Presentation To Residents

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Presentation To Residents

  1. 1. Looking at common lower- extremity problems and what to do about them
  2. 2. Common Pedal Complaints Skin Problems: nails, blisters, calluses, wounds and misc. dermatology Bone Problems: tumors, deformities, fractures Arthritities: bunions, hammertoes, general arthritis, sero-negative arthropathies Pain Syndromes: enthesiopathies, acute trauma, causalgia and RSD Diabetic Concerns: vasculopathy, neuropathy, immunopathy and attendant problems
  3. 3. Skin Problems Ingrown nails: Use antibiotics if cellulitis is seen Surgical removal of offending border: anaesthesia of lidocaine (with or without epi) and Marcaine buffered with NaCO3 if one border involved, consider if the nail is worth saving Phenol matrixectomy, saline flush dress with topical abx and gauze sponge, not Band-Aid™ Epsom salt soaks to draw out drainage
  4. 4. Skin Problems Calluses: Tell patients not to use medicated pads palliative care for comfort: trimming, cushions and wide toe-box shoes radiograph of foot may show underlying bone spur, indicating a progressive problem Tinea: Typical presentation is flaky (T. rubrum) rule out psoriasis, eczema bullous type is T. mentagraphytes rule out contact dermatitis
  5. 5. Bone Problems Tumors Gout None are common in Fractures the foot Control diet (tyromines) if seen, think use anti-inflammatories If seen in digits, osteochondroma, ‘buddy splint’ enchondroma, use colchicine unicameral bone cyst, other bones need get blood work multiple myeloma casting, ORIF possible joint tap
  6. 6. Arthritities Emphasize accommodation (shoes with wide toe-boxes, padding, trimming of corns, lesions) Sometimes surgery is And hammertoes the only choice, but it requires time off the surgical extremity Bunions The patient who is--or is suspected of being--a poor candidate for surgery Usually indicative of needs accommodation overall foot-type
  7. 7. Arthritities Heel pain General osteoarthritis typically in the hypermobile Rheumatoid (sero +) flatfoot patient Sero-negative: rule out recent trauma rule out fracture Reiter’s rule out radiculopathy Psoriatic rule out sero-negative Irritable bowel arthropathies Anklyosing spondlilitis Gonococcal arthritis SLE (systemic lupus erythematosis) Behçet’s syndrome
  8. 8. Pain Syndromes Insertion of Achilles with calcification Inferior calcaneus Heel Pain Actually a nerve entrapment syndrome, the spur means nothing Rule out radiculopathy, sero- Entheseopathies negative causes
  9. 9. Diabetic Concerns — ™ ˜ š – ‚ Transfer lesions ƒ Mallet-toe lesions „ intertrigenous lesions … hammertoe lesions † xerotic skin problems
  10. 10. Diabetic Concerns Importance: if you can’t feel your feet, you can’t feel if they’re injured if you injure your feet, it will take less force to cause ulcers if you ulcerate the skin, it will be harder to heal if the ulceration reaches bone, it may 3 changes seen: 3 types of neuropathy: mean amputation neuropathy autonomic angiopathy motor the amputation level may be proximal sensory immunopathy to injury to heal site it is unusual to have one amputation not lead to others
  11. 11. When to refer out to your local foot guy Nail infections with bone involvement, which have been treated, but have recurred, or you feel unsure about treating Wounds which need debridement, off- loading or more than simple care Bone problems (tumors, fractures, arthritic deformities) Unremitting pain recalcitrant to conservative treatment Biomechanical instability (hyperpronation), or gross deforming changes to the structure of the foot/ankle (tendon or ligament strains, sprains or tears) Yearly diabetic evaluation and assessment When you’re fed-up and don’t want to deal with it anymore!
  12. 12. T ankYou h

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