Office Longitudinal 12/1/2014 Jennifer Kelley, MD Foot Problems Office Longitudinal 12/1/2014 Jennifer Kelley, MD
Tinea Pedis
Plantar Warts
Corn Seed corn, side of foot
Plantar Fasciitis
Onychomycosis Not all dystrophic nails are fungus (wt mount or culture?). Ischemia, age, shoe pressure cause it 3-4 mo Tx, eg. terbinafine 250mg qd 1/3-1/2 of prox nail looks “cured” before stopping Complete response in about 70% Most will re-infect at some point, so consider Itraconazole prophylaxis every other week? Ben Gay hs for mild cases? eg. white nail streaks
Ingrown toenail Treatment is removal ingrown portion ASAP; no need to treat w antibiotic 1st (2% lido via side of toe then remove ingrown wedge of nail; AgNo3 to “proud flesh” granulation) longer shoes, properly tied, cut nails straight across and past end of toe Recurrent ingrown nail = lilely abnormal nail at formation .Resect 25% of nail then do 3min 88% phenol to base (after 2% lido toe block)
Chronic Foot Strain (pain) Usually mid foot and ”metatarsalgia” Related to shoes and deformities, wt, flooring Proper footware and OTC full sole inserts Nsaids ,foot soaks & massage, less standing on hard surfaces
Bunions Does not occur in barefoot societies Surgery painful- not just for cosmesis w/o pain Bracing, taping may help some but proper footwear is critical. However, once deviation and rotation start , it will usually progress There can be a bunion bursitis if tender @ medial MTP (or 5th toe bunionette). Can inject Steroid medial to joint (r/o Gout) if Nsaids fail
Q and A
Dishydrotic Eczema Sweat gland irritation-infection Worse in sweaty hands or feet (summer/gloves/etc) Combination of TAC Cream + Mupiricin ointment works well Will reoccur and so may need maintenance Tx
Other Foot Pains Morton’s Neuroma: b/w 3rd and 4th toe Women due to pressure from shoes/heels
Bunion
Hammartoe Hereditary? Tight footwear
Gout Sometimes hard to differentiate from bunion