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Injecting One Wart With Immune-Testing Agent: Study

 

TORONTO (CP) - Skin injections to test a person's immune response, similar to what doctors use to check for allergies, can get rid of unsightly warts - and not just one, but up to hundreds at a time by treating just a single bump, a study shows.

Researchers at the University of Arkansas for Medical Sciences injected warts with substances used to test a person's immunity to mumps, candida and trichophyton (the fungus that causes athlete's foot). None of the preparations, called skin test antigens, contain live infectious agents, so they can't cause disease.

Sixty per cent of those injected with the antigens saw their treated warts disappear, while about half of those with multiple lesions on their bodies ended up entirely wart-free, said lead researcher Dr. Thomas Horn, head of dermatology at the university.

That's because the injection pricks the immune system into mounting a defence against the mumps, candida (a yeast) and the trichophyton fungus - and at the same time stirs up white blood cells (lymphocytes) to take care of the human papilloma virus, the agent that causes warts.

"So while the body is initially responding to, let's say, candida, the body's immunologic repertoire is broad enough that there are lymphocytes in that mix that say: 'Let's do something about the wart virus'.

"So one of the joys of this is that patients with a large wart or patients with multiple warts, we only need to treat one of several to get many to go away, and in some cases hundreds."

The study, published in this week's Archives of Dermatology, involved 201 patients. About half had their warts treated with antigens, while the other half received injections of saline or interferon, a protein produced by cells that helps regulate the body's immune system. Patients in the antigen group had a significantly higher immune-system response rate.

The method works on all kinds of warts, from the familiar raised type found on the face, hands and soles of the feet, to flat warts, the type spread by shaving on areas like a man's face or a woman's legs.

Side-effects, including redness and soreness at the injection site and fever, were relatively rare and mild, Horn said.

Most current treatments try to destroy the wart by cutting it out, freezing it with liquid nitrogen or zapping it with a laser - methods that can be somewhat painful, especially in tender areas like the foot bottom (plantar warts) or around the fingernails.

"The nice thing about this is we treat two per cent of the surface area of the wart and we get the whole thing to go away," said Horn, noting that he's seen warts as big as saucers.

"This should become a standard treatment for warts . . . a routine treatment in our box of tools for patients with warts, whether that's a patient with a single wart or patients with multiple warts," said Horn. "It is effective, safe and relatively painless."

But Dr. Neil Shear, head of dermatology at Toronto's Sunnybrook and Women's Health Sciences Centre, said that when it comes to single warts, there are much easier ways of removal than giving patients - especially children - an injection.

Among those treatments is, of all things, duct tape. Doctors cover the wart for six days with the silver tape, then "pumice down" the dead skin on the seventh, he said. "It's easy, it works and you can do it at home."

However, Shear called the potential of eradicating numerous warts at one time "exciting. None of the other treatments we use right now really do that.

"Warts are funny creatures, and even though they're probably the most common chronic viral infection that humans have, we still haven't got very good at getting rid of them. And they're a big problem.

"Some people get a wart here and there, but some people just don't seem to fight it, their immunity is not up to snuff and they end up with quite large warts."

Still, Horn's research may have implications beyond the merely cosmetic.

The human papilloma virus is also the culprit behind genital warts, a common cause of cervical cancer.

With other research by his team being considered for publication, Horn would say only that they "have data to show that this treatment works for genital warts."

"The study that we would like to do is a long-term study in which we treat genital warts and follow women's pap smears (tests for cervical cancer)," he said.

There are dozens of strains of human papilloma virus, and the one that causes genital warts probably differs from those that cause typical warts - although even a few of those may lead to skin cancer, said Shear.

But he lauds any research that advances knowledge of this common, easily transmitted family of viruses.

"The human papilloma virus is a potentially serious infection, so it's nice to see that people are doing novel work...stimulating the body's own defence system to try to clean them up."

The Candian Press, MSN News

Magnetic Insoles Not Clinically Effective for Foot Pain Relief

Among a group of healthcare workers with non-specific foot pain, those wearing magnetic insoles reported similar pain reduction to those wearing matching insoles containing sham-magnets, according to a study in the September 2005 Mayo Clinic Proceedings [Vol. 8, No. 9, Pgs 1138-1145].
 
Mark H. Winemiller, MD, of the Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, in Rochester, Minnesota, and colleagues reported changes from baseline visual analog scale pain scores among adult healthcare workers, 36 of whom wore cushioned Active Comfort magnetic insoles (Spenco Medical Corp., Waco, Texas) and 47 who used similar insoles from the same manufacturer that contained non-magnetized metal foil embedded in the foam insole material.
 
The subjects, who were 79 percent female and reported having non-specific, mostly stable foot pain which worsened with prolonged standing for at least 30 days prior to study inclusion, were to wear the insoles for at least four hours per day, four days per week.
 
In pain assessment questionnaires collected after four weeks and eight weeks of daily insole use, 32 percent in the magnet group and 33 percent in the sham-magnet group reported being all or mostly better at both assessments. The groups reported similar improvement in daytime, evening and morning pain, with those in the sham-magnet group consistently reporting a higher but non-significant reduction in pain scores from baseline compared with the magnet group.
 

 

Overall, 20 percent of the subjects reported problems, consisting mostly of tightness or a breakdown of the colored lining on the surface of the insoles, but the investigators reported no adverse effects from either insole type. The overall study compliance rate was 91 percent at four weeks and 81 percent at eight weeks.
 
“The static magnetic insoles studied were not clinically effective for treatment of chronic nonspecific foot pain,” the authors concluded, adding that “cushioning within the study insoles may have accounted for some of the pain improvements seen in both groups.”

Common Toe Deformities

The human foot is a marvel with its 26 bones in each foot. However, in some cases, the tiny bones in the toes can cause painful problems. Deformities of the toes can lead to painful conditions such as corns, calluses, ingrown toenails and infections.

Many disorders can affect the joints of the toes, causing pain and preventing the foot from functioning as it should. People of all ages can have toe problems, from infants born with deformities, to older adults with acquired deformities. The major culprit of toe deformities in adults is biomechanical imbalances. When the natural function of the foot is disrupted (through a variety of causes), the tendons may stretch or tighten to compensate. Thus, people with abnormally long toes, flat feet or high arches have a greater tendency to develop toe deformities.

Arthritis that slowly destroys the joint surface is another major cause of discomfort and deformity. Toe deformities also can be aggravated by restrictive or ill-fitting footwear worn for a prolonged amount of time. Or, problems with toe position may occur if a fractured toe heals in a poor position. All toe deformities and related conditions can be managed by a chiropodist. Only surgical procedures can permanently correct the problem.

1. BUNIONS Bunions are a condition which affects the joint at the base of the big toe. The bunion actually refers to the bump that grows on the side of the first metatarsophalangeal (MTP) joint. In reality, the condition is much more complex than a simple bump on the side of the toe.

Interestingly, this condition almost never occurs in cultures that do not wear shoes. Pointed shoes, such as high heels and cowboy boots, can contribute to the development of a bunion. Wide shoes, with plenty of room for the toes, lessen the chances of developing the deformity and help reduce the irritation on the bunion if you already have one. However, shoes alone are not "solely" to blame for the development of bunions. Abnormal foot function comes into play in the development of almost all bunions, and the most common abnormality is overpronation or excessive flattening of the foot. A foot orthotic can reduce the amount of overpronation and thus arrest or slow down the formation or a bunion. Only surgery can remove it.

2. HAMMERTOES A hammertoe is a fixed bend at the proximal toe joint. As the toe becomes deformed, it rubs against the shoe and the irritation can cause painful corns. Corns may also develop between toes. These are usually due to a rotation of the toe, rather than a contraction (buckling). This can cause the joints to rub together and may create small bone spurs that cause corns in a similar manner. In addition, the skin can break down and become infected. A severe hammertoe may create downward pressure on a metatarsal bone at the ball of the foot, and add to the cause of a callus.

A hammertoe may be present but not always painful unless irritated by shoes. One may have enlarged toe joints with some thickened skin and no redness or swelling. However, if shoes create pressure on the joint, the pain will usually range from pinching and squeezing to sharp and burning. Cramping in the toes, foot and leg may develop from the muscles and tendons functioning in abnormal positions because of the deformed joints. In long standing conditions, the dislocated joints can cause the pain of arthritis.

Although there is little doubt shoes are responsible for causing corns, the size, shape and other characteristics of our feet are hereditary. The contraction and/or rotation of toes can be the result of poor mechanics of the foot, resulting in over-pronation. This results in low or flat arches, which cause the muscles and tendons of the foot to twist the toes and joints away from their nonnal position. High arched feet ( over-supination) can also result in similar conditions. A severe bunion may also cause a hammertoe, as the great toe twists over or under the second toe, causing it to dislocate.

Shoes cause the com, as the bony top of the toe rubs on the toe box of the shoe, but the underlying problem is the abnormal position of the toe joints, which may be hereditary.

The most important thing is to purchase well fitted, comfortable, low heeled shoes that do not irritate the crooked toe. Also, make sure your stockings are not tight, causing the toes to contract. High heel shoes should be worn at a minimum, as they cause the tendons of the toes to pull them up into an contracted position. Tennis type and walking shoes have significantly decreased the complaint of many people with hammertoe deformities. Although the crooked toe is still present, it may not hurt if the shoebox is large enough.

Treatment may range from more appropriate footwear to periodic trimming and padding of the corn. Antibiotics may be utilized in the presence of infection. Removable accommodative pads may be made for you. If conservative treatment is unsuccessful, surgical intervention may be suggested. In the early stages, when the toe joints are flexible, this may involve a minor procedure, such as cutting or lengthening the tendons tostraighten the toe. If the toe is relatively straight and the corn is caused by pressure on a spur, the enlarged bone may be remodeled and the spur removed. In more advanced cases, when the joint is dislocated, part of the bone at the joint may be removed. Temporary pins may be used to keep the toe straight while it is healing. Sometimes, the removed bone is replaced with a synthetic joint implant, to straighten the toe and help it function properly.

3. MALLET TOE A mallet toe is bent at the distal joint area of the toe, most commonly of the second or third toes. It is not always painful but may be the cause of a persistent corns or painful nail. The treatment for mallet toes is similar to that of hammer toes.

4. CLAWTOES A claw toe is bent at both the proximal and distal joints of the toe. In some cases the deformity is merely the end result of persistent impaction and constriction from ill-fitting footwear. More commonly it is symptomatic of various alternative etiologies. There is increased pressure on the top and bottom of the joints which are common sites of painful corns or bursitis. The treatment is similar to that of a hammertoe.

5. OVERLAPPING AND UNDERLAPPING TOES Any one of the toes can overlap or underlap, pushing on adjacent toes and causing irritation.

Overlapping or underlapping of the fifth toe is a common congenital problem that is easily corrected in children. Bunions can cause the second toe to overlap in adults. The treatment of associated corns is also similar to that of a hammertoe.

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David Simard

David-Simard

David Simard has been practicing chiropody for the past 20 years.  He currently practices in Sault Ste. Marie, ON and his services extend to the Greater Algoma District.

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