My experience with Ledderhose disease aka plantar fibromatosis. This information is not intended to replace your doctor. Information on this blog is provided for informational purposes only. You should not use the information on this web site for diagnosing or treating.
Today I have another interview with a specialist, this time it is with Dr Eric Silvers. The answers he has provided are short and to the point and he has clearly not put much effort into his responses as he has even ignored some parts of some questions. Still he has taken the time to respond and the one thing that he does say is that he has not much success with verapamil. I think his comment about radiotherapy, whilst not fully answering the question does actually reveal some of the reason why there is so little awareness of radiotherapy.
Dr. Eric M. Silvers founded Advanced Foot
and Ankle Center in McKinney and Prosper, Texas in 1998. During his
podiatric education, he was the recipient of the EFN and FPME scholarships as
well as the Earl G. Kaplan award for academic and clinical excellence. Dr.
Silvers completed a two-year foot and ankle surgical residency at Monrovia
Community Hospital in Monrovia, California. Upon completing his residency, Dr.
Silvers worked in Durant, Oklahoma where he practised one year prior to opening
the Advanced Foot and Ankle Centerin 1998. He now practices in McKinney and Prosper, Texas exclusively. (Above information and photo reproduced from here with permission)
1) How long having you been treating plantar
2) Roughly how many patients have you treated, and
where do you treat?
I have treated, over the
years, around 200 patients, possibly more.
3) On your website you list the
following treatments, with each can you please say whether you do them,
if yes then what is the procedure and success rate and if no why not?
Invasive Treatment Options
1. Corticosteroid injection into the
I often inject the fibroma with
corticosteroids but never exceed 3 in a 12 month period
2. Surgery – complete removal of the
fibroma or the entire plantar fascia.
Surgically, I take the fibroma along
with a very healthy portion of the plantar fascia, typically the medial and
Non-invasive Treatment Options
I don't find this effective
Often effective and I do pad the
fibromas with felt padding or accommodative custom orthotics.
4. Physical Therapy
I do not use PT for the treatment of
5. Transderml Verapamil 15% Gel
I have recently started using
Verapamil again--past experience with this has not been very effective.
4) I noticed that you do not mention
radiotherapy, this is widely regarded as a good treatment option as discussed
at the 2010 Dupuytren's Symposium, what do you think of this treatment option
and why do you think remains fairly unknown in the USA?
comment on Radiotherapy in the treatment of plantar fibroma's as I have not
used it yet.
5) Do you have any other advice you
would like to give to patients with this condition?
Excision should be the last resort and only performed by those who have
experience and training with their excision. Along the distal plantar
aspect of the central band lies several common digital nerves that can be
damaged during dissection.