1. Office Longitudinal 12/1/2014 Jennifer Kelley, MD
Foot Problems
Office Longitudinal
12/1/2014
Jennifer Kelley, MD

2. Tinea Pedis

6. Plantar Warts

9. Corn
Seed corn, side of foot

14. Plantar Fasciitis

15. 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

16. 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)

17. 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

18. 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 medial MTP (or 5th toe bunionette). Can inject Steroid medial to joint (r/o Gout) if Nsaids fail

19. Q and A

20. 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

25. Other Foot Pains Morton’s Neuroma: b/w 3rd and 4th toe
Women due to pressure from shoes/heels

26. Bunion

27. Hammartoe
Hereditary? Tight footwear

28. Gout
Sometimes hard to differentiate from bunion