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RESEARCH & PUBLICATIONS

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Published: May 2024 – Journal of the American Podiatric Medical Association (JAPMA)

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  • Ivan R. Bristow PhD, Raphael Lilker DPM, “Microwave Energy for the Treatment of Painful Intractable Plantar Keratosis”

Background: Plantar keratoma are common hyperkeratinized, deep-seated lesions, often located on weightbearing areas of the foot. Such lesions are frequently associated with pain and disability. Intractable plantar keratomata (IPK) are highly recurrent and, in most patients, require regular, palliative treatment visits with a significant impact on patient time, cost, and quality of life.

Methods: We undertook a retrospective chart review of 9 patients (with a total of 21 lesions) who underwent a minimum of two treatments using microwave therapy to their IPK. Pain levels were assessed at each of their treatments using a 10-point scale and patients were invited for review for follow-up in the following year. A total of seven patients undertook four treatments and were included in the final analysis.

Results: Mean baseline pain scores significantly dropped with each subsequent treatment, equating to a 90.4% mean reduction in pain between the first and fourth visits, with 71.4% of patients reporting a zero-pain rating at their final treatment visit.
Conclusions: The use of microwave therapy has been shown to be effective in producing significant and prolonged pain reduction in a cohort of patients with painful IPK.

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Published: November 2018 – Journal of the American Podiatric Medical Association (JAPMA)

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  • Mario E Lacouture MD, David J Kopsky MD, Raphael Lilker DPM, Fiona Damstra MD, Mecheline HM van der Linden PhD, Azael Freites-Martinez MD, Mischa PM Nagel. “Podiatric Adverse Events and Foot Care in Cancer Patients and Survivors”

Cancer is one of the leading causes of mortality and morbidity worldwide. Recent improved therapies have resulted in more patients surviving cancer and living longer. Despite these advances, the majority of patients will develop adverse events from anticancer therapies. Foot alterations, including nail toxicities, hand-foot syndrome, edema, xerosis, hyperkeratosis, and neuropathy, are frequent among cancer patients. These untoward conditions may negatively impact quality of life, and in some cases may result in the interruption or discontinuation of cancer treatments. Appropriate prevention, diagnosis, and management of podiatric adverse events are essential to maintain foot function and health-related quality of life, both of which are critical for the care of cancer patients and survivors. This article shows results related to complaint and impact on quality of life of the Oncology Foot Care program and reviews publications specific to podiatric adverse events related to cancer treatments.

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Published: September 2018 - Cancer Rehabilitation, 2nd Edition, Principles and Practice, Edited by: Stubblefield, Michael D., MD. 

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  • Monica Dhawan MD , Mischa PM Nagel, Raphael Lilker DPM, Mario E Lacouture MD. "Chapter 38: Dermatologic Complications of Cancer and Their Treatment"

This chapter discusses dermatological toxicities of anticancer therapies and mainly focuses on two adverse events: hand–foot syndrome (HFS) and paronychia. HFS is a well-documented reversible adverse effect of many chemotherapeutic therapies, causing a wide variety of cutaneous symptoms ranging from erythema, dysesthesia, pain, and desquamation of the palms and soles to impairing daily activities of living. The standard approach used in the management of HFS is treatment interruption or dose modification, with symptom improvement reported within 1 to 2 weeks. Paronychia is the inflammation of the nail folds, jeopardizing the nail fold barrier and potentially exposing the nail matrix to damage. Paronychia is also an adverse effect of chemotherapeutic agents. The known causes of acute paronychia prior to the introduction of epidermal growth factor receptor (EGFR) inhibitors included staphylococci, streptococci, and pseudomonas, whereas, Candida albicans was frequently associated with chronic paronychia, with diabetes mellitus being a predisposing factor.

In Progress:

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  • Mischa PM Nagel, Monica Dhawan MD, Raphael Lilker DPM, Christine B. Boers-Doets MD. “Therapeutic footwear improves the functional mobility and quality of life of patients with chemotherapy-induced hand-foot syndrome:
    Results of a pilot study”   

Patients with targeted therapy or chemotherapy-associated cutaneous lesions of the palmar and plantar surfaces have considerable decline in quality of life (QoL), necessitating interruption, dose modification or even discontinuation of causative anticancer agents as the mainstay of symptom management. Chemotherapy-associated hand-foot syndrome (HFS) and targeted therapy-associated hand-foot skin reaction (HFSR) and care well-documented adverse events. The QoL and outcome of the anticancer treatment may be decreased due to lack of mobility. Gaining mobility by wearing therapeutic footwear might positively increase the outcome of the lifesaving or life prolonging therapy. The purpose of this pilot study was to determine if therapeutic footwear could improve the functional mobility and QoL of patients with HFS or HFSR.

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