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Primary Foot Care. Common Nail Problems. When to Refer?. Fungal Nails. Fungal Nails - Treatment. Routine Debridement Topical Agents Oral Agents. Oral Agents. Fungal Nails - Treatment. Fluconazole (Diflucan) Itraconazole (Sporanox) Ketoconazole (Nizoral) Griseofulvin (Gris-peg) - PowerPoint PPT Presentation
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PrimaryFoot CarePrimary
Foot Care
Common Nail ProblemsCommon Nail Problems
When toRefer?
When toRefer?
Fungal NailsFungal Nails
Fungal Nails - Treatment
• Routine Debridement
• Topical Agents
• Oral Agents
• Routine Debridement
• Topical Agents
• Oral Agents
Oral AgentsOral Agents• Fluconazole (Diflucan)
• Itraconazole (Sporanox)
• Ketoconazole (Nizoral)
• Griseofulvin (Gris-peg)
• Terbinafine (Lamisil)
• Fluconazole (Diflucan)
• Itraconazole (Sporanox)
• Ketoconazole (Nizoral)
• Griseofulvin (Gris-peg)
• Terbinafine (Lamisil)
Fungal Nails - TreatmentFungal Nails - Treatment
When toRefer?
When toRefer?
Pedal Skin ProblemsPedal Skin Problems
• Tinea Pedis
• Verrucae
• Corns & Callouses
• Tinea Pedis
• Verrucae
• Corns & Callouses
Tinea PedisTinea Pedis
Tinea Pedis - Etiology
• Dermatophytes– Trichophyton
– Epidermophyton
– Microsporum
• Saprophytes and Yeast
• Bacteria
Tinea Pedis - Treatment• Topical Agents
– Imidazoles: miconazole, clotrimazole, sulconazole, etc.
– Others: undecylenic acid, tolnaftate
• Oral Agents– Used in severe/resistant cases– Griseofulvin, ketoconazole– Fluconazole, itraconazole, terbinafine
• Local Care
When toRefer?
When toRefer?
VerrucaeVerrucae
When toRefer?
When toRefer?
Corns & CallousesCorns & Callouses
Corns - When to Refer?Corns - When to Refer?
• Multiple Lesions
• Multiple Digital Deformities as Cause
• Rigid Digital Contractures
• Ulcerative Lesion– Immediate– Definitive
• Diabetics, PVD, Neuropathic
• Multiple Lesions
• Multiple Digital Deformities as Cause
• Rigid Digital Contractures
• Ulcerative Lesion– Immediate– Definitive
• Diabetics, PVD, Neuropathic
Morton’s Neuroma - EtiologyMorton’s Neuroma - Etiology• Narrow Shoes (Primary Cause)• High Heels• Biomechanical (Functional) Abnormalities
– Excessive pronation– Flatfoot– Hammertoes
• Traumatic • Anatomic
• Narrow Shoes (Primary Cause)• High Heels• Biomechanical (Functional) Abnormalities
– Excessive pronation– Flatfoot– Hammertoes
• Traumatic • Anatomic
Interosseous TendonsInterosseous Tendons
IntermetatarsalSpace
IntermetatarsalSpace
Dorsal DigitalNerves
Dorsal DigitalNerves
Morton’sNeuromaMorton’sNeuroma Deep Transverse
IntermetatarsalLigament
Deep TransverseIntermetatarsalLigament
Plantar DigitalNervesPlantar DigitalNerves
Flexor DigitorumLongus TendonFlexor DigitorumLongus Tendon
Morton’s Neuroma - Symptoms• Burning
• Tingling
• Numbness (Usually only Subjective)
• Radiating Pain into the Involved Toes
• Feeling as Though “Walking on a Pea” or “Sock is Bunched Up”
• Strong Desire to Stop, Remove Shoe, and Massage Forefoot
• Burning
• Tingling
• Numbness (Usually only Subjective)
• Radiating Pain into the Involved Toes
• Feeling as Though “Walking on a Pea” or “Sock is Bunched Up”
• Strong Desire to Stop, Remove Shoe, and Massage Forefoot
When toRefer?
When toRefer?
Hammertoes -Conservative TreatmentHammertoes -Conservative Treatment• Treat Only the Symptoms
• Aperature Pads
• Splints
• Extra-depth Shoes
• Caution When Using Acid Plasters In:– Diabetics– PVD– Neuropathic
• Treat Only the Symptoms
• Aperature Pads
• Splints
• Extra-depth Shoes
• Caution When Using Acid Plasters In:– Diabetics– PVD– Neuropathic
Pre-OpPre-Op
Post-OpPost-Op
Pre-OpPre-Op
Post-OpPost-Op
Hammertoes - When to Refer?Hammertoes - When to Refer?
• Rigid Deformities
• Recurrent Ulceration
• Chronic Pain in All Types of Shoes
• Other Associated/Contributing Deformities
• Patient No Longer Satisfied with Conservative Therapy
• Rigid Deformities
• Recurrent Ulceration
• Chronic Pain in All Types of Shoes
• Other Associated/Contributing Deformities
• Patient No Longer Satisfied with Conservative Therapy
190
When toRefer?
When toRefer?
Heel PainHeel Pain
Heel Pain - EtiologyHeel Pain - Etiology
• Plantar Fasciitis/Heel Spur Syndrome
• Heel Bursitis
• Nerve Entrapment
• Stress Fracture
• Systemic Arthritides
• Biomechanical
• Obesity
• Plantar Fasciitis/Heel Spur Syndrome
• Heel Bursitis
• Nerve Entrapment
• Stress Fracture
• Systemic Arthritides
• Biomechanical
• Obesity
Heel Spur Syndrome/Plantar FasciitisHeel Spur Syndrome/Plantar Fasciitis
• Rest Strap• OTC Arch Support• Custom Orthotic• NSAIDs• Injections - Cortisone• Stretching Exercises• Physical Therapy
• Rest Strap• OTC Arch Support• Custom Orthotic• NSAIDs• Injections - Cortisone• Stretching Exercises• Physical Therapy
Conservative TreatmentConservative Treatment
FlatfootFlatfoot
When toRefer?
When toRefer?
Flatfoot - Why Treat?
• Bunion Deformity
• Hammer Digit Syndrome
• Metatarsalgia
• Chronic Plantar Fasciitis/HSS
• Postural Pains in Legs, Knees, Back
• Arthritis of Involved Joints (AJ,STJ,MTJ)
• Bunion Deformity
• Hammer Digit Syndrome
• Metatarsalgia
• Chronic Plantar Fasciitis/HSS
• Postural Pains in Legs, Knees, Back
• Arthritis of Involved Joints (AJ,STJ,MTJ)
Conditions Associated with Untreated Flatfoot:
When toRefer?
When toRefer?
ConclusionConclusion
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