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Doctor Thierry HO-PUN-CHEUNG
Blisters, feet's bad smell, ingrown nail, tendinopathy…
FOOT's DISEASES
Tips for isolated doctor
Colloque médecine des missions extérieures 2008
- scorch / bullae (blisters)
- microtraumatic foot lesions
favored by:
- the constant wearing of shoes (RANGERS)
- intense physical effort , not progressive
- poor hygiene
however, the foot
= KEY SENSOR of the POSTURAL SYSTEM
ANY DISTURBANCE of ground SUPPORT

DISTURBANCE of POSTURE
and FOOT roll at STEP

CONSTRAINTS PATHOLOGIES
on LOWER LIMB, SPINE and PELVIS
3
1. PLANTAR HYPERHIDROSIS
20% = WET SOCKS (even in winter)
Aftermath :
→ maceration + soft and fragile skin

- scorch, blisters
- Mycosis
- Bromhidrose (horrible smell)
If FOOT ORTHOTICS = airing every day
ANTIPERSPIRANT POWDER
= Obstructs the pores by keratinization
HYDROCORTISON CREAM
EVERY NIGHT
then 2 times per week
For maintenance
Irritating early !
TREATMENT of plantar HYPERHIDROSIS
if failure → IONOPHORESIS
(Dermatologist otherwise cheap store)
4 sessions 30 min / week
then 1 / week, then 1 / month
KERATOLYSIS PUNCTUATED
+++ Bad smell (Corynebacterium)
- povidone iodine = to lather
- antibiotic gel: 2 times per day for 15 days
- imidazole cream
classique = défaut de coupe2. NAIL EMBODIED = bad cut
Stade 1: wearing shoes PAIN
→ DENTAL WIRE / SUTURE WIRE
STRAPPING
Stage 2: painful inflammatory bead
→ Resection of the nail spur
+ Baths antiseptic toe
+ Povidone iodine gel bandage
Stade 3: PERMANENT PAIN = INFECTION
→ BUDDING
PYOGENIC GRANULOMA : EMLA®
→ CURETTAGE / dermocorticoid Lysis
If FAIL / RECIDIVISM:
→ Partial EXTRACTION OF the NAIL LAME
then matrix phenolization
3. FROSTBITE OF TOES
warm bath = 38°C + ANTISEPTIC
Aspirin 250 mg
BENIGN but PAINFUL
→ CHANGE SUPPORT

-TENDINOPATHIES
-IMBALANCE WALKS
Causes: plantar hyper support
or excessive skin on
per shoe / sock's fold
SCORCH
= diffuse painful irritation of the skin (burning 1)
BLISTER
= localized scorch and serous detachment of the
dermis (superficial burns 2)
4. SCORCH and BLISTERS of FEET
= that of a 1st degree burn
disinfection
moisturizer
SCORCH Treatment
BLISTERS Treatment
A. FOR FINISH THE HIKE / WALK:
AVOID INFECTION = never put a wire in the blister !!!
DISINFECTION
VACUUM with STERILE NEEDLE AND SYRINGE
DRILL 3 HOLES
Dry
dressing protector Hydrocolloid
B. AT THE END OF WALK:
DISINFECTION
if blister ceiling is torn : Cut it in a sterile way
let it outdoors, otherwise DRESSING PROTECTOR
Until the skin tans:
DRESSING PROTECTOR HYDROCOLLOID
SOCKS = SEAMLESS
if aggressive fold foothills of rangers
→ HOOF OIL BEEF
PLANTAR ORTHOSES if static disorder
→ reduces hyper support
Treat plantar hyperhidrosis and dry feet
BLISTERS - SCORCH PREVENTION
NB: Personal double-bind Study > 600 military : the anti-scorch creams and
cushioned midsoles were ineffective !!!
3 days before the march:
> 7 days before a long walk
→ LEMON JUICE
(citric acid)
Calcaneal tendon surrounded by sliding bursa
5. CALCANEAL BURSITIS
5.1. RETRO CALCANEAL BURSITIS
= RUBBING OF THE RETROCALCANEAL FAT BURSA
(Bovis bursa : located between the Achilles tendon and skin)
PAINFUL SWELLING BEHIND THE CALCANEAL TENDON
5.2. PRE CALCANEAL BURSITIS
= support of the rangers' foothills
crushes this bursa between
the calcaneal tendon
and the posterior superior face of the calcaneus.
failure → lateral radiograph
? hypertrophy posterior superior part of the
calcaneus tuberosity
= Haglund Disease
+ - Surgical
exempted of shoes buttress
Dynamic Manual Adhesiolysis®
Icings
Bilateral heel damping = 1 cm high
CALCANEAL BURSITIS TREATMENT
SOFTEN THE FOOTHILLS OF THE RANGERS
= HOOF OIL BEEF
FLEXIBLE RANGERS
If failure → MESOTHERAPY
Dynamic Manual Adhesiolysis® +++:
Calcaneal Tendon,
Soleus/Gastrocnemius,
Plantar Flexors…
Stretching
Strengthening
5.3. CALCANEAL TENDINOPATHIES (1/3 = BURSITIS)
strapping :
If compulsory Walk
painful foot edema + impotence
= Thinking
6. STRESS FRACTURES
Tuning Fork Test (128Hz)+++
→ EXQUISITE PAIN
attenuation of sound propagation
STRESS
FRACTURE
+ Auscultation (Barford Test):
STRESS FRACTURE Treatment
Treating a vitamin D (Hormone D) deficiency
= Dynamic Manual Adhesiolysis®
SOFTEN Plantar fasciae:
- Shiatsu Massage Cushion +++
7.1. CORPOREAL PLANTAR FASCIITIS
7. PLANTAR FASCIITIS
Plantar pain + common in military > 40 years
7.2. PROXIMAL PLANTAR FASCIITIS
Dynamic Manual Adhesiolysis®
If failure: corticosteroid infiltration to the
insertion of FLEXOR PLANTARIS
heavy backpack (up to 30 kg)
favored by FLAT VALGUS FEET of the older walkers
+ - PLANTAR ORTHOSES
Analgesic TAPING
8. POSTERIOR TIBIALIS TENDINOPATHY
Tibial postérieur
TREATMENT
Dynamic Manual Adhesiolysis®
+ Strengthening FOOT ARCH
↘ ACID Food proportion (uric acid and oxalic acid)
which promote the precipitation of oxalate and sodium urate
crystals in the fasciae-tendon-muscle tissues → ADHESIONS
limiting excess:
MEAT, MEAT, DAIRY, peanut
TEA black, COFFEE / WHITE FLOUR, SUGAR
FACTORIES
↗ALKALINE Food:
FRUIT, VEGETABLE FEES
Natural FOOD FORM Omega-3, vitamin D
DIETARY common sense RULES
Avoid CHRONIC DEHYDRATION
which often precedes tendinopathy
9. Some GENERAL actions of PREVENTION
REPAY absolutely
the "SLEEP DEBT"
"This is the night
that the body regenerates"
Before a night march:
"preventive“ nap

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Foot diseases tips for isolated doctor

  • 1. Doctor Thierry HO-PUN-CHEUNG Blisters, feet's bad smell, ingrown nail, tendinopathy… FOOT's DISEASES Tips for isolated doctor Colloque médecine des missions extérieures 2008
  • 2. - scorch / bullae (blisters) - microtraumatic foot lesions favored by: - the constant wearing of shoes (RANGERS) - intense physical effort , not progressive - poor hygiene however, the foot = KEY SENSOR of the POSTURAL SYSTEM ANY DISTURBANCE of ground SUPPORT  DISTURBANCE of POSTURE and FOOT roll at STEP  CONSTRAINTS PATHOLOGIES on LOWER LIMB, SPINE and PELVIS 3
  • 3. 1. PLANTAR HYPERHIDROSIS 20% = WET SOCKS (even in winter) Aftermath : → maceration + soft and fragile skin  - scorch, blisters - Mycosis - Bromhidrose (horrible smell)
  • 4. If FOOT ORTHOTICS = airing every day ANTIPERSPIRANT POWDER = Obstructs the pores by keratinization HYDROCORTISON CREAM EVERY NIGHT then 2 times per week For maintenance Irritating early ! TREATMENT of plantar HYPERHIDROSIS if failure → IONOPHORESIS (Dermatologist otherwise cheap store) 4 sessions 30 min / week then 1 / week, then 1 / month
  • 5. KERATOLYSIS PUNCTUATED +++ Bad smell (Corynebacterium) - povidone iodine = to lather - antibiotic gel: 2 times per day for 15 days - imidazole cream
  • 6. classique = défaut de coupe2. NAIL EMBODIED = bad cut Stade 1: wearing shoes PAIN → DENTAL WIRE / SUTURE WIRE STRAPPING
  • 7. Stage 2: painful inflammatory bead → Resection of the nail spur + Baths antiseptic toe + Povidone iodine gel bandage Stade 3: PERMANENT PAIN = INFECTION → BUDDING PYOGENIC GRANULOMA : EMLA® → CURETTAGE / dermocorticoid Lysis If FAIL / RECIDIVISM: → Partial EXTRACTION OF the NAIL LAME then matrix phenolization
  • 8. 3. FROSTBITE OF TOES warm bath = 38°C + ANTISEPTIC Aspirin 250 mg
  • 9. BENIGN but PAINFUL → CHANGE SUPPORT  -TENDINOPATHIES -IMBALANCE WALKS Causes: plantar hyper support or excessive skin on per shoe / sock's fold SCORCH = diffuse painful irritation of the skin (burning 1) BLISTER = localized scorch and serous detachment of the dermis (superficial burns 2) 4. SCORCH and BLISTERS of FEET
  • 10. = that of a 1st degree burn disinfection moisturizer SCORCH Treatment BLISTERS Treatment A. FOR FINISH THE HIKE / WALK: AVOID INFECTION = never put a wire in the blister !!! DISINFECTION VACUUM with STERILE NEEDLE AND SYRINGE DRILL 3 HOLES Dry dressing protector Hydrocolloid B. AT THE END OF WALK: DISINFECTION if blister ceiling is torn : Cut it in a sterile way let it outdoors, otherwise DRESSING PROTECTOR
  • 11. Until the skin tans: DRESSING PROTECTOR HYDROCOLLOID SOCKS = SEAMLESS if aggressive fold foothills of rangers → HOOF OIL BEEF PLANTAR ORTHOSES if static disorder → reduces hyper support Treat plantar hyperhidrosis and dry feet BLISTERS - SCORCH PREVENTION NB: Personal double-bind Study > 600 military : the anti-scorch creams and cushioned midsoles were ineffective !!! 3 days before the march: > 7 days before a long walk → LEMON JUICE (citric acid)
  • 12. Calcaneal tendon surrounded by sliding bursa 5. CALCANEAL BURSITIS 5.1. RETRO CALCANEAL BURSITIS = RUBBING OF THE RETROCALCANEAL FAT BURSA (Bovis bursa : located between the Achilles tendon and skin) PAINFUL SWELLING BEHIND THE CALCANEAL TENDON
  • 13. 5.2. PRE CALCANEAL BURSITIS = support of the rangers' foothills crushes this bursa between the calcaneal tendon and the posterior superior face of the calcaneus. failure → lateral radiograph ? hypertrophy posterior superior part of the calcaneus tuberosity = Haglund Disease + - Surgical
  • 14. exempted of shoes buttress Dynamic Manual Adhesiolysis® Icings Bilateral heel damping = 1 cm high CALCANEAL BURSITIS TREATMENT SOFTEN THE FOOTHILLS OF THE RANGERS = HOOF OIL BEEF FLEXIBLE RANGERS If failure → MESOTHERAPY
  • 15. Dynamic Manual Adhesiolysis® +++: Calcaneal Tendon, Soleus/Gastrocnemius, Plantar Flexors… Stretching Strengthening 5.3. CALCANEAL TENDINOPATHIES (1/3 = BURSITIS) strapping : If compulsory Walk
  • 16. painful foot edema + impotence = Thinking 6. STRESS FRACTURES
  • 17. Tuning Fork Test (128Hz)+++ → EXQUISITE PAIN attenuation of sound propagation STRESS FRACTURE + Auscultation (Barford Test): STRESS FRACTURE Treatment Treating a vitamin D (Hormone D) deficiency
  • 18. = Dynamic Manual Adhesiolysis® SOFTEN Plantar fasciae: - Shiatsu Massage Cushion +++ 7.1. CORPOREAL PLANTAR FASCIITIS 7. PLANTAR FASCIITIS Plantar pain + common in military > 40 years
  • 19. 7.2. PROXIMAL PLANTAR FASCIITIS Dynamic Manual Adhesiolysis® If failure: corticosteroid infiltration to the insertion of FLEXOR PLANTARIS heavy backpack (up to 30 kg)
  • 20. favored by FLAT VALGUS FEET of the older walkers + - PLANTAR ORTHOSES Analgesic TAPING 8. POSTERIOR TIBIALIS TENDINOPATHY Tibial postérieur TREATMENT Dynamic Manual Adhesiolysis® + Strengthening FOOT ARCH
  • 21. ↘ ACID Food proportion (uric acid and oxalic acid) which promote the precipitation of oxalate and sodium urate crystals in the fasciae-tendon-muscle tissues → ADHESIONS limiting excess: MEAT, MEAT, DAIRY, peanut TEA black, COFFEE / WHITE FLOUR, SUGAR FACTORIES ↗ALKALINE Food: FRUIT, VEGETABLE FEES Natural FOOD FORM Omega-3, vitamin D DIETARY common sense RULES Avoid CHRONIC DEHYDRATION which often precedes tendinopathy 9. Some GENERAL actions of PREVENTION
  • 22. REPAY absolutely the "SLEEP DEBT" "This is the night that the body regenerates" Before a night march: "preventive“ nap