11/09/2005 Stuart Leeds, DPM
Verapamil for Plantar Fibromas
RE: Verapamil for Plantar Fibromas
From: Stuart Leeds, DPM
I recall reading about the use of the calcium
channel blocking Verapamil ointment
iontophoresis vis-a-vis the use of ultrasound
several years ago. The author used it for his
patient with Peyronie's disease as well with
very good results. I personally do not have any
previous clinical experience with the product.
I would imagine that ultrasound iontophoresis
with hydrocortisone gel for deep penetration
followed with off-weight-bearing lesion load
molded orthotics would probably bring the same
favorable results.
Stuart Leeds, DPM, Coral Gables, FL,
DoctorJoc@aol.com
11/09/2005 Stuart Leeds, DPM
Verapamil for Plantar Fibromas
RE: Verapamil for Plantar Fibromas
From: Stuart Leeds, DPM
I recall reading about the use of the calcium
channel blocking Verapamil ointment
iontophoresis vis-a-vis the use of ultrasound
several years ago. The author used it for his
patient with Peyronie's disease as well with
very good results. I personally do not have any
previous clinical experience with the product.
I would imagine that ultrasound iontophoresis
with hydrocortisone gel for deep penetration
followed with off-weight-bearing lesion load
molded orthotics would probably bring the same
favorable results.
Stuart Leeds, DPM, Coral Gables, FL,
DoctorJoc@aol.com
11/08/2005 Andrew Schneider, DPM
Verapamil for Plantar Fibromas
RE: Verapamil for Plantar Fibromas
I recently begun using transdermal verapamil for
plantar fibromas. My patients generally report
a significant reduction of pain within the first
month of usage and I have seen some reduction in
the size of the fibroma. At this point, it is
too soon to expect complete results, as I have
only been using the treatment since August and
it takes approximately six months for full
results to be realized. I use a compound from
PD Labs in San Antonio applied twice daily.
Their website is www.pdlabs.net. I fax the
company a prescription and they send the
medication to the patient directly. At this
point, local compounding pharmacies in my area
do not have a similar compound available,
however you may wish to check with yours.
Andrew Schneider, DPM, Houston, TX,
AJSDPM@aol.com
11/07/2005 Anthony R. Hoffman, DPM
Verapamil for Plantar Fibromas
Query: Verapamil for Plantar Fibromas
I read in one of our periodicals about treatment
with topical Verapamil
(nifedipine) for plantar fibromas. Has any one
tried this treatment? If so is it a daily or bid
application? If any one remembers the article,
please let me know.
Anthony R. Hoffman, DPM, Tracy, CA,
toedoc@inreach.com
10/14/2005 Marc A. Brenner, DPM,
Plantar Fibromatosis
RE: Plantar Fibromatosis
From: Marc A. Brenner, DPM
It is absolutely correct that once diagnosed
appropriate therapy options include surgical
intervention, custom made orthotics, and
intralesional steroid/lidocaine injections, as
per early teachings from the erudite Dr.
Steinberg.
There is a non-invasive treatment that has shown
positive results in as little 30 days. A company
in San Antonio, TX, PDLabs has developed a
topically applied calcium channel blocker to
treat the fibrotic connective tissue disorders
such as plantar fibromatosis, Peyronie’s disease
and Dupuytren’s. The application of transdermal
Verapamil 15% (1ml BID) to the lesion will help
remodel the fibroma by producing the protein
enzyme collagenase. Most patients will see the
level of pain decrease in 30 days. After 90
days, patients are usually able to palpate a
difference to the fibroma (smaller or softer).
Typically, complete resolution will falls
between 6 to 12 months, depending on condition
and patient compliance.
I have seen excellent results with my own
patients. The patients had reduction of pain in
one month and fibroma becoming smaller after 90
days. I continue to track the patients with
great expectations. The results so far have
given me hope of a non-invasive treatment for my
patients. transdermal Verapamil 15% needs to be
added our armamentarium for treatments for
plantar fibromatosis/ Ledderhose Disease.
Marc A. Brenner, DPM, Glendale, NY,
Icare4yourfeet@aol.com
10/04/2005 Mitchell R. Mosher, DPM
Plantar Fibromatosis
RE: Plantar Fibromatosis
From: Mitchell R. Mosher, DPM
Early on in my career, I found that solitary
excision and steroid injections were at best
50:50. Steindler strappings were a nightmare to
care for post-op, and at best had 60-70:40-30
results. Laser dissection has proven to me to be
the most effective 80:20. [providing the patient
will comply with 3 weeks non-weight-bearing].
Genetics. alleles, nationality? - I am part
Scandinavian and get these growths on my palms.
However, they come and go, and why, I do not
know, [right now they are absent]!! Due to
concomitant arch pains along with the growths in
some of my patients, the lesions get smaller,
and [sometimes disappear], when I tape their
feet with a "True Lawson Strapping". Also, they
disappear following myofascial release
procedures.
So, there is more than meets the eye. Remember
folks, they did not believe there were organisms
causing sepsis, septecemia, and death until
Leeuwenhoek invented the microscope.
Mitchell R. Mosher, DPM, Roseville, CA,
Bowenfootdoc@aol.com
10/03/2005 Stuart Leeds, DPM
Differential Diagnosis and Treatment For Plantar Fibromatosis
RE: Differential Diagnosis and Treatment For
Plantar Fibromatosis
From: Stuart Leeds, DPM
Regarding the differential diagnosis and
treatment for plantar fibromatosis (Lederhoses'
disease) I would like to propose the following:
Plantar fibromatosis is an autosomal-inherited
disease with variable penetration,. i.e.
diabetes, knuckle pads, and plantar
fibromatosis, which are all found on the same
allele of the gene. Another example is
simultaneous occurrence of Dupytren's
contracture of the palms of the hands and
Ledderhoses' disease of the soles of the feet. A
third example is Peyronies disease, Dupytren's
and Ledderhoses occurring in the patient.
When the disease presents as a single lesion, it
has manifested as an incomplete expression of
the disease therefore, incomplete penetration.
Clinically, it is found to be well-adherent to
the plantar fascia as all of us who have
dissected it out can attest. Fibrosarcoma is a
deep fluctuant mass and can in most cases be
differentiated clinically by this occurrence.
Intralesional injections of corticosteroids into
the plantar fibromata as initially described by
the eminent Dr. Marvin Steinberg and later in
his lecture and clinical series by Dr. Myron
Boxer relieves the pain in most cases.
The pain from the plantar fibroma is induced by
cell matrix response to "injury" of the
surrounding tissue setting off a cascade of a
non-infectious type of inflammatory response as
describe by Ledbetter. The steroid stabilizes
lysosomal membranes of this response. Of course,
if in doubt, cut it out.
Stuart Leeds, DPM, Coral Gables, FL,
DoctorJoc@aol.com
09/29/2005 Multiple Respondents
Intra-Lesional Steroid Injection of Plantar Fibromatosis (Joseph Agostinelli, DPM)
RE: Intra-Lesional Steroid Injection of Plantar
Fibromatosis (Joseph Agostinelli, DPM)
From: Multiple Respondents
I have never injected a plantar fibroma, and
excise them only when overly large, multiple,
and/or painful. My question to the readers is:
Is injecting a suspected plantar fibroma
considered “standard of care” or simply a matter
left to the particular discretion of the doctor
in light of individual clinical history and
findings (and possibly patient-directed
treatment options) ?
Neil H. Hecht, DPM , drhecht@sbcglobal.net
It is surprising to me that you have received so
many letters reference to plantar fibromas, but
no one has mentioned where the treatment came
from. Dr. Crawford practiced with me for a
short time and we have been colleagues in Ocala,
Fl. for many years. There are also at least 100
students of my father, Marvin D. Steinberg who
were exposed to his treatment of these lesions.
He warned of the dangers of excising these
lesions surgically and found that they were
sensitive to many types of inection therapy -
best of all - was lidocaine and dexamethasone.
This dates back about 40 years or more.
Lloyd Steinberg, DPM, Ocala, FL,
cumbia24@aol.com
Dr. Agostinelli (on the subject of injecting
plantar fibromas) discusses a case of a
suspected plantar fibroma that actually was a
synovial sarcoma, thereby prompting his advice
to "be sure what you are injecting." Indeed, the
literature is filled with stories of what are
termed "unexpected malignancies." Unfortunately,
the element of surprise is much less of a
problem than is the inadequate work-up of a soft
tissue tumor. The diagnosis of plantar
fibromatosis is relatively straightforward, and
even if one is inclined to get an MRI exam, the
signal characteristics can only be interpreted
as "most likely those of a plantar fibroma."
In Dr. Agostinelli's case, there was an even
added measure of trouble in that initial
histologic diagnosis was incorrect. Given that a
proper biopsy and expert histologic diagnosis is
the only way to truly divulge the nature of a
lesion, the clinical diagnosis of plantar
fibroma is nonetheless very straightforward.
Injecting it once or twice, even if it
ultimately turns out to be something else, is no
cause for alarm. Injecting it 16 times is of
course another matter. Likewise, for those of us
who are interested in and enjoy tumor surgery,
the ability to deftly excise a lesion should not
be confused with expertise in handling a soft
tissue mass. Anyone going into the OR to remove
a mass must always consider the possibility of a
malignancy, and incisional biopsy with frozen
section confirmation that the lesion is benign
must be obtained before complete excision. This
is the applicable standard, and it is true 99%
of the time.
Bryan C. Markinson, DPM, New York City, NY,
profpod@aol.com
09/28/2005 Joe Agostinelli, DPM
Intra-Lesional Steroid Injection of Plantar Fibromatosis
RE: Intra-Lesional Steroid Injection of Plantar
Fibromatosis
(William Crawford , DPM)
From: Joe Agostinelli, DPM
As to injection of plantar fibromatosis nodules-
be sure what you are
injecting ! Had a plantar fibromatosis excised
for biopsy that initially had path report
of "benign" and was in fact "synovial sarcoma!"
I’m glad I did not inject it pre-operatively.
Joe Agostinelli, DPM, Niceville, FL,
jmpa21@cox.net
09/27/2005 Richard Wilson, DPM
Intra-Lesional Steroid Injection of Plantar Fibromatosis
RE: Intra-Lesional Steroid Injection of Plantar
Fibromatosis
(William Crawford , DPM)
From: Richard Wilson, DPM
I have injected symptomatic plantar fibroma
lesions on many patients
for the last 23 years. I use the following
mixture: 1 cc. 1% plain
Xylocaine, 1 cc. 0,25% plain Marcaine ,and 1 cc.
Celestone. I'll
inject up to two or three times, but the typical
patient only
requires one injection. The injection is highly
effective, and I
have not had to surgically excise more than a
dozen of them in my
whole career.
Richard Wilson, DPM, Melbourne, FL,
coolpod712@hotmail.com
09/26/2005 Multiple Respondents
Intra-Lesional Steroid Injection of Plantar Fibromatosis (W Crawford , DPM)
RE: Intra-Lesional Steroid Injection of Plantar
Fibromatosis (W Crawford , DPM)
From: Multiple Respondents
Like Dr. Crawford, I had assumed that solid
fibrous lesions would not respond to steroid
injections. Nevertheless, I started injecting
them after a patient claimed successful
treatment from another physician. I now inject
symptomatic plantar fibromas peri-lesionally.
This almost always reduces their size to a point
where they are no longer symptomatic. Perhaps
there is another component to the syndrome other
than the solid lesion. I have also begun using
transdermal Verapamil with encouraging results.
Gary Friend, DPM, Glenview, IL,
drfriend@nspodiatry.com
Many times, years of practice and philosphy seem
to work better than what science and text would
allow us to believe.
I have been injecting plantar fibromas, single
isolated lesions and not multiple plantar
fibromatosis, for years. I inject directly into
the lesion in two week intervals. I have never
had to inject more than 3 times before obtaining
improvement significant enough to prevent
surgery or additional treatment. I follow these
patients with orthotics with
padding/accommodation for the lesion, if needed.
My rationale for doing this is similar to
injecting scars. The steroid seems to "soften"
the fibroma and shrink it in size. A smaller
softer lesion is not painful, and the orthotic
addresses the fascia contraction that we see so
frequently in these patients.
In conditions where surgery is not always
successful and is fairly extensive, injections
and orthotics have worked well for me. I think
that I may wind up excising 1 or 2 a year, if
that.
Brian Kashan, DPM, Baltimore, MD,
drbkas@worldnet.att.net
I brought up the question regarding non-surgical
treatment of plantar fibromas in this forum
several years ago. A DPM, whose name I cannot
remember, wrote me privately. He recommended
1/4 cc of Kenalog, intralesionally. I used this
on a patient of mine who presented with
bilateral plantar fibromas, two on one foot,
three on the other. The patient, who had
previous surgery, was in severe pain. I
certainly did not want to do further surgery on
this guy. I injected the patient, who returned
one week later, proclaiming me to be a genius.
Without exaggeration, his lesions shrunk by
80%. The patient e-mailed me a year later,
telling me that the fibromas had not returned to
their former sizes and that he was still
immensely satisfied. I have used these Kenalog
injections at least ten times. The last
injection I administered was one month before
hurricane Katrina hit. The patient presented two
weeks later and was doing great. I highly
recommend this procedure.
Alan Engle, DPM, New York (ex-New Orleans),
ajengle@aol.com
The reason that steroids are used is to help
dissolve the fibrous like tissue that these
lesions are made up of. The lesions due to
shrink with a mixture of Depomedrol 40 or
Kenalog 40 1/2cc mixed with ½ cc. of Wydase. I
have reduced the size and firmness of these
fibromas with this mixture.
Steven H. Goldstein, DPM, Livingston, NJ,
stevefootdr1@cs.com
09/25/2005 William B. Crawford, DPM
Intra-Lesional Steroid Injection of Plantar Fibromatosis
Query: Intra-Lesional Steroid Injection of
Plantar Fibromatosis
I would like to open a discussion of the
rationale of intra-lesional steriod injection of
plantar fibromatosis/fibroma. My understanding
is that these lesions are fibro-proliferative,
solid lesions, without significant
inflammation. Pain arises due to mass effect
with pressures of weight-bearing or injury. I do
not inject these lesions, and I would like to
know the opinion of others on this subject.
William B. Crawford, DPM, Ocala, FL,
wcrawf1052@earthlink.net
09/24/2005 Brian Dressler, DPM
Injecting a Plantar Fibroma
Query: Injecting a Plantar Fibroma
I recently injected a patient's painful plantar
fibroma with 1.0 cc of lidocaine plain and 0.5cc
of dexamethasone. What codes would I bill, with
what diagnosis code(s)?
Brian Dressler, DPM
Detroit, MI
Codingline Response: I would bill the injection
as CPT 20550 (injection tendon sheath, ligament,
aponeurosis (e.g. plantar fascia) along with the
HCPCS code for the drug injected (J1094
[dexamethasone acetate, 1 mg] or J1100
(dexamethasone sodium phosphate, 1 mg],
depending on which medication you actually
injected - your post did not say.
The diagnosis code is ICD-9 728.71 (plantar
fascia fibromatosis).
Denise Paige, CPC
Long Beach, CA
05/09/2005 Mitchell R. Mosher, DPM
Plantar Fibromas (Larry Aronberg, DPM)
RE: Plantar Fibromas (Larry Aronberg, DPM)
From: Mitchell R. Mosher, DPM
I have had a multitude of bizarre experiences
with fibromas over the years. Mostly with a
fascial release technique I use called Bowen
therapy. Also they will resolve with a
true"Lawson Strapping" sometimes. Why? I can
only speculate.
Mitchell R. Mosher, DPM
Roseville, CA
Bowenfootdoc@aol.com
01/25/2005 Joanne Davis, DPM
Plantar Fibromatosis in AIDS Patients
RE: Plantar Fibromatosis in AIDS Patients
(Richard Burnell, DPM)
I see a lot of HIV and AIDS patients, and I do
not see any increase
in the incidence of plantar fibromas.
Joanne Davis, DPM
Chicago IL
01/24/2005 Richard Burnell, DPM
Plantar Fibromatosis in AIDS Patients
Query: Plantar Fibromatosis in AIDS Patients
I have a new patient that came into my office
with large plantar
fibromas on both feet. He states that they are
not painful and does not want anything done with
them at this time. Since I see very few HIV/AIDS
patients, I am just curious if plantar
fibromatosis is a common finding in this
population.
Richard Burnell, DPM
Camden, SC
10/16/2004 Elle Farajian, DPM
Excision of Plantar Fibroma (Ivar Roth, DPM)
RE: Excision of Plantar Fibroma (Ivar Roth, DPM)
These benign lesions may overlap with nodular
fasciitis and appear as well circumscribed,
lobulated tumor attached to tendons/tendon
sheaths. This will require
removal of portion of the plantar fascia as you
have indicated. The proper code would be
28060/Fasciectomy-partial plantar fascia.
Elle Farajian, DPM
Atlanta, GA
10/15/2004 Ivar E. Roth, DPM
Excision of Plantar Fibroma
Query: Excision of Plantar Fibroma
Please clarify the correct code for excision of
a 0.75 cm plantar fibroma. The lesion was
integral to the fascia so a 2.0x1.0 cm. section
of the fascia was excised to include the plantar
fibroma.
CPT 28043 (excision, tumor, foot, subcutaneous)
and CPT 28045 (excision, tumor, foot, deep,
subfascial, intramuscular) seem like the likely
codes, but which would be correct?
Ivar E. Roth, DPM
Newport Beach, CA
Codingline Response: I would not use either of
the codes you suggested. When excising a portion
of the plantar fascia to remove a fibroma, the
proper code is CPT 28060 (fasciectomy, plantar
fascia; partial [separate procedure].
Mark Schilansky, DPM
Catskill NY
06/21/2004 Paul Kesselman, DPM
RE: Hyaluronidase for Plantar Fibromas (Jon Purdy, DPM)
RE: Hyaluronidase for Plantar Fibromas (Jon
Purdy, DPM)
I have used hyaluronidase for fibromas and scars
for many years. There are several pharmacies
that will formulate this and many other steroid-
type medications. Please feel free to contact me
for more info.
I have used hyaluronidase for fibromas and scars
for many years. There are several pharmacies
that will formulate this and many other steroid-
type medications. Please feel free to contact me
for more info.
Paul Kesselman, DPM
Woodside, NY
pkesselman@pol.net
06/17/2004 Jon Purdy, DPM
Hyaluronidase for Plantar Fibromas
Query: Hyaluronidase for Plantar Fibromas
I would like to find out what the efficacy of
treating plantar fibromas with steroid and
hyaluronidase (Wydase) has been among the docs
using this treatment. I would be interested to
know the treatment regimen being used.
Jon Purdy, DPM
New Iberia, LA
04/22/2004 David S. Wander, DPM
Plantar Fibroma Excision (Walter Pedowitz, MD)
RE: Plantar Fibroma Excision (Walter Pedowitz,
MD)
From: David S. Wander, DPM
As usual, Dr. Markinson stated his point well
and I completely agree with the question of
credibility of someone stating that he/she has
resected "hundreds" of fibromas. I'm not aware
of anyone dedicating a practice to fibromas, so
I find this claim difficult to believe. Dr.
Pedowitz was very diplomatic in his
recommendation of his opinion based on his
experience and the orthopedic literature. Any
intelligent practitioner will respect Dr.
Pedowitz's opinion and then proceed with what is
best in his/her own situation.
The response by Dr. Secord was basically an
attack on orthopedic surgeons and is certainly
not diplomatic or warranted. Because of Dr.
Pedowitz's opinion, Dr. Secord has decided to
make blanket statements regarding "all"
orthopedic surgeons. Dr. Secord goes on to state
that "the orthopods" recommend wt. bearing on
5th met fractures, and as a result, Dr. Secord
is the hero when he must reconstruct these
horribly handled cases. Dr. Secord also states
that "all" orthopedists state that type III PT
tendon tears should go on to arthrodesis. Dr.
Secord, do yourself a favor and step down off
your high horse and add some diplomacy to your
postings. You've cited several anecdotal cases
of your saving these patients with your
reconstructive talents, since the orthopedic
surgeons got everything wrong. Your attack takes
away any credibility and ruins your intended
points.
We've ALL had cases or patients that have
eventually sought care at another office, but we
don't all need to pat ourselves on the back for
being the podiatric savior. Don't attack all
orthopedic surgeons and profess to tell us
what "all" orthopedic surgeons think. When you
do, you discredit yourself. Your response should
have thanked Dr. Pedowitz for his respected
opinion, then stated that in your experience,
resection of fibromas has been successful.
Don't create enemies that don't exist and don't
attempt to build up your credibility by
attacking an entire respected profession.
David S. Wander, DPM
Philadelphia, PA
04/21/2004 Multiple Respondents
Excision of Plantar Fibromas (Walter Pedowitz, MD)
RE: Excision of Plantar Fibromas (Walter
Pedowitz, MD)
From: Multiple Respondents
I agree with Dr. Pedowitz about the regrowth of
plantar fibromas. However, no matter what the
size of the fibroma, if it is painful enough to
affect the patient's average daily living
activities, surgical excision must be
considered.
Whenever I excise a plantar mass, whether it be
a fibroma or not, I always keep the patient non-
weightbearing for at least two weeks.
Obviously, this has no effect on the possibility
of regrowth or not.
Barrett E Sachs, DPM
Plantation, FL
The casual use of language can often belie all
credibility, especially when you want to make a
point. For example, statements made in support
of plantar fibroma excision include
practitioners who have done "hundreds"
and "dozens" of these cases. These large sample
loads are not needed to make the point if you
feel that the surgical management is best. In my
first 15 years of practice, I saw this entity
about three to five times per year at most. In
the last 6 years, where I practice with a foot
and ankle orthopedist and a musculoskeletal
oncologist, I see the entity with a little more
frequency. Very little more. Based on my
experience with my "small" sample, I have
performed a total of one excision of a plantar
fibroma. The outcome was fine. Based on all
other presentations (I am sure not much more
than 100 in my entire professional life), and
the cases of my present colleagues, my total
experience leaves me agreeing wholeheartedly
with Dr. Pedowitz, not only in view of
recurrences, but the biomechanical sequelae that
may occur as well.
I have one question for the readers - How often
do you really see this entity (plantar
fibromatosis) annually?
Bryan C. Markinson, DPM
New York, NY
I've resected 55-60 of these over the years, the
largest of which was about the size of a plum
and have had zero rate of dehiscence of the
incision and 1 recurrence. I have no idea what
the ortho community is talking about here, as it
makes no sense to tell the patient to ‘live with
it’ and doesn't follow anyone’s normal, clinical
experience. Doing a fairly wide excision of
these things has allowed my low recurrence rate,
although I've only taken the entire fascia in 1
patient (bilateral case done on different
surgical dates). This lack of correlation
doesn't necessarily concern me, however. The
orthopods recommend weightbearing on 5th met
fractures, with the assurance that they will
heal and they all state that type III PT tendon
tears should go to osteotomy/arthrodesis. I see
an average of 15-18 5th met fractures a year
previously treated by orthopods with post-op
shoe/Camwalker and unrestricted weightbearing
which went on to non-union and my surgical
reconstruction. I've also done a number of PT
tears that were type I going to type II on MRI
and were clearly type III intra-op and instead
of doing a transfer or fusion, I did a primary
repair and all of these patients have had
complete return of strength and function. My
conclusion: the ortho community doesn't always
have it right.
David Secord, DPM
Corpus Christi, TX
David5603@POL.net
04/20/2004 Nicholas Varveris, DPM
Excision of Plantar Fibromas (Walter Pedowitz, MD)
RE: Excision of Plantar Fibromas (Walter
Pedowitz, MD)
I also read this posting with some confusion
about the recommendation by the Orthopedic
community to avoid excision of these tumor. I
have excised, not hundreds, but dozens over the
years and have not had complications with
recurrences, a few dehisences though over the
years.
What does the orthopedic community recommend
about toleration of a 1/2-golf-ball sized firm
nodule or mass on the now weightbearing surface
of the foot...?
Nicholas Varveris, DPM
Hilliard, OH
04/19/2004 Sloan Gordon, DPM
Excision of Plantar Fibromas (Walter Pedowitz, MD)
RE: Excision of Plantar Fibromas (Walter
Pedowitz, MD)
From: Sloan Gordon, DPM
Aside from 'coding' issues, I have done hundreds
of these cases and find that if the entire
fascial band is removed, careful resection of
the tumor is performed and a drain is used,
there are little complications with this
procedures. In 21 years of practice, I have
been fortunate to have seen only 2 recurrences.
In fact, I performed one of these yesterday with
was a revision from another physician and the
fibroma was wrapped around the medial plantar
nerve and was quite difficult to dissect. With
the aid of microscopy, the tumor was excised in-
toto without any apparent damage to the nerve.
In preparing this response, I did not perform a
literature search, however, would suspect the
podiatric and plastic surgery literature would
have some good results with respect to this
procedure. I'd be interested to hear some other
responses as well.
Sloan Gordon, DPM
Houston, TX
11/28/2003 David Zuckerman, DPM
Use of Orthotripsy to Treat Plantar Fibromas
RE: Use of Orthotripsy to Treat Plantar Fibromas
The successful use of ESWT for plantar fibromas
has proven to be very poor. There is a section
on this subject in the book published by the
International Society for MS Shockwave Therapy.
You may find additional information on the web
site www.ismst.com
David Zuckerman, DPM
Woodbury, NJ
