Guest Editorial/Case Study: In this issue of Paths, published podiatrist, Lynnelle Gabriel, DPM, FACFA shares her expertise on the latest in dermal-application creams. Following her breakdown on the uses of Ibunex and Gluconex, Dr. Gabrielle applies her knowledge to a case study involving a 68 year old woman who presented with pain on the dorsal aspect of her left foot.
Dermal-Application Creams As a specialist in the medical field, prescribing oral NSAIDs can be a double-edged sword. Many patients with chronic conditions may rely on oral medicines to get through their daily activities, yet they are justly concerned about the harmful effects on their digestive systems.  Their liver is also a concern, especially when in combination with other chronic medications they are already taking.	Lynnelle R. Gabriel DPM, FACFAS Private Practice, Western Wisconsin

When I first heard about Ibunex and Gluconex, new dermal-application creams, I was intrigued by their unique formulas, and I was interested in seeing how I could use them as an alternative to oral NSAIDs. The ingredients in Ibunex and Gluconex are encapsulated in a liposome carrier for bioavailability. One measure pump of Ibunex contains 10mg of Ibuprofen, along with Glucosamine, Chondroitin, MSM and Bromelain. Methylsulfonylmethane (MSM) is a source of sulfur and Bromelain is a proteolytic enzyme, and both of these are natural anti-inflammatories.

The Gluconex formula is Ibuprofen-free. Instead, Gluconex contains higher amounts of Glucosamine and Chondroitin, in addition to the MSM and Bromelain, for long-term muscle and joint maintenance. Because of the local application, Ibunex and Gluconex are especially attractive for podiatry. Patients no longer have to wait for distant metabolic processes and system wide transportation in order for the medicine to reach their lower extremities.

A fourteen day use of four pumps of Ibunex, followed by a maintenance daily dose of Gluconex is an appropriate way for patients to alleviate chronic symptoms of chronic ailments such as Osteoarthrits, Rheumatoid arthritis, Psoriatic arthritis, Lupus, and even Diabetic neuropathy.

Acute injuries and symptoms can also be alleviated by Ibunex. With the addition of the ibuprofen, I have seen patients with symptoms of pain and edema have significant relief. I use the Ibunex for conditions such as tendonitis and sports injuries, ankle injuries, plantar fasciitis, neuromas, apophysitis, metatarsalgia, bursitis and capsulitis, bunions and hammertoes, scars and post operative procedures after suture removal.

Another uniquely effective use of Ibunex or Gluconex is with tissue manipulation with adherent scar tissue and readying the tissues for kinetic activity. I have also used the creams with ultrasound during physical therapy treatments.

Contraindications of Ibunex would include pregnancy and children under age 12, allergies to ibuprofen and some sulfa allergies. Contraindications of Gluconex would include some sulfa allergies.

Case Study:

A 68 year old female presented to the clinic with a chief complaint of pain on the dorsal aspect of her left foot.  The patient stated that the pain was deep into the midfoot and was exacerbated by wearing shoes.  It had been occurring for approximately 3 years and progressively getting worse.  She stated that wearing sandals in the summer helped the top of her foot, however, that created pain deep into the arch.  When wearing closed toed lace up shoes the pain was better into the arch, however, they allowed more pain on the top of the foot which would get significantly red and irritated.  She could also feel a lump on the top of the foot.

Objectively, she was neurologically and vascularly intact.  She had an unremarkable dermatological exam with the exception of some thinning of the skin and mild varicosities noted.  There was a small erythemic area on the dorsum of the left 1st and 2nd metatarsal cuneiform joints.  Musculoskelatally, she presented with a dorsal prominent exostosis which was painful with palpation.  There was mild edema; some pain with range of motion of the midfoot joints.  No plantar fascial concerns; however, midfoot pain with palpation of the plantar 1st  and 2nd metatarsal cuneiform joints.  Radiographs demonstrated significant boney dorsal exostosis, cystic formation at the correlating joints and mild soft tissue edema.

The patient opted for conservative care consisting of padding and strapping.  She was also given the Ibunex followed by Gluconex course and instructed on her target treatment. She returned to the clinic 3 weeks later doing fairly better.  She stated the padding and strapping was too bulky and caused more pressure on the top of the foot hitting the shoe.  She did like the Ibunex as it helped with the redness and the swelling was reduced.  She requested further treatment.

The patient, after thorough discussion of all risks, ramifications and benefits, requested surgical correction of the dorsal exostosis and subsequently underwent surgical exostectomy of the left 1st and 2nd metatarsal cuneiform joints. She was placed into a surgical shoe for 2 weeks. Sutures were removed at 14 days postoperatively.  At this post operative visit, she was instructed to once again begin a 14 day course of Ibunex followed with the maintenance course of Gluconex.  At her 6 week post operative visit, the patient was in all normal shoes without any pain.  She stated that the scar looked “unbelievable” and she was very happy with the outcome.  Recently, the patient was seen 3 months post operatively and 100% pain free.

In conclusion, Ibunex and Gluconex topical application as opposed to oral NSAIDS therapy provide excellent safe outcomes.  Overall, I have been, and more importantly my patients have been, very satisfied with Ibunex and Gluconex to treat both acute and chronic pain and edema, in addition to post-surgical scar and tissue treatment.

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