1. Office Longitudinal 12/1/2018 Jennifer Kelley, MD
Foot Problems
Office Longitudinal
12/1/2018
Jennifer Kelley, MD

2. Tinea Pedis
Terbinafine (Lamisil) works better than miconazole/otc yeast tx

4. Mocassin type, often requires systemic antifungals

6. Plantar Warts

7. 2/3 resolve w/ no tx but can take 2 years

9. Corn
Seed corn, side of foot

12. 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

15. Plantar Fasciitis
Repetitive microtears of the fascia…this is why NSAIDS don’t work all that well

16. Hard heel cup, works better than soft ones but more difficult to fit in shoe

18. Night splint – needs to flex the ankle and the plantar fascia

19. 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

20. Ingrown toenail

21. 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)

22. Bunion

23. Bunion

24. 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

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

26. Hammar toe
Hammartoe
Hereditary? Tight footwear

28. Gout
Sometimes hard to differentiate from bunion