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Diagnosis and Treatment of Diagnosis and Treatment of Common Foot Conditions Common Foot Conditions Your Name and address here Your Name and address here

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Page 1: Commonwealth Foot & Ankle Treatments

Diagnosis and Treatment of Diagnosis and Treatment of Common Foot ConditionsCommon Foot Conditions

Your Name and address hereYour Name and address here

Page 2: Commonwealth Foot & Ankle Treatments

What is a Podiatrist?What is a Podiatrist?

Specializes in diagnosis and treatment of Specializes in diagnosis and treatment of conditions effecting the foot, ankle and conditions effecting the foot, ankle and lower leg in all age groupslower leg in all age groups

Attends one of seven Colleges of Podiatric Attends one of seven Colleges of Podiatric Medicine for four yearsMedicine for four years

Completes a post-graduate residency Completes a post-graduate residency between one and four yearsbetween one and four years

Page 3: Commonwealth Foot & Ankle Treatments

Conditions We TreatConditions We Treat

DermatologicDermatologic OrthopedicOrthopedic NeurologicNeurologic Diabetes-related foot and ankle Diabetes-related foot and ankle

ailmentsailments

Page 4: Commonwealth Foot & Ankle Treatments

Dermatologic ConditionsDermatologic Conditions

OnychomycosisOnychomycosis ParonychiaParonychia VeruccaVerucca Tinea PedisTinea Pedis

Page 5: Commonwealth Foot & Ankle Treatments

Orthopaedic ConditionsOrthopaedic Conditions

Plantar FasciitisPlantar Fasciitis HammertoeHammertoe Bunion and Bunion and

bunionettebunionette Osteoarthritis and Osteoarthritis and

Bone spursBone spurs Sports medicine Sports medicine

related injuriesrelated injuries

Page 6: Commonwealth Foot & Ankle Treatments

Neurologic ConditionsNeurologic Conditions

NeuromaNeuroma Cutaneous Nerve Cutaneous Nerve

EntrapmentEntrapment NeuropathyNeuropathy Tarsal Tunnel Tarsal Tunnel

SyndromeSyndrome

Page 7: Commonwealth Foot & Ankle Treatments

Diabetes Related Foot and Ankle Diabetes Related Foot and Ankle ConditionsConditions

Neurotrophic UlcersNeurotrophic Ulcers NeuropathyNeuropathy Charcot FootCharcot Foot

Page 8: Commonwealth Foot & Ankle Treatments

OnychomycosisOnychomycosis

DermatophyteDermatophyte Often seen with skin Often seen with skin

manifestationsmanifestations Usually acquired but Usually acquired but

may be inheritedmay be inherited More treatable than in More treatable than in

the pastthe past Differentiate from Differentiate from

MelanomaMelanoma

Page 9: Commonwealth Foot & Ankle Treatments

Onychomycosis TreatmentOnychomycosis Treatment

DebridementDebridement TopicalTopical OralOral MatrixectomyMatrixectomy Nail Biopsy for Nail Biopsy for

dermatopathologydermatopathology

Page 10: Commonwealth Foot & Ankle Treatments

ParonychiaParonychia

Erythema and edema Erythema and edema of the ungual labiaof the ungual labia

Wide or incurvated Wide or incurvated nail platenail plate

May drain serous to May drain serous to purulent exudatepurulent exudate

Hallux most effectedHallux most effected

Page 11: Commonwealth Foot & Ankle Treatments

Paronychia TreatmentParonychia Treatment

Incision and DrainageIncision and Drainage Oral antibiotics usually Oral antibiotics usually

not necessarynot necessary Longstanding infection Longstanding infection

may require X-raymay require X-ray Chemical Chemical

matrixectomy, partial matrixectomy, partial or totalor total

Page 12: Commonwealth Foot & Ankle Treatments

Verruca? Verruca?

Page 13: Commonwealth Foot & Ankle Treatments

Verruca!Verruca!

Human Papilloma Human Papilloma Virus (HPV)Virus (HPV)

ContagiousContagious Usually plantar on Usually plantar on

footfoot

Page 14: Commonwealth Foot & Ankle Treatments

Verruca TreatmentVerruca Treatment

Debridement is diagnostic and Debridement is diagnostic and therapeutictherapeutic

ChemocauteryChemocautery Various topical treatments availableVarious topical treatments available Oral Cimetidine for pediatric usage Oral Cimetidine for pediatric usage

(30-40Mg/Kg in 3 divided doses)(30-40Mg/Kg in 3 divided doses) CurretageCurretage

Page 15: Commonwealth Foot & Ankle Treatments

Plantar FasciitisPlantar Fasciitis Inflammation and pain Inflammation and pain

of the plantar fascia, of the plantar fascia, usually at its insertion usually at its insertion at the plantar medial at the plantar medial tubercle of the tubercle of the calcaneouscalcaneous

Becomes chronic in 5-Becomes chronic in 5-10% of all patients10% of all patients

Is not necessarily Is not necessarily associated with a heel associated with a heel spurspur

Over 90% resolve with Over 90% resolve with conservative conservative treatmenttreatment

Page 16: Commonwealth Foot & Ankle Treatments

Plantar Fasciitis SymptomsPlantar Fasciitis Symptoms

Weight-bearing pain on Weight-bearing pain on arisingarising

Pain subsides, returns Pain subsides, returns with activitywith activity

Footwear related to pain?Footwear related to pain?

Page 17: Commonwealth Foot & Ankle Treatments

Plantar Fasciitis Risk FactorsPlantar Fasciitis Risk Factors

Weight gainWeight gain Equinus deformityEquinus deformity Poor shoegearPoor shoegear Biomechanical Biomechanical

abnormalitiesabnormalities Work SurfaceWork Surface

Page 18: Commonwealth Foot & Ankle Treatments

Plantar Fasciitis DiagnosisPlantar Fasciitis Diagnosis

Pain on palpation Pain on palpation Antalgic gaitAntalgic gait Pes planusPes planus X-rayX-ray UltrasoundUltrasound

Page 19: Commonwealth Foot & Ankle Treatments

Plantar Fasciitis TreatmentPlantar Fasciitis Treatment

StretchingStretching RICERICE Change shoesChange shoes OTC insertsOTC inserts

Page 20: Commonwealth Foot & Ankle Treatments

Plantar Fasciitis TreatmentPlantar Fasciitis Treatment

Nocturnal Anti-Nocturnal Anti-contracture contracture DevicesDevices

OrthoticsOrthotics NSAIDSNSAIDS Cortisone shot(s)Cortisone shot(s) Rarely surgeryRarely surgery

Page 21: Commonwealth Foot & Ankle Treatments

ESWTESWT

Heel LithotripsyHeel Lithotripsy Surgical alternativeSurgical alternative 72% effective72% effective 3 months until 3 months until

significant relief in significant relief in most patientsmost patients

Few complicationsFew complications

Page 22: Commonwealth Foot & Ankle Treatments

HammertoeHammertoe

Digital ContractureDigital Contracture Usually PIPJUsually PIPJ May have MPJ May have MPJ

dorsiflexiondorsiflexion May have clavusMay have clavus Pre-ulcerative in Pre-ulcerative in

patients with patients with diabetesdiabetes

Page 23: Commonwealth Foot & Ankle Treatments

Hammertoe TreatmentHammertoe Treatment

DebridementDebridement PaddingPadding Shoe gear changeShoe gear change Surgery as a last Surgery as a last

optionoption

Page 24: Commonwealth Foot & Ankle Treatments

Hallux Valgus Hallux Valgus

Painful bump Painful bump secondary to increase secondary to increase IM angleIM angle

Poor biomechanicsPoor biomechanics Hurts in shoesHurts in shoes Usually bump pain vs Usually bump pain vs

joint painjoint pain Wider shoes helpWider shoes help Orthotics slow or stop Orthotics slow or stop

progression and painprogression and pain

Page 25: Commonwealth Foot & Ankle Treatments

OsteoarthritisOsteoarthritis

Usually at first MPJUsually at first MPJ Hallux Hallux

limitus/rigiduslimitus/rigidus Poor biomechanicsPoor biomechanics Painful to walkPainful to walk

Page 26: Commonwealth Foot & Ankle Treatments

Osteoarthritis TreatmentOsteoarthritis Treatment

Cortisone injectionCortisone injection Physical therapyPhysical therapy NSAIDSNSAIDS OrthoticsOrthotics SurgerySurgery

Page 27: Commonwealth Foot & Ankle Treatments

Ankle - Foot OrthosisAnkle - Foot Orthosis

Articulated hinge Articulated hinge devicedevice

Used when Used when functional orthotic functional orthotic fails or will failfails or will fail

For active patient For active patient that can tolerate that can tolerate motionmotion

Excellent for sportsExcellent for sports

Page 28: Commonwealth Foot & Ankle Treatments

Ankle – Foot OrthosisAnkle – Foot Orthosis

Gauntlet style for Gauntlet style for total control total control

For patients that For patients that cannot tolerate cannot tolerate motionmotion

Good for severe Good for severe DJD and Charcot DJD and Charcot footfoot

Page 29: Commonwealth Foot & Ankle Treatments

Ankle SprainsAnkle Sprains Tear or stretching of the

ligaments of the ankle. Usually the ligaments on the outside of the ankle are involved.

Caused by and twisting injury of the foot / ankle .

Instability of the ankle can develop due to the ligament injury.

Most often treated conservatively. Surgical repair can be performed to treat chronic ankle sprains.

Page 30: Commonwealth Foot & Ankle Treatments

Ankle SprainsAnkle SprainsTreatmentTreatment

Immobilize early Immobilize early Consider Non-Consider Non-

Weight bearingWeight bearing RICERICE NSAIDSNSAIDS

Page 31: Commonwealth Foot & Ankle Treatments

Ankle SprainsAnkle SprainsRehabilitationRehabilitation

CAM walker to CAM walker to StirrupStirrup

Stirrup to gauntletStirrup to gauntlet Physical therapyPhysical therapy

Page 32: Commonwealth Foot & Ankle Treatments

Morton’s NeuromaMorton’s Neuroma

Painful swelling of the Painful swelling of the interdigital nerveinterdigital nerve

Most commonly seen Most commonly seen in third web spacein third web space

Patients can feel Patients can feel numbness of adjacent numbness of adjacent digits and plantar paindigits and plantar pain

Etiology is abnormal Etiology is abnormal stretching of the nervestretching of the nerve

Page 33: Commonwealth Foot & Ankle Treatments

Morton’s Neuroma Differential Morton’s Neuroma Differential DiagnosisDiagnosis

Stress fractureStress fracture CallusCallus Freiberg's Freiberg's

infractioninfraction CapsulitisCapsulitis Bone tumorBone tumor Local manifestation Local manifestation

of systemic diseaseof systemic disease

Page 34: Commonwealth Foot & Ankle Treatments

Morton’s Neuroma TreatmentMorton’s Neuroma Treatment

Change shoe gearChange shoe gear PaddingPadding OrthoticOrthotic Cortisone injectionCortisone injection 4% dehydrated 4% dehydrated

alcohol injection for alcohol injection for neurolysisneurolysis

Surgical excisionSurgical excision

Page 35: Commonwealth Foot & Ankle Treatments

Diabetic ulcerDiabetic ulcer

Etiology is usually Etiology is usually traumatic caused by traumatic caused by shoesshoes

Bony promonence is Bony promonence is usually involved usually involved (hammertoe, bunion, (hammertoe, bunion, plantarflexed plantarflexed metatarsal, bone spur)metatarsal, bone spur)

Often start as a Often start as a blister, corn or callousblister, corn or callous

Page 36: Commonwealth Foot & Ankle Treatments

Diabetic ulcer treatmentDiabetic ulcer treatment Always obtain serial X-rays Always obtain serial X-rays

to rule out osteomyelitisto rule out osteomyelitis Debride the wound to Debride the wound to

granular bedgranular bed Remove hyperkeratosisRemove hyperkeratosis Gently probe wound for Gently probe wound for

deep sinusdeep sinus Dress initially with Dress initially with

Silvadene creamSilvadene cream Consider other wound Consider other wound

productsproducts Consider offloadingConsider offloading

Page 37: Commonwealth Foot & Ankle Treatments

Charcot JointCharcot Joint Diabetic Diabetic

NeuroarthropathyNeuroarthropathy Often involves both Often involves both

pathologic dislocation pathologic dislocation and fractureand fracture

Usually effects Usually effects midfoot, but all lower midfoot, but all lower extremity joints are extremity joints are susceptiblesusceptible

Foot is acutely Foot is acutely edematous and warmedematous and warm

Deformity is commonDeformity is common

Page 38: Commonwealth Foot & Ankle Treatments

Charcot Joint TreatmentCharcot Joint Treatment

Non-weight bearing Non-weight bearing for 12 weeksfor 12 weeks

Patient education is Patient education is critical to outcomecritical to outcome

Serial X-rays to Serial X-rays to document deformitydocument deformity

Molded shoe often Molded shoe often needed after needed after coalescencecoalescence

Surgical TreatmentSurgical Treatment

Page 39: Commonwealth Foot & Ankle Treatments

Therapeutic ShoesTherapeutic Shoes

Newly diagnosed + Newly diagnosed + 33% 1990’s33% 1990’s

Amputations + Amputations + 28% 2000 -200128% 2000 -2001

Medicare has Medicare has stated that 50% of stated that 50% of amputations were amputations were preventablepreventable

Page 40: Commonwealth Foot & Ankle Treatments

Therapeutic ShoesTherapeutic Shoes

Focal pressure keratosis with Focal pressure keratosis with accompanying risk factors are the major accompanying risk factors are the major cause of ulcer.cause of ulcer.

Patients who have regular, frequent foot Patients who have regular, frequent foot clinic visits that include risk evaluation, clinic visits that include risk evaluation, debridement of lesions, prescription of debridement of lesions, prescription of appropriate shoes and patient education appropriate shoes and patient education are less likely to ulcerate. 1are less likely to ulcerate. 1

1 Sage RA, Webster JK, Fisher SG: Outpatient Care and Morbidity Reduction in Diabetic Foot Ulcers Associated with Chronic 1 Sage RA, Webster JK, Fisher SG: Outpatient Care and Morbidity Reduction in Diabetic Foot Ulcers Associated with Chronic Pressure Callus. JAPMA Pressure Callus. JAPMA 9191:275, 2001.:275, 2001.

Page 41: Commonwealth Foot & Ankle Treatments

Thank You!Thank You!