Tuesday, 16 July 2013

Interview with Dr Silvers, a podiatrist in Texas

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 Center in 1998. He now practices in McKinney and Prosper, Texas exclusively.
(Above information and photo reproduced from here with permission)

To see the location on a map click here.

1) How long having you been treating plantar fibroma's? 

Since 1997

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 fibroma

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 central band.

Non-invasive Treatment Options

1. Stretching

I don't find this effective

2. Padding 

Often effective and I do pad the fibromas with felt padding or accommodative custom orthotics.

3. Orthotics

See above

4. Physical Therapy

 I do not use PT for the treatment of fibroma.

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? 

I cannot 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? 

Surgical 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.