Primary Foot Care Primary Foot Care

Common Nail Problems

When to Refer? When to Refer?

Fungal Nails

Fungal Nails - Treatment Routine Debridement Topical Agents Oral Agents Routine Debridement Topical Agents Oral 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 - Treatment

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Pedal Skin Problems Tinea Pedis Verrucae Corns & Callouses Tinea Pedis Verrucae Corns & Callouses

Tinea 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

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Verrucae

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Corns & Callouses

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 - 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 Tendons Interosseous Tendons Intermetatarsal Space Intermetatarsal Space Dorsal Digital Nerves Dorsal Digital Nerves Morton’s Neuroma Morton’s Neuroma Deep Transverse Intermetatarsal Ligament Deep Transverse Intermetatarsal Ligament Plantar Digital Nerves Plantar Digital Nerves Flexor Digitorum Longus Tendon Flexor Digitorum Longus 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 to Refer? When to Refer?

Hammertoes - 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-Op Post-Op

Pre-Op Post-Op

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

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When to Refer? When to Refer?

Heel Pain

Heel 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 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 Treatment

Flatfoot

When to Refer? When to Refer?

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:

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Conclusion