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Primary Foot Care. Common Nail Problems. When to Refer?. Fungal Nails. Fungal Nails - Treatment. Routine Debridement Topical Agents Oral Agents. Oral Agents. Fungal Nails - Treatment. Fluconazole (Diflucan) Itraconazole (Sporanox) Ketoconazole (Nizoral) Griseofulvin (Gris-peg)

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Presentation Transcript

Primary

Foot Care



When to

Refer?



Fungal nails treatment
Fungal Nails - Treatment

  • Routine Debridement

  • Topical Agents

  • Oral Agents


Oral agents
Oral Agents

Fungal Nails - Treatment

  • Fluconazole (Diflucan)

  • Itraconazole (Sporanox)

  • Ketoconazole (Nizoral)

  • Griseofulvin (Gris-peg)

  • Terbinafine (Lamisil)


When to

Refer?


Pedal skin problems
Pedal Skin Problems

  • Tinea Pedis

  • Verrucae

  • Corns & Callouses



Tinea pedis etiology
Tinea Pedis - Etiology

  • Dermatophytes

    • Trichophyton

    • Epidermophyton

    • Microsporum

  • Saprophytes and Yeast

  • Bacteria


Tinea pedis treatment
Tinea Pedis - Treatment

  • Topical Agents

    • Imidazoles: miconazole, clotrimazole, sulconazole, etc.

    • Others: undecylenic acid, tolnaftate

  • Oral Agents

    • Used in severe/resistant cases

    • Griseofulvin, ketoconazole

    • Fluconazole, itraconazole, terbinafine

  • Local Care


When to

Refer?



When to

Refer?



Corns when to refer
Corns - When to Refer?

  • Multiple Lesions

  • Multiple Digital Deformities as Cause

  • Rigid Digital Contractures

  • Ulcerative Lesion

    • Immediate

    • Definitive

  • Diabetics, PVD, Neuropathic


Morton s neuroma etiology
Morton’s Neuroma - Etiology

  • Narrow Shoes (Primary Cause)

  • High Heels

  • Biomechanical (Functional) Abnormalities

    • Excessive pronation

    • Flatfoot

    • Hammertoes

  • Traumatic

  • Anatomic


Dorsal Digital

Nerves

Intermetatarsal

Space

Interosseous

Tendons

Flexor Digitorum

Longus Tendon

Morton’s

Neuroma

Plantar Digital

Nerves

Deep Transverse

Intermetatarsal

Ligament


Morton s neuroma symptoms
Morton’s Neuroma - Symptoms

  • Burning

  • Tingling

  • Numbness (Usually only Subjective)

  • Radiating Pain into the Involved Toes

  • Feeling as Though “Walking on a Pea” or “Sock is Bunched Up”

  • Strong Desire to Stop, Remove Shoe, and Massage Forefoot


When to

Refer?


Hammertoes conservative treatment
Hammertoes -Conservative Treatment

  • Treat Only the Symptoms

  • Aperature Pads

  • Splints

  • Extra-depth Shoes

  • Caution When Using Acid Plasters In:

    • Diabetics

    • PVD

    • Neuropathic


Pre-Op

Post-Op


Pre-Op

Post-Op


Hammertoes when to refer
Hammertoes - When to Refer?

  • Rigid Deformities

  • Recurrent Ulceration

  • Chronic Pain in All Types of Shoes

  • Other Associated/Contributing Deformities

  • Patient No Longer Satisfied with Conservative Therapy


190


When to

Refer?



Heel pain etiology
Heel Pain - Etiology

  • Plantar Fasciitis/Heel Spur Syndrome

  • Heel Bursitis

  • Nerve Entrapment

  • Stress Fracture

  • Systemic Arthritides

  • Biomechanical

  • Obesity


Heel spur syndrome plantar fasciitis
Heel Spur Syndrome/Plantar Fasciitis

  • Rest Strap

  • OTC Arch Support

  • Custom Orthotic

  • NSAIDs

  • Injections - Cortisone

  • Stretching Exercises

  • Physical Therapy

Conservative Treatment



When to

Refer?


Flatfoot why treat
Flatfoot - Why Treat?

Conditions Associated with Untreated Flatfoot:

  • Bunion Deformity

  • Hammer Digit Syndrome

  • Metatarsalgia

  • Chronic Plantar Fasciitis/HSS

  • Postural Pains in Legs, Knees, Back

  • Arthritis of Involved Joints (AJ,STJ,MTJ)


When to

Refer?



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