Wednesday, 3 October 2012

High-energy focussed extracorporeal shockwave therapy reduces pain in plantar fibromatosis (Ledderhose's disease)



Today I came across a paper and have since seen on facebook that the British Dupuytren's Society have also seen it. Indeed the paper does look promising but it is from such a limited numbers that I am not going to get too excited. The paper as you may guess from the title is about ESWT which is something that I have covered before: 

Firstly I was discussing HERE it in relation to an article that goes directly again what this paper is saying, in fact the previous paper had concluding comments of  " we can not advise the shock wave therapy in the therapy of the Dupuytren's or Ledderhose’s Contracture" and they looked in 55 patients in total. I also have a bit in that post about what ESWT is so will only cover it briefly below. 

The second time that I have previously mentioned this was in my interview with Dr Spilken where although we were mainly discussing cryotherapy ESWT came up in relation to treating plantar fasciitis but is not used in his facilities to treat plantar fibomatosis. 

So back to the paper of the day

Basically what they are trying to do in this paper is use shock waves to kick the fight out the lumps in the feet, their rationale behind doing this was that it has worked for the related condition peyronie's disease and so why not give it a try with this condition. 

They only have a small number of patients, 6, 5 of whom are male and the average age is nearly 60. This patient and their introduction is pretty much all standard for these conditions and anyone who reads this blog will already know that information. 

The treatment regime that they use is 2 sessions with a one week interval and they list the settings which I doubt will mean anything to any of us. They seem to measure pain on some kind of arbitrary scale which I think must be 1 - 10 with 10 being bad. Pain seems to start at an average of 6 months and then decreases to 2 after 14 days and then 1 at a 3 month follow up with all patients noticing a softening of the nodules. 

In terms of side effects there were none which is always promising. The results from this are promising though it does concern me that the patient group is so small (something they want to change by doing large scale trials) and that a previous paper says that the same thing does not work. There are limitations in the old data though as I do not know what settings they used and how this compares to the new paper, overall though I always like to hear of treatments that might be able to help people in pain. I may also consider contacting the author to see if they are willing to discuss this in e-mails with me. 

One thing I do not want to happen is for me to pass this onto any kids that I may have and interestingly I saw a paper which may be relevant to the genetic factors that pass on Dupuytren's and from what I can gather from what I have access to it is likely that I am not genetically predisposing any future children to these conditions. That paper is here. Hopefully I will be able to discuss that in the near future, at the very least I will   talk about what we can see in that link. 

All the best to everyone.