CONDITIONS, TERMINOLOGY AND INSTRUMENTS COMMONLY

USED IN OFFICE PROCEDURES

Christopher Browning, DPMCindy Pezza, PMAC

ABSCESS

• Localized collection of pus in a cavity

• Podiatrists often perform what is referred to an “incision and drainage” to alleviate pressure

and infection

ANKLE FOOT ORTHOSIS/AFO

•An orthosis or brace that encumbers the ankle and foot. AFOs are externally applied

and intended to control position and motion of the ankle, compensate for

weakness, or correct deformities. •AFOs can be used to support weak limbs,

or to position a limb with contracted muscles into a more normal position. They are also used to immobilize the ankle and lower leg in the presence of arthritis or

fracture, and to correct drop foot.

ANESTHESIA

• Loss of feeling or sensation induced to permit surgery

•Common example: Injection given to “numb up” the toe prior to performing an ingrown

toenail procedure

APPLIANCES

• A mechanical device used to support or realign a part of the body or to improve

function •Common Example: Custom Orthotics as they

are used to correct biomechanical deficiency

ATHLETE’S FOOT (TINEA PEDIS)

• Layman term (“Athlete’s Foot”) for a fungus infection of the foot (skin)

•Common Example: “Interdigital tinea pedis” (between the toes)

ATROPHY

• A defect or wasting away in the size of a cell, organ, tissue or part.

BILATERAL

• Pertaining to, involving, or affecting two or both sides, factions, parties, or the like:

• Common Examples: bilateral ingrown toenails (on the medial and lateral sides of one toe or

medial sides of both great toes), or a condition involving both feet (as shown here)

BIOMECHANICAL DEFICIENCY

•Mal-alignment of limbs, muscular imbalances, degenerative processes, and other anatomical factors which may contribute to orthopedic

injury

•Common examples/symptoms: hyper-mobility, structural weakness, pronation, supination,

foot, knee, hip or back pain

BUNION (HALLUX ABDUCTOVALGUS)

•Deformity characterized by medial deviation of the first metatarsal and lateral deviation of the

hallux (big toe), often described as an enlargement of bone or tissue around the joint

at the head of the big toe.

BURSITIS

• The inflammation of bursa

CALLOSITY/CALLUS

• A circumscribed thickening of the skin; hypertrophy of the horny layer from friction; pressure, or other irritation/ same as callosity, also used to describe the healing following the

fracture of a bone

CHARCOT JOINT/CHARCOT FOOT“NEUROPATHIC ARTHROPATHY”

• Progressive degeneration of a weight bearing joint, a process marked by bony destruction,

bone resorption and eventual deformity • If this pathological process continues

unchecked, it could result in joint deformity, ulceration and/or super-infection, loss of function, and in the worst- cast scenario,

amputation and death. • Early identification of joint changes is the best

way to limit morbidity

CONTRACTED TOES

• Also called hammertoes, toes bent upward at the middle joint

•Often caused or worsened due to bunion deformity

CORN

• A horny induration and thickening of the skin, usually found on the toes, that is produced by friction and pressure followed by irritation and

pain.

•Common Example: corns are often caused by two hammertoes (that rub together due to

deformity)

CYST

• Pouch or sac, normal or abnormal, especially one that contains liquid or semisolid material

•Common Example: Ganglion cyst

DIABETES

• A metabolic disorder of blood vessels and nerves secondary to the inadequate ability of the pancreas to produce insulin and the body

to utilize it in metabolizing glucose. • It is especially important that Diabetic Patients

visit their Podiatrist regularly, manage their blood glucose levels and check their feet every

day•Diabetic Patients may not heal as quickly as non-diabetics and often suffer from a condition

know as “Neuropathy” which decreases sensation in the feet

DEBRIDEMENT

• The medical removal of dead, damaged, or infected tissue to improve healing potential of

the remaining healthy tissue. • Removal may be surgical, mechanical or

chemical and is generally performed on thickened toenails, calluses, warts and

ulcerations.

EDEMA

• Swelling, the presence of abnormally large amount of fluid in the tissue of the body.

• Examples shown here: Lower left (non-pitting edema – suggestive of a

problem with the lymphatic system)

Circled picture (pitting edema- suggestive of a circulatory issue)

EXCISION

•The act of cutting away or taking out tissue, bone, etc.

EXOSTOSIS

• Bony growth projecting outward from the surface of the bone.

FASCIA

• Ligamentous tissue, a layer of membrane beneath the skin.

•Common Example/Related Condition: Plantar Fasciitis (inflammation of the plantar fascia).

FISSURE

• Any cleft, crack, or groove, normal or abnormal

•Common Example: Heel fissures, grooves or cracks in callus of

heels)

FLATFOOT(PES PLANUS)

• A condition in which one or more of the arches of the foot have flattened out.

• This causes the foot to roll-in as seen here.

FRACTURE

• Break in a bone.

GAIT

•Manner or style of walking

• Podiatrists commonly perform “gait analysis” to see what happens during a patient’s normal

walking pattern, and to check for biomechanical deficiencies.

GANGRENE

•Death of a tissue associated with loss of blood supply followed by bacterial invasion and

putrefaction. • This may be due to an injury, poor circulation,

or an infection that was not controlled.

HALLUX

• The great toe or first digit of the foot.

HALLUX RIGIDUS

• Painful flexion deformity of the great toe where there is almost complete limitation of motion at the first metatarsophalangeal joint.• Often described by the patient as stiff or

painful especially with increased activity

HELOMA DURUM

•Hard Corn

•Often self- diagnosed by patient as a “wart”)

INGROWN NAILS

• Toenails that break through or cut into the skin or tissue around them to cause pain

• Commonly caused by improper trimming, improper shoes or hose, injury, or congenital

disorders.

METATARSALGIA

• Term to describe pathology in the metatarsal bones and phalangeal bones of the toes.

NEUROMA“MORTON’S NEUROMA”

• A tumor or new growth largely made up of nerve cells and nerve fibers: a tumor growing

from a nerve. • Patients often describe symptoms as burning,

tingling or feeling as if their sock is “bunched up” in their shoe

ONYCHO

• The combining word form denoting relationship to the nails. This prefix, combined with many suffixes, describes many diseases of

the nails.

•Common Examples:

Onychomycosis (Fungal nail)

Onychocryptosis (Ingrown Nail)

OSSIFICATION

• The formation of bone; the conversion of fibrous tissue into bone.

• This x-ray of a child’s foot clearly shows that the bone formation is not complete

OSTEOMYELITIS

• Inflammation of bone caused by pyogenic (pus-forming) bacteria.

• Long term ulceration/infection may lead to this type of complication potentially leading to

surgical resection or amputation

PALLIATIVE

• Affording relief, but not a cure.

• Palliative treatment in podiatry provides temporary relief of corns, calluses or nail

problems,

• It does not permanently resolve the cause of the problem (as in surgical correction).

PEDIS

• Latin term meaning “foot”

PERIPHERAL NEUROPATHY

•Damage to or disease affecting nerves which may impair sensation, movement, gland or organ function, or other aspects of health, depending on the type of nerve affected.

•Common causes include systemic diseases such as diabetes, leprosy, vitamin deficiency, and

medications such as chemotherapy.

• Symptoms include pain, burning, tingling, and numbness of the hands and feet and may

become worse if left untreated.

PHLEBITIS

• Inflammation of a vein

• Characterized by swelling, stiffness and pain in the affected part.

PRONATION

• The result of a combination of factors in the tarsal and metatarsal area of the foot which lowers the arch and allows the forefoot to

splay or turn outward from the midline of the body.

• Patients with “flat feet” pronate as shown in this picture

RESECTION

• Removal of bone.

SPRAIN

• A joint injury where the supporting ligaments are stretched or ruptured, but the continuity

of the ligaments remains in tact.

SPUR

• A projecting bony enlargement.

•Common Example: Heel spur, calcaneal spur, or spur of the “Os Calcis” (another term for heel

bone)

• A bone protruding from the lower surface of the heel bone.

STRAPPING

• A short term solution for help in obtaining better alignment / movement, reducing stress

to the area, reducing pain, allowing for the area to start healing and also help in distinguishing a

more beneficial long term solution to the underlying cause (use of custom orthotics).

SUBUNGUAL EXOSTOSIS

• Spur bone projected upward under the nail.

•Often the cause of repeated ingrown toenails (clearly shown through x-ray)

TENDON ACHILLES

• The tendon that connects the posterior calf muscles to the heel bone

• The strongest tendon in the body.

TENDONS/TENDINITIS

• Tendons are thick cords of tissue that connect muscles to bone.

• Tendinitis, or an inflammation of the tendon, is one of the most common causes of foot or

ankle pain.

TENOTOMY

• The cutting of a tendon for correction of contracted or hammertoes.

•When hammertoes are flexible and not rigid, a procedure referred to as a “Flexor

Tenotomy” can be performed

• In this procedure, the tendon is released and the toe is splinted as it heals, resulting in a

much straighter toe.

TUMOR

• Swelling, more often used to describe a mass of new tissue that persists and grows

independently of its surrounding structures. • A tumor has no physiologic use.

ULCERATION

• An open sore of the skin or mucous surface of a body organ, characterized by gradual

disintegration and necrosis (dying) of tissue.• It is important for Diabetics (especially those

with neuropathy -tingling and numbness) to check their feet everyday and wear white

soled socks to check for blood

UNILATERAL

• Single, one side

VERRUCA

• A tumorous growth of the skin

• More commonly referred to as a “wart” and caused by a virus

• The body works to protect the verruca by forming thickened skin (callus) over and

around the area which may be painful to the patient

• Plural Verrucae

BONES OF THE FOOT26 IN TOTAL

SIDES OF THE FOOT MEDIAL = TOWARDS THE

INSIDE LATERAL= TOWARDS THE

OUTSIDE

MOVEMENT OF THE FOOT

INVERSION = TOWARDS THE INSIDE OF THE BODY

EVERSION = AWAY FROM THE BODYDORSIFLEXION = MOVEMENT WHERE TOES ARE

BROUGHT CLOSER TO THE SHINPLANTAR FLEXION = MOVEMENT WHICH

DECREASES THE ANGLE BETWEEN THE SOLE OF THE FOOT AND THE BACK OF THE LEG. (THE

MOVEMENT WHEN DEPRESSING A CAR PEDAL)ABDUCTION = MOTION THAT PULLS A

STRUCTURE OR PART AWAY FROM THE MIDLINE OF THE BODY.

ADDUCTION = MOTION THAT PULLS A STRUCTURE OR PART TOWARD THE MIDLINE OF THE BODY

DISTAL = AWAY FROM(FURTHEST DISTANCE FROM

THE BODY)MIDDLE= BETWEEN

PROXIMAL = CLOSEST TO THE BODY

PODIATRIC INSTRUMENTS

PODIATRIC INSTRUMENTS

Podiatry utilizes a variety of instruments in our daily duties. These instruments require special care and

handling to ensure our safety and that of the patient.

TOENAIL NIPPERS

Podiatry utilizes Toenail Nippers when reducing or debriding toenails. Our

instruments are called Toenail Nippers and NOT clippers. Below are two toenail

clippers on the right for thin toenails. The Toenail Nippers on the left are sharper, have an angled tip, and a large handle. They are designed for thicker toenails and to wedge

out ingrowing toenails.

TOENAIL NIPPERS

These double action Nippers give the user more leverage when trimming very thick angulated toenails.

These single action Nippers trim thinner toenails with ease.

TISSUE NIPPERS

Tissue Nippers have a very sharp cutting edge to debride non viable skin and soft tissue.

The tip is angled so the user can easily reach deep tissue edges.

ENGLISH ANVIL

The English Anvil is a toenail splitter used during ingrown toenails. It cuts out the edge of the toenail from front to back.

HEMOSTATS

Straight Hemostat Curved Hemostat

A hemostat is essentially a type of gripping instrument. It is built similar to a pair of scissors, except it does not cut. The hemostat also has a locking function. They can have straight tips or curved tips.

TISSUE FORCEPS

Forceps can be used to touch sterile bandaging when a physician cannot touch it. Forceps can also hold onto small pieces of tissue during surgeries or in areas where the fingers cannot reach or fit.

Adson-BrownTissue Forceps are for holding and manipulating delicate tissues. These forceps have a wide, flat thumb grasp area that is commonly serrated. The jaws are short and the tips are narrow. Also just called “Browns.”

TISSUE FORCEPS

Forceps can be used to touch sterile bandaging when a physician cannot touch it. Forceps can also hold onto small pieces of tissue during surgeries or in areas where the fingers cannot reach or fit.

Adson Tissue Forceps have 1x2 teeth for gripper thicker tissues. Also called a “rat tooth” forcep.

TISSUE FORCEPS

Forceps can be used to touch sterile bandaging when a physician cannot touch it. Forceps can also hold onto small pieces of tissue during surgeries or in areas where the fingers cannot reach or fit.

Debakey Adson Forceps have smooth teeth for gripping delicate tissues without leaving marks or damaging tissues. These are also called “atraumatic forceps.”

NEEDLE HOLDER

A needle Holder is used when suturing to drive the needle through tissues.

SCISSORS

Scissors can be utilized for different functions. Cutting tissue, cutting bandages, and also for dissection.

Iris Scissorscurved

Bandage Scissors Iris Scissors straight

SURGICAL BLADE HANDLES

A flat blade handle is used for number 10

and number 15 blades. This blade handle utilized a groove

system to insert and the hold the blade.

A round blade handle is used for number 12 and number 310 blade handles. The tip is screwed out, a blade inserted, and the tips is screwed back to keep the blade in place.

SURGICAL BLADE HANDLES

These are number 10 and number 15 blades

for the flat blade handle.

These are number 312 and number 316 blades

for the round blade handle.

TOENAIL ELEVATOR OR TOENAIL LIFTER

The Toenail Elevator is used during ingrown toenail procedures to pry the corner of the

toenails or lift the entire toenail for removal. It is

also called the Toenail Lifter.

CURETTE

A curette is a surgical instrument designed for scraping or debriding biological tissue or debris in a biopsy, excision, or cleaning procedure. In form, the curette is a small hand tool, often

similar in shape to a stylus; at the tip of the curette is a small scoop, hook, or gouge.

CONCLUSION

• Podiatry practices utilize a large assortment of surgical instruments. You are required to know all of the instruments and be able to

recall and retrieve them at a moments notice.