Welcome

Welcome to the Ledderhose disease (plantar fibroma) blog.

My name is Gary and I am the author of this blog. I am a ledderhose patient from the UK. I am an ex-scientist and hold a degree in Molecular Genetics and I try and put this experience to good use exploring this condition.

I have pages here about the treatment options, patient experiences including my own, insights from medical professionals, explanations of the science and whatever else I think may be useful for fellow patients. Through the blog I have made contacts with many patients, professionals and charities and now work as a trustee for the British Dupuytren's Society.

Hopefully you can find the pages you want using the navigation menu above or use the search box to look for specific information.

Hope you enjoy reading the blog and please contact me at ledderhosedisease@gmail.com or leave a message on here to get in touch. All information will be kept private unless you tell me otherwise.

Thank you for visiting.

Saturday, 13 September 2014

Laser treatment Plantar fibroma patient from USA

Today I have an interview with a plantar fibroma patient from the USA, she has undergone laser therapy and shares her results so far....

1) Do you have Dupuytren’s and /or Plantar fibromatosis?

Just Plantar Fibromatosis

2) How old were you when you first noticed the fibroma?

67

3) Where are you from and do you consider yourself to have any of the common risk factors?

I was born in Butler, PA., USA of Scotch, Irish, German decent.

I have none of the known risk factors.

4) What treatment options were you initially offered?

I was referred to a foot surgeon who told me that there was very little successful treatment for this condition. He told me that neither he nor his patients were satisfied with the outcome of surgery or cortisone injections. 

He was working in conjunction with the University of Arizona researching the use of laser in the treatment of neuroma and was having some success. He thought that fibromas might also respond to laser treatment and asked if I would be interested in giving it a try. Faced with the other treatment options that seemed to not work, I chose to undergo the laser treatment he suggested.

5) How was the laser treatment?

The treatment was for a fibroma on my right arch which looked remarkably like the photo you posted of yours.  I received 14 laser treatments between July 27, 2013 and February 14, 2014.  Each treatment lasted approximately 14 minutes and only about 2 minutes involved moderate pain.  The first 10 treatments were one week apart.  The final 4 were approx.. 1 month apart.  In mid-October (part way through the laser treatment) we decided to include Verapamil Gel Therapy as part of my treatment plan.

At this point I was part way through the laser treatments and it seemed like it was working.  When Dr. Bocian suggested and explained the addition of verapamil gel, I trusted his opinion that this was a reasonable course of action for me.  

I had developed 3 very small nodules on my left foot, but they were not bothering me in any way so they have not been treated with the laser.

I used the gel 2 times per day on both feet and Dr. Bocian would apply it to my right arch fibroma immediately preceding the laser.  So the Verapamil was used 7 times with the laser on my right foot.  I continued to use the Verapamil gel on both feet 2 times per day for 9 months from October through June.  This concluded my treatment.

Today the nodules on my left foot remain small and asymptomatic, and the laser treated fibroma on my right foot cannot be seen and can barely be felt.  The pain is gone.  Occasionally I experience a very mild discomfort (where the restructured tissue of the fibroma is) with weather changes (we have no idea why this would be) or if I wear shoes with a high or padded arch.  The discomfort disappears when I change shoes or the storm front passes. I currently walking 7,000 – 8,000 steps a day and I attend 3 aerobic fitness classes a week.  All in all, I am very happy with the outcome of my treatment from Dr. Bocian.

As a side note – The laser treatments have not been approved to treat fibroma, so my health insurance covered none of the expenses.  The cost of the Verapamil Gel was $790.00.   I filed a request with my health insurance carrier to cover the Verapamil Gel and was denied.  I filed an appeal, since they did cover the use of Verapamil for other ailments.  There was much sarcastic laughter around our house the day I got the letter from them stating that they were going to reimburse me 22 cents for the sterile water used in the compounding of the gel !

Interview with Dr Bocian, Laser treatment for Ledderhose

Today I have an interview with a Dr who does Laser treatment. I actually only asked for this interview after a patient e-mailed me asking if I had heard of it. I have heard of it but I have not seen any evidence for it or any information in the public domain and thought it was worth trying to do something about that. 

The person I contacted was Darin whose website can be found here. Darin has been very helpful and has been very happy to answer my questions and has kindly asked a patient if they would contact me. They did contact me and I have an interview with them as well. So please keep reading to find out a but about Laser therapy for Plantar Fibromatosis. 

1) Do you often come across plantar fibroma’s? How common would you say they are in the USA?

It is relatively uncommon; I see about 5-10 cases per year. Some of them are small and may be asymptomatic.
  
2)  Do you seen any common risk factors in patients?

Although in the literature there are risk factors associated with plantar fibromas, due to the limited amount I see,  I have not been able to drawn any conclusions.

3) I understand that every case is different but what course of treatment do you recommend for early stage Ledderhose?

If lesion(s) are asymptomatic, no treatment, simply monitor for changes.

If painful, I have found cortisone injections are not very helpful; if any improvement achieved, it is temporary. An accommodative shoe insert may help.

I recommend transdermal verapamil gel 15% with Nd:YAG laser treatment. I have found verapamil alone provides extremely slow and limited improvement. However, the gel combined with the laser seems to work synergistically. Using the laser and topical gel together, seems to enhance the reduction of symptoms and reduces the time it takes to reach this goal. I have also seen a reduction of the size of the nodules following the treatment. This is most notable in the smaller lesions.

4) I see on your website that you perform laser treatment, what is this and how does it help with plantar fibroma’s? What sort of success rate does it have and can it be repeated?

The exact mechanism of how the Nd:YAG pulsed laser works for plantar fibromas is still uncertain. In fact, the mechanisms of interaction between laser and tissues in general is not well understood. It is FDA cleared here in the USA for scar tissue.

According to the limited research available, it seems to have an effect in the inflammatory process and in the formation of functional tissue. It is suggested in the literature that the ” Nd:YAG pulsed laser can efficaciously promote tissue repair process”. Much research is needed in the biomedical effects of laser.

5) What is the procedure and recovery times for laser treatment?

The procedure involves weekly in office laser treatments. Topical transdermal 15% verapamil gel is applied to the lesion and allowed to be absorbed for several minutes.

The laser treatment is performed without anesthesia. There is mild discomfort as the absorption of the light to the area will generate heat. Stopping the treatment for a few seconds alleviates the discomfort and then laser treatment is immediately restarted. Between these short interruptions of treatment, the lesions is gently massaged. It is necessary to undergo several treatments depending on the size of the lesion. Number of treatments can range from 10 to 20. There is no down time following treatment. Patients continue activity as tolerated. The entire treatment time ranges between 5-10 minutes.

6) You also recommend Verapamil with Laser treatment, what are your thoughts on verapamil as a stand alone treatment? 

Verapamil gel alone in my experience provides only minimal improvement even after several months of treatment.

7) Why do you think that a combination of the 2 treatments work? 

I believe the key to my successful treatment of plantar fibromas is the combination of the laser and the gel.

8) Do you have any other advice that you would like to give to patients with this condition?

Surgical excision in my experience should be avoided if possible. I have surgically removed many plantar fibromas. The success rate is not very good. The complications following the procedure can include hypertrophied scar tissue, adhesions and of course reoccurrence. Unfortunately, the undesirable outcomes following the procedure can make both the doctor and patient wonder if the surgery was successful.


Darin Alan Bocian, DPM, FACFAS
1845 W. Orange Grove Road, Suite 125
Tucson, Arizona, USA  85704