2016: Foot Care in Older Adults-Kruse
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Common foot problems in the geriatric population include bunions, plantar fasciitis, ingrown toenails, and fungal nails. Bunions can be treated conservatively with proper footwear or surgically if pain limits activity. Plantar fasciitis causes heel pain that improves with walking and can be treated with stretching, orthotics, and ice. Ingrown toenails are caused by trauma or improper nail cutting and may require partial or full nail removal. Fungal nails are treated with topical or oral antifungal medications and regular debridement. Proper foot care including daily examination is important for geriatric patients.
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ORAL CANDIDOSIS
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diabetic foot care
This document discusses diabetic foot, defining it as pathologic changes affecting the lower extremity in diabetics that can lead to amputation or death. It outlines the etiology as sensory neuropathy, ischemia, and infection. Treatment involves patient education, offloading, wound care, revascularization if needed, and limited amputation if infection is uncontrolled. Prevention focuses on glucose control, foot care, and accommodative shoe wear to avoid injury and ulceration.
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The document provides information about common foot problems and their causes. It discusses that 3 out of 4 people experience foot problems in their lifetime due to factors like ill-fitting shoes and neglect of proper foot care. It also notes that women experience foot issues like high heels more than men. The document includes diagrams of foot bones and ligaments as well as information about specific conditions like plantar fasciitis, bunions, corns and calluses, heel spurs, Achilles tendonitis, and diabetic foot complications.
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- 1. FOOT PROBLEMS IN THE GERIATRIC POPULATION Ingrid Kruse, DPM VA San Diego Healthcare System UCSD School of Medicine
- 5. Common Foot Problems in the Geriatric Population • Hallux Valgus (Bunion) • Ingrown toenails • Corns and Calluses • Plantar fasciitis (Heel pain) • Onychomycosis( Fungal nails)
- 6. 6 Bunions
- 7. Bunions: Conservative Treatment Proper Shoe gear OTC Arch supports Custom orthotics Bunion shields/padding
- 9. 9 Indications Pain Activity Limitation Deformity Must Have: Good circulation Good Diabetes control Appropriate expectations understand and accept risks Bunions: Surgical Treatment
- 11. Plantar calluses
- 12. PLANTAR FASCIITIS • Heel spur syndrome • Symptoms: – Pain after rest / improves on walking – “Stone bruise” – Sharp pain – Pain at end of day
- 13. 13 Heel Pain (plantar fasciitis)
- 14. 14 Proper Shoe gear for Plantar fasciitis • Shoes with solid heel counters • Shoes with thick mid-soles • Rocker bottom shoes
- 15. 15 Heel Pain (plantar fasciitis) stretching • Feet turned • Back and knee straight • No bouncing • 5 x 30 seconds / twice a day
- 16. 16 Heel Pain (plantar fasciitis) icing • 2-3 times per day x 10 minutes • Try using re-useable device: Plastic bottle with 4 parts water and one part rubbing alcohol store in freezer
- 17. 17 PLANTAR FASCIITIS • What NOT to do: • Thin-soled shoes • Walking bare foot • Fire dancing
- 18. 18 PLANTAR FASCIITIS Anti-inflammatory drugs Injections cortisone & local anesthesia Surgery – rarely indicated
- 20. Partial Nail Removal • Resolves infection • For recurrent problem: • Kill the root by chemical or Surgical method
- 21. 21 Surgical Treatment Matrixectomy : Permanent removal of nail Effective/Safe High satisfaction • 89% Phenol Ingrown Nails
- 22. 22 Signs & Symptoms Usually Pain Free Difficult to cut Nails can be thick, loose or discolored Can be ingrown Onychomycosis
- 23. 23 Causes Fungus invades nail bed Previous injury to nail Genetic factors Reduced Immune system • Fungal nails Onychomycosis
- 24. Onychomycosis • TOPICAL TREATMENTS: • 2% Miconazole tincture (Fungoid Tincture) • 10 % Efinaconazole ( Jublia) • 5% Tavaborole ( Kerydin)
- 25. 25 Oral Terbinafine (Lamisil) Most effective of the oral agents 250 mg q day x 3 months Reccurrence: 1yr = 15% 2yrs = 22% Must monitor liver function Onychomycosis
- 27. Onychomycosis • Regular debridements and thinning out of the nails • Homeopathic : • Tea Tree oil, Vick’s Vapor rub • Diluted vinegar soaks • Diluted bleach soaks
- 28. TINEA PEDIS • “Athlete’s Foot” • Cracks between the toes • Blisters in arch area or along side of foot • May be itchy or painful • Often just looks like dry scaly skin
- 30. ATHLETE’S FOOT • TREATMENT: • Lamisil creme • Spectazole creme • Lotrimine • Tinactin • KEY: use TWICE a day!
- 31. Other Foot Problems in the Geriatric Population • Peripheral Arterial Disease • Peripheral Neuropathy • Diabetes • Malignancies • Psoriasis • Gout
- 34. What is the diagnosis?
- 37. Walking barefoot in the House
- 38. Puncture Wound in Diabetic
- 39. Rusty Nail
- 42. 42 Make Foot Care Part of Your Daily Routine • Examine your feet every day. • Check your shoes before you put them on. • No “bathroom” surgery. • No barefoot walking, use proper shoes • Get early treatment for any foot problem, even a minor one.
- 43. Thank You!