seekerofwisdom
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Post by seekerofwisdom on Jul 8, 2009 18:22:01 GMT
What is the difference between:-
A fiberous corn A neurological Corn A neurovascular corn
In terms of aetiology and treatment.
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Post by dewdrop on Jul 8, 2009 19:05:31 GMT
Hello seekerofwisdom, Are you involved in the foothealth industry or are you a member of the public. I ask so I can pitch my response accordingly?
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seekerofwisdom
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Post by seekerofwisdom on Jul 8, 2009 20:30:42 GMT
I'm a Podiatrist. Long time poster enjoying the anonymity
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Post by dewdrop on Jul 9, 2009 20:07:55 GMT
Then if you are a pod you should know the answer, shouldn't you ? ;D
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seekerofwisdom
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Posts: 180
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Post by seekerofwisdom on Jul 10, 2009 5:41:11 GMT
Well dewdrop that was not very nice was it.
Certainly a discussion stopper.
Perhaps you would like to answer this one?
A first time shy poster.
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Post by samrandall on Jul 10, 2009 6:47:34 GMT
I Agree,
Even if the person asking the question knows the answer, it might help others who are browsing the forum, students and the like, to understand. To stimulate questions, no matter how simple. We don't really want to turn this into Podiatry Arena, where I know there are plenty of people too scared to post for fear of being shot down or embarrased. Let that be the sixthform to our high school.
Anways, I'm sure I will be corrected on some points, but that is half the fun so here are some answers:
A neurovascular corn has a nerve and capillary growing into it. They are a night mare to treat as they can be super painful, as to enucleate them means to cut straight through the nerve. They also bleed which makes it a little difficult to see what you are doing..
There are a couple of ways that you can treat them. Normal enucleation if done very very carefully and slowly may be possible, but often you will only get part of it away before the patient has to return. A few months back I treated a lady by administering a tibial block into the affected foot and enucleating the HD fully and fairly aggressively. It wasn't particularly painful and the LA is easy enough to do if a) have your OSCE and b) you can find a surgeon willing to supervise you for a couple. Apart from that it can be difficult.. anyone else in with any suggestions?
A Fibrous corn, IMO is a HD that has been in place in the foot for a long time and the tissue surrounding the HD turns a whitish colour, similar to maceration, but feels a bit chalky on the blade. I debride these as far as possible, take away as much of the white tissue as I can. Although I haven't seen any since I got to singapore, so could it be an environment or genetic thing?? Not sure.
Hope this helps,
Sam
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Post by dewdrop on Jul 10, 2009 6:47:55 GMT
If the previous poster, who says they are a pod, does not know the differential diagnosis between the types of corns specified then they should not be practicising. See HPC standards of competance.
Before I answer your question about VP can you tell me if you are a member of the public or footcare person, then I can pitch my response accordingly?
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Post by dewdrop on Jul 10, 2009 6:51:41 GMT
Sam, I don't understand your response. If the poster knows the answer, than why would they ask the question? Also, it gives our profession no credibility if qualified pods are asking questions that a first year podiatry student should be able to answer. It makes me think that these posts are a wind-up.
However, re VPs they can be confused with (and consiquently mistreated) subungual exostoses, subungual lymphoma, subungual malignant melanoma, subungual squamous-cell carcinoma, tuberous sclerosis ( Koenen tumours).
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Post by samrandall on Jul 10, 2009 7:35:13 GMT
It is my belief that Robert is trying to build a come one, come all ethos. I thought, however correct you are, that your post was a little blunt, and might put people off asking future questions. Plus, if the question was a wind up.. how subtle do they wanna be? Seemed like a fairly innocent question to me.
I agree VP's can be confused with many other things, at my hospital we often get referrals from the Dermatology department asking for "paring of corns" on what turns out to be a VP.. But you have listed some pretty rare DDx's in that post four of which are subungal..
If people are so sad they wanna wind us up and abuse the "Seeker of wisdom" login like that then let them.. they will soon show themselves up for being who they truely are.
Your (perhaps naively),
Sam
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Post by Admin on Jul 10, 2009 11:29:10 GMT
Dewdrop
"If you're a pod you should know the answer" is not really very helpful. Not to the poster and certainly not to anyone else who may happen by.
This section is for answers, not discussions of whether the askee should know the answer.
I will let the above series of posts stand but please note.
So far as whether the poster is a member of the public, this is the professional part of the forum so assume the askee is a Podiatrist.
Admin
PS, I'm not exactly clear on the difference between a fiberous HD (which can be NV) and a pure NV HD myself so I don't think its a silly question! Anyone beside sam care to crack at the answer? Dewdrop? Martin?
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Post by dewdrop on Jul 10, 2009 12:43:42 GMT
No Robert, My post wasn't very helpful, it wasn't meant to be, and yes, it was blunt. I'm all for helping students but if there are practitioners out there who call themselves pods and don't know the difference between the different types of corns and how to treat them, then they need help alright - out of this profession into another. If the public have access to this forum and read it I am sure they would be appalled to find a supposed professional has such poor knowledge of one of the most common conditions they are likely to come across.
That's why I wondered if it was a wind up.
Sam, yes, those DDxs that I mentioned are rare but I have seen some of them mistreated as VPs with near disasterous consequences. Some were subungual but others were visible as a lesion under the free edge of the nail.
Admin, As regards the difference between a fibrous HD which can be NV and a purely NV HD I don't think it matters as you may only get a differential diagnosis using microscopy. Either way they are b****** to treat !
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Post by billliggins on Jul 10, 2009 18:04:48 GMT
I think that the question is reasonable in that it specifically asks "in relation to aetiology and treatment" rather than simply a definition or differential diagnosis. There must be many legit. pods who are not totally up to speed on the latest treatments and may be interested in what others are doing.
IMHO there is little difference in the aetiology. They are all chronic but n.v. and 'neurological' are most usually seen in the elderly patient with dystrophic skin, whilst fibrous are generally noted in patients with 'better' tissue. The predisposing factor is shearing stress, frequently associated with abduction and eversion during gait, (sorry to be old fashioned you functional characters) and flexion deformity of the affected digit.
I suppose that there are as many treatments as pods. but the aim is to deal with the underlying factors. Fixed flexion deformities can be dealt with by surgery, the mechanical dysfunction can be dealt with by appropriate diagnosis and orthoses. For non fixed deformity the atavistic amongst us used to use wheatgerm and pyrogalic oitment - now banned. Good reports have latterly been made of fulguration and laser cautery in the case of vascular and n.v. corns.
I hope this helps, and perhaps Dewdrop and others will care to weigh in with their favoured treatments.
All the best
Bill Liggins
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Post by twirly on Jul 10, 2009 18:16:42 GMT
Hi Bill, used to use wheatgerm and pyrogalic oitment - now banned. Bill Liggins Not wishing to derail the thread. I am interested to know when this occurred? The item detailed is still available. I would not wish to be using this if it is no longer within our remit of approved items. Many thanks, Mandy
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Post by billliggins on Jul 10, 2009 18:20:26 GMT
Stand corrected then, I can't find the reference! If it's still available, don't ask the question.
All the best
Bill
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Post by Admin on Jul 10, 2009 19:21:58 GMT
Sigh.
This is not an auspicious beginning.
This is an interesting contention and worthy of discussion. So lets do so in the discussion section of the forum. Please refer to the board guidelines.
In the interests of freedom of information I'll leave this all here for a day or two then I'll be cropping this thread back to the question and the answers.
I'll even shift this to the discussion section myself.
Kind regards Admin
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