the GP with a snotty note saying we don't do these no more. So we will do neither education nor intervention. I suspect you are correct in your opinion that this will move the problem to people far less able to deal with it. We too see the occasional HD sitting in a damn great thermal burn care of practice nurses.

    Thats how it goes in the NHS these days. If you're foot is'nt about to go black and drop off they're not interested.

    regards
    Robert
     
  10. George Brandy

    George Brandy Active Member

    Robert,

    Whilst I appreciate that the letter will be a little more professional than snotty it doesn't do much for inter professional PR.

    What a shame that it appears you hold such a low opinion of private podiatrists. We are not all like this.

    It is also a shame that your PCT, in its policy of not treating verruca, cannot suggest a private practice route to give the VP patient an option.

    Oh heck, never mind perhaps the voluntary sector can add another skill to their list and become PCT "approved" VP cutters as well as nail choppers.

    GB
     
  11. GB

    I'm sure it'll be a beautifully worded letter. We have some very gifted wordsmiths who will doubtless come up with a dignified, elegant and polite way of saying "sorry, this is yet another thing we won't do, please sod off and stop sending us patients". Fortunatly not my job as i would be tempted to do something along the lines of "due to the new carpets and pot plants at the pct management headquarters, the cost of the legion of administrators and accounts needed to massage the figures to fit the targets and the annual re organisation costs we have no money left in the budget for minor fripperies like treating patients. Therefore we are once again upping the access criteria for the service in line with our 10 year plan to eventually see only those who are either losing toes in the bedclothes or are clinically dead".

    I suspect my underlying frustration with the circumscription of our practice has bled through into my language and obfuscated my meaning.

    If that is the impression you got i can assure you that the appearance is misleading. I hold NO opinion of private pods as a group at all, low or otherwise. Like NHS pods there are some good ones, some ok ones and some not so good. To lump any group together and consider their abilities as a whole would be foolishness.

    The inability of the pct to hold a list of "approved alternative suppliers" of podiatry for those patients we are unable to see is indeed somewhat frustrating. I beleive that in order to avoid favoritism we can only recommend that the person seeks the advice of "an HPC registered Chiropodist". I suppose given that most of the pods who work here also do some private work it would be seen as a potential abuse of position to advertise oneself but it is irritating.

    I prophecy that within ten years the voluntery sector and the private sector will be all that there is. Were it not political suicide to kill the holy cow the NHS would have been allowed to die, with dignity, of natural causes years ago instead of lurching along from crisis to crisis spending ever increasing amounts on papering over the ever widening cracks.

    Sorry. Having a bad day. Toying with the idea of become a snail farmer in Brittany.

    Regards

    Robert
     
  12. Not my cup of tea, but i know that if you look at the Cochrane review, you might as well use a placebo. As I recall they reviewed trials of sal acid versus placebo- no diff and then cryo versus sal acid- no difference. Not sure if this is correct, but it was something like that.

    I do recall a paper in "the Chiropodist" (or "shmopodist" as I used to enjoy calling it) some years ago in which intentional haemorrhage was employed "effectively".

    I used to freeze mine weekly until I got bored of the pain. Then about two years latter it went away on it's own. n=1.

    Personally, I now educate.

    If this fails, I rub raw meat on it, bury the meat in my garden, drop a couple of acid tabs and dance naked around it at midnight.

    If this fails, I take multiple X-rays and MRI scans as I find the radiation helps. :rolleyes:
     
  13. Any evidence for firewalking? Glasswalking?
     
  14. Careful, you might burn down your clinic. ;)
     
  15. Cameron

    Cameron Well-Known Member

    Glass walking no...but firewalking...yes

    Fire Walking (Ummu Ti, Tah he, or Nistinaire)
    The ceremonial "Fire walk" has its history rooted in antiquity and was certainly known in Biblical times. From available records the ceremony was practised in the Society Islands, the Tonga (or Friendly Islands), New Zealand, Fiji and Hawaii. There are also records of the same practice in Africa, South India, China, Japan, Italy, South America, Spain and Bulgaria. Fire walking appears to have been imported by seafarers into different areas and incorporated into different faiths. The act of fire walking is generally thought to increase religious merit or power (manna) and is intimately connected to the seasonal expulsion of evil influences. Different cultures use different types of fire beds, for example Polynesians use heated stones whilst others use glowing charcoal. In Southern India is an act of faith undertaken to safeguard their cattle and crops from evil doings. Also when a believer suffers an illness they can take a vow in the name of the goddess (Draupadi) and if they are cured they will walk over the fire in gratitude. In Africa it is a test of chastity for priests and priestesses. In most religious fire walking, the walker will fast on the day and pray or meditate with others. Before the walk they bathe their feet in a tank to secure perfect cleanliness. The fire bed is made first from burning a ton of jungle wood to make charcoal, they when it is glowing hot a thin layer is spread to form a walking platform. The great marvel of fire walking is those who walk on red hot embers do not seem to sustain any burns or suffer obvious pain. The whole issue remains a mystery with even firewalkers themselves firmly unaware of why their feet do not burn. Many believe this is an act of faith and the absence of pain and damage is because of divine aid. In truth many fire walkers do experience flesh burns. Devotees believe when these occur the walker is not in tune with the deity. Many scientists and sceptics have tried to disprove the theory including trying to explain the phenomenon. The feet of the firewalkers have thicker skin than normal and many go unshod. As part of the ceremony leading up to fire walking the participants soak their feet in water. This means many are cold damp and dirty from walking barefoot. In the physical world the heat of a fire bed depends on its length, breadth and depth as well as the materials which are alight. The higher the surface the temperature the greater the heat transferred to the feet when they are applied to the fire. According to scientists the reason why fire walkers do not get burns on their feet is because their feet are not in contact with the burning umbers long enough to damage the skin. This is helped by having cold feet which are wet and finally the dirt on the sole of the feet further reduces the conduction of heat. When scientists conducted experiments they showed ordinary people could walk across burning coals without being burnt. Much was dependent on the time of foot contact and the same researchers were able to show severe burning of the skin could occur if the feet were in contact for too long. They believe firewalkers know exactly how long they can make contact. What was interesting about the described experiments was it was possible to cross a charcoal bed, without abstinence from meat, alcohol and sex which kind of debunks the myth of many devotees. However in truth, self denial may strengthen resolve to overcome any adversity.

    References
    Fonseka C. 1971 Fire-walking: a scientific investigation Ceylon Medical Journal 16:2 104-109.
    Mackenzie DA 1996 South seas: Myths and legends London: Senate

    toeslayer
     
  16. Tess Bowen

    Tess Bowen Member

    Hi Robert
    If the vp. is located over a pressure area it will be painfull so why not treat it as a friction/ pressure area and use a silicone pad or advise the patient to purchase one . The leison won't worry them anymore and they will be less inclined to seek a more invaisive form of treatment that will scar and lead to a long term problem.
    Tess
     
  17. jane.e.benson

    jane.e.benson Active Member

    Hya,
    I don't 'treat' verrucas any more. ( I have over twenty years of experience with these critters!) Now I explain that the pain is caused by callous build up around the edges on vp's on weight bearing areas and pare this down for comfort if required, and then I reccommend rubbing with a pointed end of a mouse shaped pumice while the foot is wet (enough to cause some friction but not enough to cause a heamorrage) the results are impressive. I don't know though whether it's the friction or perhaps a chemical compound in the stone that works but every patient that has followed my advice has had a successful result.
    Jane
     
  18. Cameron

    Cameron Well-Known Member

    Jane and Tess

    I would disagree with your explanation simply because the pathology of the skin would support the bloating of the Spinosum layer compresses upon the adjacent nerve ending and causes pain (usually by lateral pressure). The overlying callus is a physiologial protection which is formed to reduce peak forces and rarely is the wart painful on direct pressure. Callus removal will assist in the application of medications and is essential after breakdown to establish drainage. The decision to not treat leaves the body immune response to deal with the infection.

    Robert
    Caustic labelleing of high solutions of silver nitrate or similar products is a COSH (Health and Safety) requirement, but the action of this caustic is protein precipitation.

    To treat or not treat
    I have done both with warying degrees of success but as a private practitioner I preferred not to for purel mercinary reason. I was introduced to the herbal prep Kalanchoe and have found this treatment to be 100% successful.

    More recently the association with cervical cancer and papova virus has made me a little more interested in the benefits of treating plantar warts early, especially in adolescent populations where unprotected sex is likely. In Australia cervical cancer vacinations have recently been introduced and I will be would be interested to see what effect, if any, this has on the presence of verucca in females.

    toeslayer
     
  19. Steve5572

    Steve5572 Active Member

    ToeSlayer
    Thanks for the tip on Kalanchoe, ill have to do a some more research on this treatment. Anything that can stop the spread of HPV's is of great help to all pt's and innocent bipedal standers. Leaving HPV's to spontaneously resolve or talking to them for hours on end seems like wishfull thinking. I have recently inherited a pt. with a HPV 10cm in diameter, it completely covers the heel and will grow up to 1cm thick in 10 weeks. If there is a treatment to prevent this i will certainly do al that is in my power to prevent my other pt's from being physically debiliated by this viral growth.
    Steve
     
  20. pd6crai

    pd6crai Active Member

    Have you ever had electrosurgery done?! It is a painful procedure. I had it done 5 years ago (I still have the scar), not only did I have an ulcer for 9 weeks, but the vp multiplied on healing and I developed a further 5! I have never recommended this procedure since undergoing it my self. It is not nice at all!!!!!!

    I only treat painful vps, I send others way with the knowledge that banana skins can help as does Thuja. The banana skins appear to take out the pain of these vps and also softens the callous over it.
    Only last month I treated my 7 year old nephew and after 3 treatments, his vp had virtually gone, we used sal acid and silver nitrate combo, and it works a treat, I don't find silver nitrate on its own is strong enough!!!
     
  21. Cameron

    Cameron Well-Known Member

    netizens

    I understand that many of the alternative treatments involving herbal or onion family derivatives are likely to work because they contain natural salicylates which breakdown side salt linkages of the keratin and irritate the lesion sufficiently to illicit an epidermal blister (referred to as breakdown).

    The synthetic salicylates will have the same effect but this is usually more virulent.

    toelsayer
     
  22. Sarah B

    Sarah B Active Member

    Hi Toeslayer

    It's not usually adolescent feet that spread the subtypes of HPV associated with cervical cancer! (16 & 18, 30 & 31 are the ones that have been identified as 'high risk') As far as I am aware, the subtypes responsible for verrucae are considered 'low risk' with respect to malignancy developing (although I realise that this can & does occur). The greatest risk is lack of diagnosis and risky behaviour; safer sex may not always offer protection against spread of warts (it depends on where precisely they are located). I am very doubtful that immunisation against these strains of HPV will make any difference to the incidence of plantar warts. (Unless Aussie girls do some things differently from us Pommies!) But that is not say I'd object to being proved wrong!

    Sarah
     
  23. Cameron

    Cameron Well-Known Member

    Sarah B

    You are quite correct and the evidence is scant. The risk if it does arise is mainly boys with penal warts engaging in pentrative sex with younger girls. Surveys would suggest this behaviour (apart from natural inquisitiveness) is more far prevalent in young teenage and pre pubescent communities than commonly believed.

    The potential for a generation of females immune to the cancer causing virus would be ideal but a downside mght be the lower grade virus becomes more pathological. No evidence but more reason perhaps, to treat warts.

    Cheers
    toeslayer
     
  24. jane.e.benson

    jane.e.benson Active Member

    hello fellow feet people,
    I put my thread in hoping for some feedback regarding the use of pumice stones on verrucas. Am I the only one to recommend this form of treatment? does anyone know the reason why it works.
    Jane
     
  25. Anne McLean

    Anne McLean Active Member

    Hi Jane,

    Could be that abrading the lesion by whatever means helps to stimulate the immune response.

    Regards

    Anne
     
  26. Anne McLean

    Anne McLean Active Member

    Hi Toeslayer,

    I have used Kalanchoe since the early 1970's without much success.

    What is your methodology for using this plant? You obviously have some secret that I haven't discovered.

    Regards

    Anne
     
  27. Robyn Elwell-Sutton

    Robyn Elwell-Sutton Active Member

    Having been hit recently with some shockers(including every known treatment going) I am having success with Thuja ointment (in a sticky base) . It does not produce a breakdown but reveals the truly distorting damage to the stratum spinosa layer. Invariably it seems to hit the very active teens and after 23 years, I have concluded there is a strong association between this affliction and growth spurts and / or stress which seems to affect the immune system through the glucocorticoid axis.
    Therefore anti inflammatory & immune enhancing education is needed, as well as "rest", both global and local ,to the affected part.
    robyn
     
  28. twirly

    twirly Well-Known Member

    Robert, Snail farming! Is there a vacancy for a vegetarian assistant at your new location in Brittany? I could look after the greens for the lil blighters. I'm also a wizard with a pot noodle so could double up as your housekeeper. Will be delighted to forward my CV if requested. Regards,
     
  29. twirly

    twirly Well-Known Member

    Dear all,
    Just breezing through the net once again. Paused at this section RE: VPs . Just a quick Q for any who care to respond. Have any of you undergone cryo yourselves?
    Not at the provision end of the probe though, I mean as the recipient.
    Never had a verruca myself but a few years ago I developed a small wart (called percy) on my peter pointer finger. Local GP offered to freeze it for me. Following a 20 second blast I went back to my clinic to complete my afternoons work. GP called in to see how I was doing & asked if it was stinging a little. Stinging, no. ABSOLUTE AGONY!! yes. I lost 3 nights sleep & wanted the damned thing amputated.
    However I am pleased to tell you that Percy, (the wart) is no more. Since this happened I have been far more cautious when advising patients to seek cryotherapy (particularly for weight bearing areas). My usual advice is if it aint hurtin' leave the thing alone.

    A private patient was quite upset though when I advised her that the non-painful VP on her 3 year olds sons 5th toe was best left alone. I had printed her copies of advice from the Societys web site. The little chap was not bothered by the verruca until his mum insisted on filing it until it bled & tried to apply bazooka to his tiny foot.

    Pondering ringing child line.:rolleyes:
     
  30. pd6crai

    pd6crai Active Member

    Twirly, I have had cryo about 9 times, I have had the sal acid and silver nitrate combo and electrosurgery.
    I too would agree, :empathy: if it isnt sore dont touch!! I had a vp for years and when I did Podiatry decided it would be good to see what treatments were like (I even had a pna). Well I coped with the cryo, but yes it throbs and keeps you awake, gives you sore knees and hips as you try to adjust your walking. But nothing and I mean nothing compares to electrosurgery. I will never ever send a patient for that. I had an ulcer for 9 weeks (I am relatively young and healthy!), it got infected and I needed abs and I had to pad it up to walk it was over my 3rd mpj.:butcher:

    My standard treatments for vps now are, either banana skin, tea tree and lemon oil or the thuja tincture.
    Tea tree and lemon oil seems to work, I had a colleague(SP) that used it on a sty on her eye :wacko: and thought she was going to loose all sight due to the burning sensations!! On your foot though it is not painful.
     
  31. Mart

    Mart Well-Known Member

    I have and remain completley baffled by the research evidence and anecdotes presented above.

    Sorry to sound so contrary but feel research methodology and practitioners approach as a genalisation are too rigid and ignor variable responce both of individual dose efficacy and pain tolerance.

    This is one of my least favourite tasks and humour seems ot help a lot.

    For past 20 years my treatment plan has been simple and outlined below.

    Explain treatment options, infection avoidance strategies and mechanism of wart formation to patient.

    Explain that success is conditional on destroying infected tissue faster than it can recover, that epidermis normnaly takes four weeks to migrate from basal layer to surface, hence theortical rational for return interval, non compliance to this = likely failure.

    Assuming no contra-indications have patient decide on plan vis a vis speed, convenience and pain

    ranked options in order of pain/speed of resolution

    self treatment salicylic acid +- formaldehyde gluteraldehyde daily, self debridement, review four weeks.

    cryo - titrated degree of injury according to tolerance and effect, period two weeks. Use Madajet for infiltration when treatment rather than sequel is poorly tolerated. Dose between 30 secs to 3 minutes with wide range of probe sizes using CO2 spenby cryoprobe. Ofload weight-bearing sites after treatment and drain subsequent haematoma if painful.

    electrosurgery +- phenol and cryo before healed where cryo alone is ineffective or poorly tolerated.

    cauterisation with trichloro-acetic acid and 75% silver nitrate at end stage if very superficial disorganised tissue remains.

    BTW

    I stopped using monochloroacetic acid, pyrogallol and vessicants early in my career after nasty unpredictable episodes of lymphangitis.

    I have experienced on my own foot both cryo (adminstered by my 10 yr old daughter after I treated her likewise) and electrosurgery treatment, effective with single treatment (early detection) - nothing onerous in either event.

    I hesitate to make this post and realise that this is horribily anecdotal and as a rule I hate the statement "well it has worked for me" when going against the opinion of the scientific literature.

    However I feel it would be difficult to evalute scientifically such an approach.

    The studies I have looked at are horribly lacking because they fail to recognise that a wart is not a wart, they have a variety of depths, and volumes, peoples reactions to pain and their skin properties vary, sites and skin thickeness varies considerably, degree of dermal/epidernal junction disruption varies, compliance varies . . . . . . .. just to mention a few variables which seem to be ignored.

    Sometimes healthcare remains an art despite our best efforts :eek:

    cheers


    Martin


    The St. James Foot Clinic
    1749 Portage Ave.
    Winnipeg
    Manitoba
    R3J 0E6
    phone [204] 837 FOOT (3668)
    fax [204] 774 9918
    www.winnipegfootclinic.com
     
  32. twirly

    twirly Well-Known Member

    Thanks for your reply pd6crai,
    must admit I prefer the more gentle approach. Am glad to hear that others also prefer more natural remedies ie. t- tree with lemon. Has anyone had any success though? I would be interested on views. The lady with the sty on her eye (was she mad!) :wacko: I'm sure we've all done daft things, lol.
    Regards,
     
  33. The eternal and oft lamented problem with medical research. N=1. :bash:
     
  34. Mart

    Mart Well-Known Member

    Here's a little extra to my last post

    Perhaps this is true but the vast majority of people I treat have had a chronically painful lesion on weight-bearing site for over one year. After resolution of the wart the pain is cured not simply palliated. Pain is the usual sequella to a destructive therapy so this should be no suprise.


    agreed

    I am unaware that this is true for long standing lesions.

    I interpret this as very poor and lazy clinical decision making.

    we do not have ideal treatments ie demonstrated efficacy with no pain, if only natural and nice smelling was all that was needed :rolleyes:

    There are clear flaws in the research methodology ie ignoring that warts are not a homogenous entity and likely will have wide variation in therapeutic requrements which so far have not been studied properly.


    Nuff said

    cheers


    Martin



    The St. James Foot Clinic
    1749 Portage Ave.
    Winnipeg
    Manitoba
    R3J 0E6
    phone [204] 837 FOOT (3668)
    fax [204] 774 9918
    www.winnipegfootclinic.com
     
  35. topical keratolytics work reasonably well.I have used 10% lazerformaldehyde[formalin] with good results.it also comes in a 20 % concentration.topical application is used under occlusion.injectable bleomycin works well:this mut be diluted down in 30 cc of sterile saline or bacteriostatic water.well documented in literature.punch biopsy may be necessary for recalcitrant lesions as they may not be a wart.
    dlbdpm@yahoo.com
     
  36. I've just written a letter to my daughter's school principal requesting they give parents some basic foot health advice to prevent the spread of tinea and verrucae at the upcoming 2 week swimming program. I thought I would have a browse on the arena for any new information only to read you guys aren't even going to bother to treat them. Gee I hope the cancer researchers don't catch your bosses attitude. I have treated VP's for many years with banana skin! Now pick youselves up off the floor and stop laughing. Effective 100%success, easy, cost effective as the patient treats themselves. Just apply a piece of banana skin over the wart and cover with Leukoplast(red spool). Remove in the morning and replace with plain tape. Just repeat this process daily using banana skin at night and tape in the day and before too long they won't be there and your patient will love you and it has cost them heaps.
    TRry it out-it works.

    regards M
     
  37. I... can't...stop...laughing

    :hammer:

    100% successful. On a sample size of how many exactly? Well i suppose on a long enough timeframe mefix would be as well. I don't suppose there is a study to back this up? No? Why do you think that might be?

    We'll just add banana skin to the list of suggested remedies along with dead cats, stump water, going to 4 funerals, steak, bean skin, snail slime, eye of newt, oregano, ****ake mushrooms, essential oils, garlic, potato skin, baked onion, epsom salts, cider vinegar, mashed banana, unheated honey (and it was specified that it must be unheated), spit, mango and papaya juice danylion roots, watercress, mustard cress, lettuce, spinach, celery, paprika, black pepper and as simon rather worryingly advocates

    As things which have somebody swearing blind it works but no evidence which would make it past a undergraduate class much less a peer review journal.

    Can't try that. Unfortunatly our treatments have to be evidence based to SOME degree. If something went wrong and i had to justify myself in court i'd struggle to explain attaching soft fruit, veg or fungi to people.

    Regards
    Robert
    (ps i made the eye of newt one up but the rest i've heard good things for!)
     
    Last edited: Oct 24, 2007
  38. Iain Johnston

    Iain Johnston Active Member

    well I certainly do like treating verrucae. I empathise with peoples frustration, and dont get me wrong there are some that dont respond the way I would like.

    The bottom line with these lesions is that the body has to wake up and realise it has an infection, and deal with it. It flies under the radar otherwise and simply wont respond unless aggressive techiques are used like cryo or electrosurgery

    But this is what I do. There are a few choices at my disposal, depending on the size , site, number and age.
    1) acids - or varieties of such - I generally use to reduce or debulk particulary large isolated lesions on skin that is moist, not too dry, as acids work better with moisture.
    2) once the lesion is reduced, a couple of 2 weekly sessions with Cryo to blast the rest out.
    3) the young and the scared and those with large clumps or multiples will have the choice of Marigold Therapy. Its a techniques that treats painlessly and ge ntly and proposes to be anti-viral as well as immune stimulating. And is great on Kids.
    4) Electro surgery with the radiolase - again on isolated lesions, ans aggressive3 tissure destruction technique.
    5) Cellfood - a nutritional product that introduces 78 minerals, enzymes, proteins and oxygen to the system with the intention of improving general well being and immunity. I've found this to a great back up to those tghat dont show responsiveness to treatment

    Good luck

    Iain Johnston
     
  39. I was at a meeting the other night and had dinner with 3 other podiatrists, all of us have been working for 25 years plus and 3 of us use banana skin as an easy home application that patients can use. I also debride and use formaldehyde , AgNO3 and Salc. acid and have had 1 patient have a major allergic reaction to the Formaldehyde that's scary. Can't say any allergic reactions to banana. Of course most of these are small lesions but some have been long standing and I stand by the effectiveness . Don't forget most drugs and ointments are plant based.
    I was interested to read about the cellfood as we also discussed was to improve kick starting the immune system. This I will trial on my daughter with the banana skin treatment.

    Why not give it a go it can't hurt.

    MT
     
  40. Cameron

    Cameron Well-Known Member

    Sorry Anne I missed your posting.

    Kalanchoe

    It was Martin Reid who told me about the plant when were teaching at Glasgow. Flash blew a fuse and would not let us experiment however Martin continued to use it with 100% success and I have certainly not been dissappointed when I have recommended it.

    Cut the shape of the lesion from a leaf and remove the thin clear film to reveal the juicey surface. Apply this to the lesion then use occlusive strapping to hold in place. Replace the leaf ever two to three days and usually within a fortnight the lesion has separated out from the epidermis. The surrounding skin is macerated but this dries out with a post op astringent paint.

    Syd
     
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