Welcome to the Podiatry Arena forums

You are currently viewing our podiatry forum as a guest which gives you limited access to view all podiatry discussions and access our other features. By joining our free global community of Podiatrists and other interested foot health care professionals you will have access to post podiatry topics (answer and ask questions), communicate privately with other members, upload content, view attachments, receive a weekly email update of new discussions, access other special features. Registered users do not get displayed the advertisements in posted messages. Registration is fast, simple and absolutely free so please, join our global Podiatry community today!

  1. Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
    Dismiss Notice
Dismiss Notice
Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
Dismiss Notice
Have you liked us on Facebook to get our updates? Please do. Click here for our Facebook page.
Dismiss Notice
Do you get the weekly newsletter that Podiatry Arena sends out to update everybody? If not, click here to organise this.

Mosaic verrucae-help with treatment

Discussion in 'General Issues and Discussion Forum' started by poppet, Feb 27, 2009.

  1. poppet

    poppet Active Member

    mmm, as you said in a previous reply...the acronym for Steve's was a little dodgy to say the least...still it raised a smile;):D

    poppet
     
  2. stevewells

    stevewells Active Member

    Just for the record I didnt use the word System I have been misquoted as a certain someone with a certain sense of humour added system to produce said acronym. Let the record show that my suggestion was Percutaneous Immune Stimulation and I think still the best suggestion - so there!! - and that what I'm gonna call it - ner!
     
  3. :D

    More an art than a science I'm told.

    I'd Love to be a Percutaneous Immune system stimulation artist but we don't get to do VPs in the NHS any more! :boohoo:.

    Might do some private work just to have a go at this!

    Regards
    Robert
     
  4. linpea

    linpea New Member

    Hi,
    Verrucae are virus infections and can be very resistant to treatment. Often those with poor immunity have problems.
    Have you considered essential oils. These are oils extracted from plants and have helpful properties. Lemon and tea tree oils work well together, having antiviral, immuno stimulant, antifungal and antiseptic properties. The oils can be applied directly to the verrucae daily. They can be used while on holiday and also after freezing or other acid treatments. I achieve excellent results ( but not always!) Sometimes I use ravensara essential oil added to the lemon and tea tree mix.
    Linda:)
     
  5. stevewells

    stevewells Active Member

    Yes I have - I use them in the shower and they make me smell nice!
     
  6. blinda

    blinda MVP

    :D:D

    Hi linpea,

    Don`t be put off by Mr Wells, he`s obviously just graduated from the Spooner School of Etiquette ;)

    I think that this is the statement that most would question. I would be very interested to see any evidence base for it. The antimicrobial effect of tea tree oil against virus (herpes simplex only) has only been demonstrated in in vitro studies and no clinical studies have revealed superiority of TTO over existing licensed pharmacological tx.

    Cheers,
    Bel
     
  7. stevewells

    stevewells Active Member

    A Fine School
     
  8. Nina

    Nina Active Member

    I'd like to say Thank You to everyone who has contributed to this thread, I can't remember when I have ever felt so excited about treating mosaic warts.

    I spent 12 years working in a local hospital where the dermatologist referred me the verrucae he couldn't get rid of as he didn't like surgically excising plantar lesions in case a corn developed over the resultant scar. I'm proud to say I had a very good success rate. But in private practice patients want more instant results, they also want to be able to bathe daily.

    I've had my first success with needling and I'm considering writing to local GP's to tell them about my 'new' treatment as the local NHS podiatrists no longer treat warts.

    I'm just feeling a bit peeved that I've only just found out about this treatment and I've been qualified for 26 yrs.

    Thanks too for the photography tips now I know where I'm going wrong.

    :)

    Nina
     
  9. stevewells

    stevewells Active Member

    dont give too much away - they'll nick it!
     
  10. stevewells

    stevewells Active Member

    Nina - how long between procedure and resolution and have you got any pics? how bad were they what was the history etc??
     
  11. Nina

    Nina Active Member

    Hi Steve,

    It was 3 weeks from needling procedure to resolution, there are still some black eschars from the procedure but on debridement the skin striae were all normal. Couldn't seem to take a decent photo but have asked him to return in one month to see if satellite lesions have resolved.

    Have read instructions for camera now, so hopefully I'll get an 'after' pic to go with the 'before' pic (which must have been a fluke).

    Nina
     
  12. stevewells

    stevewells Active Member

    3 weeks - what sort of size was it? how long had the pt had it?
    My first three are all past 8/52 now and still no significant change - done some others that are due for review shortly.
     
  13. Burris

    Burris Welcome New Poster

    Hi Steve,
    Sorry for the confusion... A little short wtih my reply.
    We would have treated approx 30-35 patients with this technique over the past 4 years. Having said that, this is only between 2 podiatrists, and we would only see about 5-6 new VP patients per month. Compared to some pods, I suppose this isn't a great deal of VP patients.
    I could always look up exact past histories for exact numbers, but I think my estimate would be pretty close.
    Working on 5 new VP patients each month over 4 years - then we would use this technique for 1 in 7 patients.
    Although we strongly support it, some patients will be completely opposed to the idea because of the thought of an anesthetic, and others just prefer less invasive techniques.
    The 'typical' patient for us is one who is pressed for time and wants a quick option without many return visits. Often we see patients elect this option when they've tried and failed previous options. Perhaps a little bit overzealous... but for a patient to be eligible for this treatment, we use the same criteria as we do for if we were to perform a PNA. We just decided on this across the board, and although we've never had any complications, there's no reason to do anything if you are unsure.
    Hopefully this gives you some more insight as to the kinds of numbers we've seen come through for this treatment.
    Cheers,
     
  14. carolethecatlover

    carolethecatlover Active Member

    Dentists never mention 'needle' injection or even anaesthetic....
    "First, I'll just make the area numb, then you tell me when you feel it going cold....."
    It's all in the wording.
     
  15. stevewells

    stevewells Active Member

    In this country (UK) we have a thing called informed consent. I have never been asked by a dentist whether I have any allergies to anything and more worryingly whether I have had anaesthetic in the last 24 hours or whether i have ever has a reaction to a local aneasthetic - to do something to a patient without their knowledge is unethical and dangerous so please stop going on about dentists!!
    It is unethical to inject a substance into someone without first informing them of the benefits and risks involved.
    Dentists in my experience are severly lacking in this regard
     
  16. JMD

    JMD Member

    I,ve just carried out my first attempt at needling with a posterior tibial block using 2% lidocaine, and there seemed to be quite a delay before the onset of anaesthesia i.e. approximately 40 minutes. I don't know if it is a bad technique on my part or if such a delay is normal. Can anyone advise.
     
  17. stevewells

    stevewells Active Member

    I had one yesterday took ages - sometimes you just get unlucky. What has happened to me before is that the nerve bifurcates more proximally than you you expect and you only knock out one side of the sole of the foot
    I often inject more proximally but then i have had some not go at all when doing this
    If I am going to do a lot of these I will invest in a peripheral nerve stimulator - can get it right every time then. Braun and Pajunk do good devices - work out about £500-£850 depending on what you want it to do
     
  18. JMD

    JMD Member

    Thanks for that Steve I'll keep that in mind.

    It must be infuriating to find out that premature bifurcation of the nerve means you have only knocked out one side. If it happens to me I hope it's the side the verrucae is on.
     
  19. I never use posterior tibial nerve blocks for doing verrucae....they take too long and are too unpredictable....I use only local infiltration directly plantar to the verrucae with ethyl chloride spray to numb the skin during the initial needle puncture.
     
  20. stevewells

    stevewells Active Member

    How much pain do they experience Kevin? I don't want to shell out for a stimulator if I don't need to.
     
  21. carolethecatlover

    carolethecatlover Active Member

    Steve, it's true! But remember they give a LOT more injections, and who, in their right mind, would refuse a local for dental treatment. 20 years ago, I worked for the BEST dentist for nerveous patients, they never knew they had received an injection.
     
  22. JMD

    JMD Member

    Kevin,

    Injecting plantar to the lesion do you not find that the dermal structures offer a great deal of resistance to the needle and the LA solution?
     
  23. Steve:

    Save your money for something you really need.

    I use about 3-5 cc of 0.5% Marcaine plain, in a 5 cc syringe, with a 25 gauge 1.25" needle for the injection. The needle stick for the injection is preferably from dorsal or medial or lateral, but also is done plantar, always using ethyl chloride spray for about 5-10 seconds to freeze the skin so the needle stick pain is slight. The injection is done into the subcutaneous fat, not the dermis, fanning the needle and injection just deep to the lesion (i.e. dorsal to the lesion) that I will be either excising (i.e. curretting) or needling. All this takes about one minute. Also, it is important to have the patient lying flat, either supine or prone, for the injection. I tell them the injection will hurt a bit, but that it will all be over in one minute. Using the ethyl chloride spray and not trying to inject too large of a volume of anesthetic in too short a time is the secret to being able to give injections like this routinely with a minimum of patient discomfort.

    Hope this helps.
     
  24. twirly

    twirly Well-Known Member

    Hi all,

    Needling patient number two:

    Female patient.

    Mid forties.

    Good general health.

    Pt. complains of: Mosaic V/Ps left plantar calc' > 2 years duration. Very painful & pain worsens following activity.

    Occupation: Cattery owner.

    Activities: Bowling.

    Pre- injection ethyl chloride spray (many thanks Kevin. Great tip).

    Tibial block(as central calc' plantar location considered too tender to block directly).

    2ml Scandonest plain
    3ml Marcaine 0.5% (for prolonged pain relief post op).

    1ml additional Scandonest locally to area as was slow to 'go off'.

    Area needled 100-130 Xs

    1st photograph pre-op
    2nd photograph post needling

    Consent to use photographs obtained.

    I am still unlikely to win any photography awards though I think with practice I hope to improve. ;)
     

    Attached Files:

  25. drsarbes

    drsarbes Well-Known Member

    Another success!

    14 year old with MULTIPLE lesions plantar Rt. foot with a large (4cm) mother of a wart (or is that Mother wart).
    Needled 8 weeks ago. She came in today with almost 100% resolution. What remains won't last long.

    I did take pictures but I just spent my entire lunch hour uploading pics from my 6 metatarsal 6 toes patient (see under Surgery)

    I did have one failure recently. I redid the needling and we will wait and see.

    Steve
     
  26. stevewells

    stevewells Active Member

    Nice One Steve - or as you say "way to go" !! - i think my first two have both been failures - seeing the first one again tomorrow 12/52 post op - but subsequent ones I am more hopeful for - think my technique was a bit off on the first two - now more confident and am being more aggressive with them.
    will keep everyone posted
     
  27. cornmerchant

    cornmerchant Well-Known Member

    Hi Twirly


    "Pre- injection ethyl chloride spray (many thanks Kevin. Great tip)."

    Could you tell me where you obtained your ethyl chloride spray please?

    Regards

    Cornmerchant
     
  28. stevewells

    stevewells Active Member

    mobilis do it - but if you google uk it you will find it fairly easily

    cheers

    Steve
     
  29. twirly

    twirly Well-Known Member

  30. Griff

    Griff Moderator

    Is anyone currently offering this needling in London?

    Thanks

    Ian
     
  31. stevewells

    stevewells Active Member

    No I tend to just do it in the Foot!!!!! :D
     
  32. Only on the werewolves..... :cool::eek:


     
    Last edited by a moderator: Sep 22, 2016
  33. Ryan McCallum

    Ryan McCallum Active Member

    Ian,

    I am doing my 1st one tomorrow morning in London (West). Having said that, I'm not sure it will be something I will do routinely as tomorrow is more of a 'favour' for an A&E registrar at a neighbouring hospital and my consultant would go nuts if verrucaes start coming through the doors! Maybe if it's a success, he will start doing them privately!!

    Will try and provide an update on how it goes.

    Ryan
     
  34. blinda

    blinda MVP

    I have it on good authority that Steve Wells does a cool `Sweet Home Alabama`, perhaps he should post the link?



    Cheers,
    Bel


    -
     
  35. G Flanagan

    G Flanagan Active Member

    Ryan i am in the same position, i'm going to try and use stealth to see a couple of these at the end of a theatre list. If my consultant notices i'll be the one getting the needling!
     
  36. Kent

    Kent Active Member

    I've tried the multiple puncture technique on a couple of patients lately. This patient below had a 7 month histroy of bilateral VPs that were very painful to walk on. He was unable to go skiing due to the pain and it was affecting his daily life. His medical histroy was otherwise unremarkable. He had 3 VPs - R PMA 1, L PMA 5 and L plantar base of D5/sulcus.

    The first 2 photos are before shots of the left and right forefoot. The last 2 photos are 2 weeks after the procedure following light debridement. The patient didn't have any pain after the procedure. I would estimate I punctured both of the main lesions approximately 100 times each. I did not treat the small VP at the base of the left 5th toe. At 2 weeks he was extremely happy. No more pain walking. He was also going to book his skiing holiday.
     

    Attached Files:

  37. Kent:

    Awesome photos! Thanks for the detailed images.
     
  38. cornmerchant

    cornmerchant Well-Known Member

    Kent


    Thanks for the pictures- may I just ask if the maceration in the first photos was due to use of an acid treatment the patient was using prior to needling? Also, could you tell me what anaesthesia you gave ie ankle block or local infiltration?

    many thanks

    Cornmerchant
     
  39. Kent

    Kent Active Member

    Cornmerchant,

    For approximately 6 months prior to seeing me, the patient was using Duofilm daily and would also sit in the bath for 30 minutes every morning with a pumice stone in an attempt to debride the lesions.

    I performed local infiltrations on both lesions using 1% lignocaine (about 4-5ml for each VP).
     
  40. twirly

    twirly Well-Known Member

    now including post t/x 2 weeks.

    Picture 1: pre- debridement. Eschar formation. No localised erythema.

    Picture 2: post- debridement.

    Further review in 2 weeks.

    Pt. noted painful to weight bear for over a week post op.

    Photographic quality still needs improving :eek:. Although, pic. 2 was taken by pts. beloved in an attempt to improve quality/focus (thank you Simon) I am glad that it isn't just me. :eek:
     

    Attached Files:

Loading...

Share This Page