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Diagnosis and management by PCPs of simple podiatric problems
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Diagnosis and management by PCPs of simple podiatric problems

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Lecture for PCPs on common foot problems

Lecture for PCPs on common foot problems


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  • 1. Diagnosis and Management by PCPs of Simple Podiatric Problems Don Pelto, DPM Central Massachusetts Podiatry, PC Worcester, MA
  • 2. I have no actual or potential conflict of interest in relation to this presentation
  • 3. Plantar Fasciitis / Heel Spur
    • Inflammation and partial tearing of a ligament band
    • Spur may be present
    • Pain first thing in morning
  • 4. Plantar Fasciitis Treatment
    • New shoes
    • Ice
    • NSAIDs
    • Night Splint
    • Stretching vs Deep Tissue Massage
  • 5. Plantar Fasciitis Treatment
    • Steroid Injection
      • 25G Needle
      • 3cc Syringe
      • 1cc 1% Lidocaine
      • 1cc 0.5% Marcaine
      • 0.5cc Kenalog
      • 0.5cc Dexamethasone
  • 6. Flat Feet
    • Congenital or acquired
    • Pain may occur in the feet, ankles, knees or back
  • 7. Flat Feet Treatment
    • Non-Custom Orthotics
    • Supportive Shoes
    • Orthotics
  • 8. Morton’s Neuroma
    • Compressed Nerve
    • Most often 3 rd interspace
    • Burning / pain on the ball of the foot or toes
    • r/o stress fracture, metatarsalgia
  • 9. Morton’s Neuroma Treatment
    • Wide shoes
    • No high heel shoes
    • NSAIDs
    • Physical Therapy
    • Orthotics
    • Metatarsal Pad
    • Steroid Injection
    • Sclerosing Injection 4%
      • 48cc 0.5% Marcaine with epi
      • 2cc Dehydrated Alcohol
  • 10. Hallux Valgus
    • Painful bump secondary to increase IM angle
    • Poor biomechanics
    • Hurts in shoes
    • Usually bump pain vs joint pain
    • Wider shoes help
    • Orthotics slow or stop progression and pain
  • 11. Hallux Valgus Treatment
    • Radiographs
    • Wider shoes
    • Padding, Bunion Bra
    • Trimming Keratoma
    • Corticosteroid Injection
      • Bump vs Joint
    • Orthotics slow or stop progression and pain
  • 12. Tailor’s Bunion / Bunionette
    • Bony deformity which is located on the outside part of the foot.
    • The bump, bunionette or Tailor’s Bunion, can become very painful due to shoe irritation.
    Note prominent 5 th metatarsal head
  • 13. Tailor’s Bunion / Bunionette
    • Wider shoes
    • Padding
    • Trimming Keratoma
    • Corticosteroid Injection
      • Bump vs Joint
    • Orthotics
  • 14. Hallux Rigidus
    • Arthritis of 1 st MPJ
    • Poor biomechanics
    • Painful to walk
  • 15. Hallux Rigidus Treatment
    • Cortisone injection
    • Physical therapy
    • NSAIDS
    • Orthotics
  • 16. Hammertoe Deformity
    • Digital contracture can be flexible or rigid in nature
    • Usually PIPJ
    • May have MPJ dorsiflexion
    • May have callus
    • Pre-ulcerative in patients with diabetes
  • 17. Hammertoe Treatment
    • Debridement
    • Padding
    • Shoe gear change
  • 18. Callous / Corn
    • Thickened skin caused by chronic rubbing or irritation of a bony prominence by the ground or shoe gear
  • 19. Callous / Corn Treatment
    • Trimming Callus
    • Callus Cream & Pumice Bar
    • Padding
    • Decreasing friction
    • Don't use acid pads
  • 20. Athlete's Foot
    • Fungal infection (Dermatophyte).
    • May occur anywhere on the foot and may burn and/or itch
    • The affected areas of skin will often peel or may have small blisters
  • 21. Athlete's Foot Treatment
    • Topical Antifungal – Cream vs Gel
    • Topical Steroid
    • May be dermatitis
    • Biopsy if not responding
  • 22. Plantar Wart
    • Human Papilloma Virus (HPV)
    • Contagious
    • Usually plantar on foot
  • 23. Verruca Treatment
    • Debridement
    • Chemocautery
    • Laser
    • Topical treatments
    • Oral Cimetidine for pediatric usage (30-40Mg/Kg in 3 divided doses)
    • Liquid Nitrogen not very effective on thick plantar foot skin
  • 24. Hyperhydrosis
    • Excess perspiration
    • Stress or overactive sweat glands
    • Predispose patient to fungal infections, bacterial infections or foot odor
    • Can be treated with topical medications
  • 25. Hyperhydrosis Treatment
    • Topical Formalin
    • Antiperspirant
    • Aluminum Hydroxychloride
    • Talc Power
    • Dry Wick Socks
  • 26. Ganglion Cyst
    • Benign soft tissue mass which arises from a weak area in a tendon lining or joint
    • Cyst is often filled with a gelatinous fluid
    • Cyst may change size depending on irritation
  • 27. Ganglion Cyst Treatment
    • Aspiration
    • Cortisone Injection
    • Trauma
    • Pressure
  • 28. Eczema/Fissures
    • Skin inflammatory condition
    • Worse in winter
    • Make sure not ulceration
  • 29. Ezema/Fissure Treatment
    • Cream
    • Pumice Stone
    • Off-loading Boot
  • 30. Eczema/Fissure Treatment
  • 31. Ingrown Nails/Paronychia
    • Painful to edge of nail with pressure or tight shoes
    • Erythema, edema, purulent exudate
  • 32. Ingrown Nail Treatment
    • Antibiotic
    • Massaging Nail Edge
    • I&D
    • Phenol & Alcohol (P&A)
  • 33. Onychomycosis
    • Dermatophyte
    • Often seen with skin manifestations
    • Usually acquired but may be inherited
    • May be caused by trauma
  • 34. Onychomycosis Treatment
    • Debridement
    • Topical Antifungal
    • Oral Antifungal
    • Nail Avulsion
    • Matrixectomy
    • Nail Biopsy
  • 35. Nail Injury
    • Chronic injury (i.e. athletic activities)
    • Isolated injury (trauma)
    • Nail bed laceration
  • 36. Nail Injury Treatment
    • Watch and wait
    • Nail avulsion
    • Puncture
  • 37. Subungual Exostosis
    • Bone and cartilage growth under the great toe nail
    • Pain may arise if pressure is placed over the area
  • 38. Subungual Exostosis Treatment
    • Shoe Modification
    • Toe Cap
    • Nail Avulsion
    • Cortisone Injection
    • Exostectomy
  • 39. Haglund’s Deformity / Retrocalcaneal Exostosis
    • Prominent bone on the back of the heel.
    • Back of the heel is irritated by shoes and activity.
  • 40. Haglund’s Deformity / Retrocalcaneal Exostosis Treatment
    • Open Backed Shoes
    • Steroid Injection around Bursa
    • Orthotics
  • 41. Fractures
    • 5 th Metatarsal – Difficulty healing
    • Digital
    • Calcaneus
    • Stress Fracture
  • 42. Fracture Treatment
    • Surgical Shoe
    • CAM Walker
    • Bone Stimulator
    • Buddy Taping
    • MRI vs CT
  • 43. Ulcerations
    • High pressure areas
    • Bony prominence
    • 4 Reasons Why Won’t Heal
      • High Glucose
      • Poor Circulation
      • Deeper Infection
      • Walking on Wound
  • 44. Diabetic Ulcer Treatment
    • X-rays: Rule out osteomylits
    • Debride the wound to granular bed
    • Remove hyperkeratosis
    • Gently probe wound for deep sinus
    • Apply DSD
    • Consider other wound products
    • Consider offloading
  • 45. Therapeutic Shoes
    • 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
    • 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.
  • 46. Therapeutic Shoes
    • Need to have Diabetes and
      • Partial/Complete Amputation
      • Previous Ulceration
      • Pre-Ulcerative Callus
      • Neuropathy with Callus
      • Foot Deformity
      • Poor Circulation
  • 47. Thank You Don Pelto, DPM Central Massachusetts Podiatry, PC Worcester, MA [email_address] (508) 757-4003

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