Saturday, 13 September 2014

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