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Diagnosis and Treatment of Common Foot Conditions Your Name and address here Your Name and address here.

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Presentation on theme: "Diagnosis and Treatment of Common Foot Conditions Your Name and address here Your Name and address here."— Presentation transcript:

1 Diagnosis and Treatment of Common Foot Conditions Your Name and address here Your Name and address here

2 What is a Podiatrist? Specializes in diagnosis and treatment of conditions effecting the foot, ankle and lower leg in all age groups Specializes in diagnosis and treatment of conditions effecting the foot, ankle and lower leg in all age groups Attends one of seven Colleges of Podiatric Medicine for four years Attends one of seven Colleges of Podiatric Medicine for four years Completes a post-graduate residency between one and four years Completes a post-graduate residency between one and four years

3 Conditions We Treat Dermatologic Dermatologic Orthopedic Orthopedic Neurologic Neurologic Diabetes-related foot and ankle ailments Diabetes-related foot and ankle ailments

4 Dermatologic Conditions Onychomycosis Onychomycosis Paronychia Paronychia Verucca Verucca Tinea Pedis Tinea Pedis

5 Orthopaedic Conditions Plantar Fasciitis Plantar Fasciitis Hammertoe Hammertoe Bunion and bunionette Bunion and bunionette Osteoarthritis and Bone spurs Osteoarthritis and Bone spurs Sports medicine related injuries Sports medicine related injuries

6 Neurologic Conditions Neuroma Neuroma Cutaneous Nerve Entrapment Cutaneous Nerve Entrapment Neuropathy Neuropathy Tarsal Tunnel Syndrome Tarsal Tunnel Syndrome

7 Diabetes Related Foot and Ankle Conditions Neurotrophic Ulcers Neurotrophic Ulcers Neuropathy Neuropathy Charcot Foot Charcot Foot

8 Onychomycosis Dermatophyte Dermatophyte Often seen with skin manifestations Often seen with skin manifestations Usually acquired but may be inherited Usually acquired but may be inherited More treatable than in the past More treatable than in the past Differentiate from Melanoma Differentiate from Melanoma

9 Onychomycosis Treatment Debridement Debridement Topical Topical Oral Oral Matrixectomy Matrixectomy Nail Biopsy for dermatopathology Nail Biopsy for dermatopathology

10 Paronychia Erythema and edema of the ungual labia Erythema and edema of the ungual labia Wide or incurvated nail plate Wide or incurvated nail plate May drain serous to purulent exudate May drain serous to purulent exudate Hallux most effected Hallux most effected

11 Paronychia Treatment Incision and Drainage Incision and Drainage Oral antibiotics usually not necessary Oral antibiotics usually not necessary Longstanding infection may require X-ray Longstanding infection may require X-ray Chemical matrixectomy, partial or total Chemical matrixectomy, partial or total

12 Verruca?

13 Verruca! Human Papilloma Virus (HPV) Human Papilloma Virus (HPV) Contagious Contagious Usually plantar on foot Usually plantar on foot

14 Verruca Treatment Debridement is diagnostic and therapeutic Debridement is diagnostic and therapeutic Chemocautery Chemocautery Various topical treatments available Various topical treatments available Oral Cimetidine for pediatric usage (30-40Mg/Kg in 3 divided doses) Oral Cimetidine for pediatric usage (30-40Mg/Kg in 3 divided doses) Curretage Curretage

15 Plantar Fasciitis Inflammation and pain of the plantar fascia, usually at its insertion at the plantar medial tubercle of the calcaneous Inflammation and pain of the plantar fascia, usually at its insertion at the plantar medial tubercle of the calcaneous Becomes chronic in 5- 10% of all patients Becomes chronic in 5- 10% of all patients Is not necessarily associated with a heel spur Is not necessarily associated with a heel spur Over 90% resolve with conservative treatment Over 90% resolve with conservative treatment

16 Plantar Fasciitis Symptoms Weight-bearing pain on arising Weight-bearing pain on arising Pain subsides, returns with activity Pain subsides, returns with activity Footwear related to pain? Footwear related to pain?

17 Plantar Fasciitis Risk Factors Weight gain Weight gain Equinus deformity Equinus deformity Poor shoegear Poor shoegear Biomechanical abnormalities Biomechanical abnormalities Work Surface Work Surface

18 Plantar Fasciitis Diagnosis Pain on palpation Pain on palpation Antalgic gait Antalgic gait Pes planus Pes planus X-ray X-ray Ultrasound Ultrasound

19 Plantar Fasciitis Treatment Stretching Stretching RICE RICE Change shoes Change shoes OTC inserts OTC inserts

20 Plantar Fasciitis Treatment Nocturnal Anti- contracture Devices Nocturnal Anti- contracture Devices Orthotics Orthotics NSAIDS NSAIDS Cortisone shot(s) Cortisone shot(s) Rarely surgery Rarely surgery

21 ESWT Heel Lithotripsy Heel Lithotripsy Surgical alternative Surgical alternative 72% effective 72% effective 3 months until significant relief in most patients 3 months until significant relief in most patients Few complications Few complications

22 Hammertoe Digital Contracture Digital Contracture Usually PIPJ Usually PIPJ May have MPJ dorsiflexion May have MPJ dorsiflexion May have clavus May have clavus Pre-ulcerative in patients with diabetes Pre-ulcerative in patients with diabetes

23 Hammertoe Treatment Debridement Debridement Padding Padding Shoe gear change Shoe gear change Surgery as a last option Surgery as a last option

24 Hallux Valgus Painful bump secondary to increase IM angle Painful bump secondary to increase IM angle Poor biomechanics Poor biomechanics Hurts in shoes Hurts in shoes Usually bump pain vs joint pain Usually bump pain vs joint pain Wider shoes help Wider shoes help Orthotics slow or stop progression and pain Orthotics slow or stop progression and pain

25 Osteoarthritis Usually at first MPJ Usually at first MPJ Hallux limitus/rigidus Hallux limitus/rigidus Poor biomechanics Poor biomechanics Painful to walk Painful to walk

26 Osteoarthritis Treatment Cortisone injection Cortisone injection Physical therapy Physical therapy NSAIDS NSAIDS Orthotics Orthotics Surgery Surgery

27 Ankle - Foot Orthosis Articulated hinge device Articulated hinge device Used when functional orthotic fails or will fail Used when functional orthotic fails or will fail For active patient that can tolerate motion For active patient that can tolerate motion Excellent for sports Excellent for sports

28 Ankle – Foot Orthosis Gauntlet style for total control Gauntlet style for total control For patients that cannot tolerate motion For patients that cannot tolerate motion Good for severe DJD and Charcot foot Good for severe DJD and Charcot foot

29 Ankle Sprains Tear or stretching of the ligaments of the ankle. Usually the ligaments on the outside of the ankle are involved. Caused by and twisting injury of the foot / ankle. Instability of the ankle can develop due to the ligament injury. Most often treated conservatively. Surgical repair can be performed to treat chronic ankle sprains.

30 Ankle Sprains Treatment Immobilize early Immobilize early Consider Non- Weight bearing Consider Non- Weight bearing RICE RICE NSAIDS NSAIDS

31 Ankle Sprains Rehabilitation CAM walker to Stirrup CAM walker to Stirrup Stirrup to gauntlet Stirrup to gauntlet Physical therapy Physical therapy

32 Mortons Neuroma Painful swelling of the interdigital nerve Painful swelling of the interdigital nerve Most commonly seen in third web space Most commonly seen in third web space Patients can feel numbness of adjacent digits and plantar pain Patients can feel numbness of adjacent digits and plantar pain Etiology is abnormal stretching of the nerve Etiology is abnormal stretching of the nerve

33 Mortons Neuroma Differential Diagnosis Stress fracture Stress fracture Callus Callus Freiberg's infraction Freiberg's infraction Capsulitis Capsulitis Bone tumor Bone tumor Local manifestation of systemic disease Local manifestation of systemic disease

34 Mortons Neuroma Treatment Change shoe gear Change shoe gear Padding Padding Orthotic Orthotic Cortisone injection Cortisone injection 4% dehydrated alcohol injection for neurolysis 4% dehydrated alcohol injection for neurolysis Surgical excision Surgical excision

35 Diabetic ulcer Etiology is usually traumatic caused by shoes Etiology is usually traumatic caused by shoes Bony promonence is usually involved (hammertoe, bunion, plantarflexed metatarsal, bone spur) Bony promonence is usually involved (hammertoe, bunion, plantarflexed metatarsal, bone spur) Often start as a blister, corn or callous Often start as a blister, corn or callous

36 Diabetic ulcer treatment Always obtain serial X-rays to rule out osteomyelitis Always obtain serial X-rays to rule out osteomyelitis Debride the wound to granular bed Debride the wound to granular bed Remove hyperkeratosis Remove hyperkeratosis Gently probe wound for deep sinus Gently probe wound for deep sinus Dress initially with Silvadene cream Dress initially with Silvadene cream Consider other wound products Consider other wound products Consider offloading Consider offloading

37 Charcot Joint Diabetic Neuroarthropathy Diabetic Neuroarthropathy Often involves both pathologic dislocation and fracture Often involves both pathologic dislocation and fracture Usually effects midfoot, but all lower extremity joints are susceptible Usually effects midfoot, but all lower extremity joints are susceptible Foot is acutely edematous and warm Foot is acutely edematous and warm Deformity is common Deformity is common

38 Charcot Joint Treatment Non-weight bearing for 12 weeks Non-weight bearing for 12 weeks Patient education is critical to outcome Patient education is critical to outcome Serial X-rays to document deformity Serial X-rays to document deformity Molded shoe often needed after coalescence Molded shoe often needed after coalescence Surgical Treatment Surgical Treatment

39 Therapeutic Shoes Newly diagnosed + 33% 1990s Newly diagnosed + 33% 1990s Amputations + 28% Amputations + 28% Medicare has stated that 50% of amputations were preventable Medicare has stated that 50% of amputations were preventable

40 Therapeutic Shoes Focal pressure keratosis with accompanying risk factors are the major cause of ulcer. Focal pressure keratosis with accompanying risk factors are the major cause of ulcer. Patients who have regular, frequent foot clinic visits that include risk evaluation, debridement of lesions, prescription of appropriate shoes and patient education are less likely to ulcerate. 1 Patients who have regular, frequent foot clinic visits that include risk evaluation, debridement of lesions, prescription of appropriate shoes and patient education are less likely to ulcerate. 1 1 Sage RA, Webster JK, Fisher SG: Outpatient Care and Morbidity Reduction in Diabetic Foot Ulcers Associated with Chronic Pressure Callus. JAPMA 91:275, 2001.

41 Thank You!


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