The following issues were discussed with the patient:
- Lesions are frequently cause by micro trauma from bone prominence and resultant core of hyperkeratotic tissue and entrapment of cutaneous nerve.
- Conservative measures include trimming of lesion, padding, and Salicylic acid daily applications and weekly debridements. Advantages include no injections and limited pain. Disadvantages include long treatment time and poor success rate.
- Surgical measures: Cryotherapy using liquid nitrogen with local anesthesia injections. Sharp surgical excision of lesions. Advantages include fairly high success rate and short treatment time. Disadvantages include post operative pain, possible limping, need for injection anesthesia and scarring.
- Injection therapy involves weekly injections for seven consecutive weeks of anhydrous alcohol 4% in Marcaine. Injections destroy nerve involved in entrapment and cause skin lesion to resolve. Advantages are a high success rate. Disadvantages include need for weekly injections. Patient warned occasionally injections cause temporary increase in pain intensity.
- Unpredictability of skin lesions and possibility of failure to respond to treatment or recurrence following treatment.