Commonwealth Foot & Ankle Treatments

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Commonwealth Foot & Ankle Treatments

  1. 1. Diagnosis and Treatment of Common Foot Conditions <ul><li>Your Name and address here </li></ul>
  2. 2. What is a Podiatrist? <ul><li>Specializes in diagnosis and treatment of conditions effecting the foot, ankle and lower leg in all age groups </li></ul><ul><li>Attends one of seven Colleges of Podiatric Medicine for four years </li></ul><ul><li>Completes a post-graduate residency between one and four years </li></ul>
  3. 3. Conditions We Treat <ul><li>Dermatologic </li></ul><ul><li>Orthopedic </li></ul><ul><li>Neurologic </li></ul><ul><li>Diabetes-related foot and ankle ailments </li></ul>
  4. 4. Dermatologic Conditions <ul><li>Onychomycosis </li></ul><ul><li>Paronychia </li></ul><ul><li>Verucca </li></ul><ul><li>Tinea Pedis </li></ul>
  5. 5. Orthopaedic Conditions <ul><li>Plantar Fasciitis </li></ul><ul><li>Hammertoe </li></ul><ul><li>Bunion and bunionette </li></ul><ul><li>Osteoarthritis and Bone spurs </li></ul><ul><li>Sports medicine related injuries </li></ul>
  6. 6. Neurologic Conditions <ul><li>Neuroma </li></ul><ul><li>Cutaneous Nerve Entrapment </li></ul><ul><li>Neuropathy </li></ul><ul><li>Tarsal Tunnel Syndrome </li></ul>
  7. 7. Diabetes Related Foot and Ankle Conditions <ul><li>Neurotrophic Ulcers </li></ul><ul><li>Neuropathy </li></ul><ul><li>Charcot Foot </li></ul>
  8. 8. Onychomycosis <ul><li>Dermatophyte </li></ul><ul><li>Often seen with skin manifestations </li></ul><ul><li>Usually acquired but may be inherited </li></ul><ul><li>More treatable than in the past </li></ul><ul><li>Differentiate from Melanoma </li></ul>
  9. 9. Onychomycosis Treatment <ul><li>Debridement </li></ul><ul><li>Topical </li></ul><ul><li>Oral </li></ul><ul><li>Matrixectomy </li></ul><ul><li>Nail Biopsy for dermatopathology </li></ul>
  10. 10. Paronychia <ul><li>Erythema and edema of the ungual labia </li></ul><ul><li>Wide or incurvated nail plate </li></ul><ul><li>May drain serous to purulent exudate </li></ul><ul><li>Hallux most effected </li></ul>
  11. 11. Paronychia Treatment <ul><li>Incision and Drainage </li></ul><ul><li>Oral antibiotics usually not necessary </li></ul><ul><li>Longstanding infection may require X-ray </li></ul><ul><li>Chemical matrixectomy, partial or total </li></ul>
  12. 12. Verruca?
  13. 13. Verruca! <ul><li>Human Papilloma Virus (HPV) </li></ul><ul><li>Contagious </li></ul><ul><li>Usually plantar on foot </li></ul>
  14. 14. Verruca Treatment <ul><li>Debridement is diagnostic and therapeutic </li></ul><ul><li>Chemocautery </li></ul><ul><li>Various topical treatments available </li></ul><ul><li>Oral Cimetidine for pediatric usage (30-40Mg/Kg in 3 divided doses) </li></ul><ul><li>Curretage </li></ul>
  15. 15. Plantar Fasciitis <ul><li>Inflammation and pain of the plantar fascia, usually at its insertion at the plantar medial tubercle of the calcaneous </li></ul><ul><li>Becomes chronic in 5-10% of all patients </li></ul><ul><li>Is not necessarily associated with a heel spur </li></ul><ul><li>Over 90% resolve with conservative treatment </li></ul>
  16. 16. Plantar Fasciitis Symptoms <ul><li>Weight-bearing pain on arising </li></ul><ul><li>Pain subsides, returns with activity </li></ul><ul><li>Footwear related to pain? </li></ul>
  17. 17. Plantar Fasciitis Risk Factors <ul><li>Weight gain </li></ul><ul><li>Equinus deformity </li></ul><ul><li>Poor shoegear </li></ul><ul><li>Biomechanical abnormalities </li></ul><ul><li>Work Surface </li></ul>
  18. 18. Plantar Fasciitis Diagnosis <ul><li>Pain on palpation </li></ul><ul><li>Antalgic gait </li></ul><ul><li>Pes planus </li></ul><ul><li>X-ray </li></ul><ul><li>Ultrasound </li></ul>
  19. 19. Plantar Fasciitis Treatment <ul><li>Stretching </li></ul><ul><li>RICE </li></ul><ul><li>Change shoes </li></ul><ul><li>OTC inserts </li></ul>
  20. 20. Plantar Fasciitis Treatment <ul><li>Nocturnal Anti-contracture Devices </li></ul><ul><li>Orthotics </li></ul><ul><li>NSAIDS </li></ul><ul><li>Cortisone shot(s) </li></ul><ul><li>Rarely surgery </li></ul>
  21. 21. ESWT <ul><li>Heel Lithotripsy </li></ul><ul><li>Surgical alternative </li></ul><ul><li>72% effective </li></ul><ul><li>3 months until significant relief in most patients </li></ul><ul><li>Few complications </li></ul>
  22. 22. Hammertoe <ul><li>Digital Contracture </li></ul><ul><li>Usually PIPJ </li></ul><ul><li>May have MPJ dorsiflexion </li></ul><ul><li>May have clavus </li></ul><ul><li>Pre-ulcerative in patients with diabetes </li></ul>
  23. 23. Hammertoe Treatment <ul><li>Debridement </li></ul><ul><li>Padding </li></ul><ul><li>Shoe gear change </li></ul><ul><li>Surgery as a last option </li></ul>
  24. 24. Hallux Valgus <ul><li>Painful bump secondary to increase IM angle </li></ul><ul><li>Poor biomechanics </li></ul><ul><li>Hurts in shoes </li></ul><ul><li>Usually bump pain vs joint pain </li></ul><ul><li>Wider shoes help </li></ul><ul><li>Orthotics slow or stop progression and pain </li></ul>
  25. 25. Osteoarthritis <ul><li>Usually at first MPJ </li></ul><ul><li>Hallux limitus/rigidus </li></ul><ul><li>Poor biomechanics </li></ul><ul><li>Painful to walk </li></ul>
  26. 26. Osteoarthritis Treatment <ul><li>Cortisone injection </li></ul><ul><li>Physical therapy </li></ul><ul><li>NSAIDS </li></ul><ul><li>Orthotics </li></ul><ul><li>Surgery </li></ul>
  27. 27. Ankle - Foot Orthosis <ul><li>Articulated hinge device </li></ul><ul><li>Used when functional orthotic fails or will fail </li></ul><ul><li>For active patient that can tolerate motion </li></ul><ul><li>Excellent for sports </li></ul>
  28. 28. Ankle – Foot Orthosis <ul><li>Gauntlet style for total control </li></ul><ul><li>For patients that cannot tolerate motion </li></ul><ul><li>Good for severe DJD and Charcot foot </li></ul>
  29. 29. Ankle Sprains <ul><li>Tear or stretching of the ligaments of the ankle. Usually the ligaments on the outside of the ankle are involved. </li></ul><ul><li>Caused by and twisting injury of the foot / ankle . </li></ul><ul><li>Instability of the ankle can develop due to the ligament injury. </li></ul><ul><li>Most often treated conservatively. Surgical repair can be performed to treat chronic ankle sprains. </li></ul>
  30. 30. Ankle Sprains Treatment <ul><li>Immobilize early </li></ul><ul><li>Consider Non-Weight bearing </li></ul><ul><li>RICE </li></ul><ul><li>NSAIDS </li></ul>
  31. 31. Ankle Sprains Rehabilitation <ul><li>CAM walker to Stirrup </li></ul><ul><li>Stirrup to gauntlet </li></ul><ul><li>Physical therapy </li></ul>
  32. 32. Morton’s Neuroma <ul><li>Painful swelling of the interdigital nerve </li></ul><ul><li>Most commonly seen in third web space </li></ul><ul><li>Patients can feel numbness of adjacent digits and plantar pain </li></ul><ul><li>Etiology is abnormal stretching of the nerve </li></ul>
  33. 33. Morton’s Neuroma Differential Diagnosis <ul><li>Stress fracture </li></ul><ul><li>Callus </li></ul><ul><li>Freiberg's infraction </li></ul><ul><li>Capsulitis </li></ul><ul><li>Bone tumor </li></ul><ul><li>Local manifestation of systemic disease </li></ul>
  34. 34. Morton’s Neuroma Treatment <ul><li>Change shoe gear </li></ul><ul><li>Padding </li></ul><ul><li>Orthotic </li></ul><ul><li>Cortisone injection </li></ul><ul><li>4% dehydrated alcohol injection for neurolysis </li></ul><ul><li>Surgical excision </li></ul>
  35. 35. Diabetic ulcer <ul><li>Etiology is usually traumatic caused by shoes </li></ul><ul><li>Bony promonence is usually involved (hammertoe, bunion, plantarflexed metatarsal, bone spur) </li></ul><ul><li>Often start as a blister, corn or callous </li></ul>
  36. 36. Diabetic ulcer treatment <ul><li>Always obtain serial X-rays to rule out osteomyelitis </li></ul><ul><li>Debride the wound to granular bed </li></ul><ul><li>Remove hyperkeratosis </li></ul><ul><li>Gently probe wound for deep sinus </li></ul><ul><li>Dress initially with Silvadene cream </li></ul><ul><li>Consider other wound products </li></ul><ul><li>Consider offloading </li></ul>
  37. 37. Charcot Joint <ul><li>Diabetic Neuroarthropathy </li></ul><ul><li>Often involves both pathologic dislocation and fracture </li></ul><ul><li>Usually effects midfoot, but all lower extremity joints are susceptible </li></ul><ul><li>Foot is acutely edematous and warm </li></ul><ul><li>Deformity is common </li></ul>
  38. 38. Charcot Joint Treatment <ul><li>Non-weight bearing for 12 weeks </li></ul><ul><li>Patient education is critical to outcome </li></ul><ul><li>Serial X-rays to document deformity </li></ul><ul><li>Molded shoe often needed after coalescence </li></ul><ul><li>Surgical Treatment </li></ul>
  39. 39. Therapeutic Shoes <ul><li>Newly diagnosed + 33% 1990’s </li></ul><ul><li>Amputations + 28% 2000 -2001 </li></ul><ul><li>Medicare has stated that 50% of amputations were preventable </li></ul>
  40. 40. Therapeutic Shoes <ul><li>Focal pressure keratosis with accompanying risk factors are the major cause of ulcer. </li></ul><ul><li>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 </li></ul><ul><li>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. </li></ul>
  41. 41. Thank You!

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