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.
