Interview with Dr Spilken, Cryosurgery specialist for plantar fibromas

Today I have another interview with a specialist, Dr Terry Spilken.

Dr Terry L. Spilken earned his doctorate in podiatric medicine in 1979 at the New York College of Podiatric Medicine. He did his residency training at Kingsbrook Jewish Medical Center and Community Hospital. Within a decade, he was back at the College as a member of the adjunct faculty, climbing the podiatric stairway to the position of Dean of Graduate Medical Education and then Dean of Student Services. He has obtained the rank of Associate Professor in the Division of Medical Science.

He has also worked with the International Dupuytren’s society in the production of the book “Dupuytren’s Disease and related hyperproliferative disorders” where he was author on a chapter on “Cryotherapy and other therapeutic options for plantar fibromatosis” where here covered not only several of the options for the treatment of plantar fibroma’s including cryosurgery and surgery but also the associated risk factors, symptoms and inheritance.

You can find more information here

All information above is provided with permission and is available from the above link.

Here I have questioned him on the above subject of plantar fibromatosis / Ledderhose disease:

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

Plantar fibromatosis is a very rare condition.  We see it quite often because of our specialization in treating this condition.

2) What are the risk factors for this disease and do you see these in patients, in particular what percentage of patients tend to have a family history of the disease?

The cause of plantar fibromatosis is still unknown.  There is thought that it is an inherited disease.  The necessary genes may remain dormant in the family over many generations.  Besides family history, there is a higher incidence in males.  Patients with these conditions have a higher risk factor: Dupuytren's disease, Peyronie's disease, epilepsy, other seizure disorders, diabetes mellitus, chronic liver disease and hypothyroidism.

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

Patients respond to cryosurgery very successfully the earlier in the course of the condition we get to do the procedure.  Cryosurgery has proven to be a very good option for patients and they seem very happy with the results.

b) Other options I have heard of being used early on include physio and verapamil. Do you know of any cases where these have been successful or the success rate? I ask as I have visited 2 physiotherapist who both said this could not be used to help with this condition and have heard poor results about verapamil.

I have not had success with verapamil.  Research is still being done on this treatment but so far the patient comments have been negative.  I don't think physical therapy is an option at all.  I have not come across any success rate doing PT.

4) I see on your website that you perform cryosurgery, 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?

Cryosurgery is an ambulatory procedure done in the doctor's office.  It involves freezing of nerve cells performed through a small incision, no sutures are required.  An autoimmune response is created with a change in the protein antigenic properties.  We have about an 80% success rate when the fibromas are in the early stages.  For advanced cases, we repeat the procedure several times until we receive the desired effect.

5) What is the procedure and recovery times for cryosurgery?

A small incision is made on the side of the foot under local anesthesia.  A trochar is used to cut into the fibroma.  The probe is then inserted into the fibroma and ice balls are created to destroy the fibroma.  Patients need 24 hours to elevate and foot and keep the bandage dry.  They need to avoid rigorous activity for about 1 week.  It takes 2 months for the full effectiveness of the procedure but the patient is ambulating fully within a few days.

6) I have also seen on the site that you performed ESWT, I have seen reports linking this to treatment of plantar fibroma’s, is this something that you do or know anything about?

(I covered it here http://ledderhose.blogspot.co.uk/2012/04/eswt-treatment-option.html)

I have not used ESWT for fibromatosis.  We use it for plantar fasciitis.

7) In the book chapter you cover surgical treatment of the disease, what are the options when it comes to surgery?

Removing the lesion alone does not work.  In fact, it has a 90% failure rate.  The only traditional surgery that has a good success rate is a complete fasciotomy.  We remove the entire fascia band so there is no fibrous tissue available for a fibroma to form.  There is a very long recovery time for this painful procedure.  The patient is left without a plantar fascia that can affect their ambulation in the future.  That is the reason why cryosurgery has been so popular as an alternative to this drastic procedure.

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

Patients are very educated and do research on their conditions.  That is a wonderful development of the computer age.  The more knowledge the patient gathers the more options they give themselves.  Most doctors are not familiar with plantar fibromatosis and therefore don't know the best treatment choices to offer.  My advice is to keep as current as possible with the options available to them and follow the latest research.

I would again like to thank Dr Spilken for his answers.